| Objective:(1)Based on the mixed-method study,to investigate the willingness to use Pre-exposure Prophylaxis(Pr EP)for HIV prevention and its associated factors among men who have sex with men(MSM)in Changsha,China.(2)To develop the questionnaire on the willingness to use Pr EP for HIV prevention among Chinese MSM and test the reliability and the validity of the questionnaire.Methods:(1)A qualitative study of the MSM population’s willingness to use Pr EP.This phase was a descriptive qualitative study,in which MSM were selected for half-structured in-depth interviews,using purposive sampling in three MSM-friendly organizations in Changsha from March 16 to May31,2019.Thematic analysis was used for data analysis with the NVivo12.0 software.(2)Development of the willingness evaluation questionnaire for Pr EP use among Chinese MSM.Combining the themes extracted from the qualitative analysis and the hints from the literature review,a pool of items and a pre-test evaluation questionnaire were developed after group discussions,two rounds of expert-consultation and a pilot study.From 25 June to 31 August 2019,MSM were recruited for the questionnaire testing.The convenient sampling method was used in three MSM-friendly organizations in Changsha.The questionnaire was subjected to item analysis(critical ratio method,correlation coefficient method,homogeneity test),exploratory factor analysis,reliability test(internal consistency reliability,split-half reliability,re-test reliability),and validation factor analysis(content validity and structural validity,)to evaluate the reliability and validity of the questionnaire,using SPSS 25.0and Amos 24.0 software.(3)The data from the validation phase of the scale were used to analyze the associated factors of willingness to use Pr EP among MSM.The SPSS 25.0 software was used to perform univariate logistic regression and multivariate logistic regression.p <0.05 were considered significant.Results:(1)A total of 24 MSM participated in the interviews,with 13(54.2%)willing to use Pr EP and 11(45.8%)unwilling to use Pr EP.Four themes were extracted: willingness to use Pr EP,preferred ways,facilitators of Pr EP use,and barriers to Pr EP use.Taken together,motivation for risk compensation of Pr EP,the perceived stigma associated with Pr EP,selfperceived risk of HIV infection,and the two-sided role of circle culture were the four most important factors influencing MSM’s willingness to use Pr EP.The results of the qualitative study provided the basis for the refinement of the questionnaire’s item pool.(2)A total of 255 MSM were recruited for the questionnaire testing.1)Results of item analysis and screening: there were 62 items in the item-pool.After selection,the initial questionnaire had 44 items and four dimensions.After two rounds of expert consultation and pre-testing,the pre-testing questionnaire had 24 items and three dimensions.After item analysis and exploratory factor analysis,three items were deleted,resulting in a final official questionnaire of 21 items in three dimensions(evaluation of willingness,perceived barriers,and risk compensation).The questionnaire was scored on a 5-point Likert approach,with a range of 1to 5 points for each item,and a mean score of ≥4 points on the total score indicated that the MSM were willing to use Pr EP.2)Reliability tests results: the Cronbach’s α for the total scale was0.938,and the Cronbach’s α for each dimension were 0.939,0.902 and0.941;the half-measure reliability for the total scale was 0.965,and the half-measure reliability for each dimension was 0.959,0.921 and 0.950;the re-test reliability for the total scale was 0.958 and the re-test reliability for each dimension was 0.938,0.912 and 0.953.3)Validity tests results: The universal scale-level CVI was 0.959,and the average scale-level CVI was 0.967.The exploratory factor analysis extracted three common factors with a cumulative contribution of variance of 67.051%.The validated factor analysis showed that this questionnaire had a value of 1.853 for the chi-squared ratio of freedom,0.058 for the root mean squared error of approximation,0.962 for the comparative fit index,0.889 for the goodness of fit index,0.857 for the adjusted goodness of fit index,0.963 for the incremental fit index,0.956 for the Tucker-Lewis index,and 0.962 for the normed fit index,with a stable model structure.4)The mean scores of the total scale were 3.24±0.05.There were 38 participants scored≥4 points on the total questionnaire,indicating that they were willing to use Pr EP.And the scores for the three dimensions were:3.41±0.05 for the willingness evaluation dimension,2.75±0.06 for the perceived barriers dimension(reversed scores),and 3.30±0.08 for the risk compensation dimension.(3)The multivariate logistic regression model showed that the two facilitators were associated with the willingness to use Pr EP: actively sharing one’s own sexual orientation with parents or siblings(OR: 2.910,95% CI: 1.324-6.397)and having received detailed counselling on Pr EP(OR: 3.843,95% CI: 1.857-7.949).Conclusions:(1)The MSM population had a low level of willingness to use Pr EP.Factors that promote Pr EP use among MSM are motivation for risk compensation for Pr EP,perceived benefits of Pr EP in terms of increased safety and satisfaction with sexual behavior,facilitation by circle culture,having initially told parents or siblings about sexual orientation,and having received detailed counselling on Pr EP.Factors that discourage Pr EP use among MSM are barriers to the use of the medication itself,particularly price and accessibility,the perceived stigma associated with Pr EP,low self-perceived risk of HIV infection,and circle culture barriers.(2)The intention measurement scale for Pr EP use among Chinese MSM has good reliability and validity,which is useful for willingness evaluation among MSM in China. |
PDF Full Text Request