| Objective To evaluate the influence of the adherence to oral PrEP among MSM on the effectiveness of the prevention against HIV infection and analyze the protection motivation of the adherence, so as to provide reference for the future study of PrEP among MSM.Method A clinical trial of oral PrEP to prevent HIV infection among MSM was conducted in Chongqing with non-probabilistic sampling used for subjects recruitment. After the baseline questionnaire survey, the eligible subjects based on the inclusion and exclusion criteria were randomized to daily oral TDF or intermittent oral TDF(one dose before sex within 48h-24h and one after within 2h, not to exceed one dose per day) or blank control. Subjects were followed every 3 months for HIV test and adherence evaluation. Univariate and multivariate Cox regression analyses were used to explore the influence of adherence to oral PrEP on the effectiveness of prevention against HIV infection. Descriptive analysis was adopted to evaluate protection motivation for adherence to PrEP.Results (1) 633 MSM were enrolled with 204 assigned to daily oral PrEP,224 to intermittent oral PrEP and 205 to blank control. The mean age was about 30 years and the majority (96.68%) was Han ethnic group. Most MSM were urban residents (64.92%), employed (80.25%) and unmarried (70.46%).29.07% of MSM received education of university or higher and 39.07% earned more than 3000RMB monthly. (2) Subjects were followed for 579.5 person-years (median,12 months; minimum,3 months; maximum, 24 months) and 36 new HIV cases were found during follow-up. The overall incidence of HIV was 6.21 per 100 person-years,1.28 per 100 person-years (2/156 person-years) for the high adherence group,7.41per 100 person-years (18/243 person-years) for the low adherence group and 8.86 per 100 person-years (16/180.5 person-years) for the blank control group. Multivariate Cox regression analysis indicated that the risk of HIV infection among high adherence group was 0.142 times (95% CI=0.032-0.621) of that among the blank control group. But there was no significant difference between the low adherence group and the blank control group (AHR=0.858, 95%CI=0.433-1.704). MSM who had no more than 1 male sexual partner had lower risk of HIV infection compared with those who had more than 1(AHR=0.487,95%CI=0.245-0.968). (3) The average level of medication rate among MSM used PrEP was (0.64±0.32), (0.94±0.07) for the high adherence group (35.75%) and (0.44±0.26) for the low adherence group (64.25%).The analysis of protection motivation suggested that the median scores of evaluation on the severity of and susceptibility to AIDS among MSM used PrEP were 0.75 and 1.00, respectively. And the self-efficacy, the response efficacy and the response cost to use PrEP were 0.41,0.50 and 0.29, respectively. There was no significance difference between the high adherence group and the low adherence group for these five factors.Conclusion (1)The prevalence rate of HIV is relatively high among MSM in Chongqing and the situation of prevention and control is challenging. (2)The effectiveness of prevention against HIV infection for PrEP among MSM is preliminarily confirmed in China and high adherence is the precondition of achieving ideal effect. (3) The self-efficacy and the response efficacy to use PrEP both are low among MSM. Effective measures must be taken to promote MSM’s protection motivation so as to improve their adherence to PrEP. |
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