Associations Between Perceived Barriers And Benefits Of Using HIV Pre-Exposure Prophylaxis And Adherence Among Men Who Have Sex With Men

Objective: Based on the fact that adherence to medication is crucial for the efficacy of HIV pre-exposure prophylaxis(PrEP),this study investigate the associations between the perceived barriers and benefits of using HIV PrEP,including worries about the side effects,thinking taking medicine is inconvenient,positive expectations as to the efficacy of the drugs and so on,and medication adherence among men who have sex with men(MSM),and explore the cohort retention and its’ associated factors,to provide a target for improving medication adherence and reducing HIV infection among MSM.Methods: MSM were recruited in western China by non-probability sampling,randomly administered daily oral tenofovir(TDF)group or intermittent oral TDF group or blank control group and followed up every 12 weeks after baseline survey.At each follow-up,barriers and benefits perceived during medication and the adherence were explored,medication rate was calculated based on the self-reported number of missed doses over 2 weeks,and then,the medication adherence was evaluated.The effects of perceived barriers and benefits on medication adherence were analysed by Generalized estimating equation(GEE).Cox regression was used to analyse the factors associated with cohort retention.Results:(1)Of 1127 MSM,526 were in daily oral tenofovir(TDF)group and 601 were in intermittent oral TDF group.The average age was(29.60±8.03)years,72.42% were urban residents,38.76% graduated from university and above,and 75.33% were unmarried.Nearly half had an average monthly income above 3000 yuan.The prevalence of anxiety and depression was 24.13% and 36.82%,respectively.(2)1127 MSM were included in the analysis of cohort retention,75.95% completed at least one follow-up(3 months)and only 37.25% finished the whole follow-up.Older and MSM who had higher positive expectations to the efficacy at baseline had better cohort retention.(3)A total of 2829 follow-up observation points were provided,and the proportion of high adherence was 49.35%(1396/2829).At each follow-up,the proportion of high adherence was 45.33%,46.11%,45.42%,49.29%,56.36%,56.70%,52.87%,62.16%,respectively.Compared with the proportion at 12 week,the proportion of high adherence increased significantly at 60 week,72 week and 96 week(P<0.05).(4)After adjusting for potential confounding factors,intermittent oral TDF group had better medication adherence,when compared with daily oral tenofovir(TDF)group(β=0.5009,P<0.0001).MSM who had higher positive expectation of the efficacy were more adherent to medication(β=0.1713,P<0.0001).However,the worries about the side effects and thinking taking medicine was inconvenient were barriers to medication adherence(β=-0.126,P<0.001;β=-0.1458,P<0.0001).Conclusion:(1)The medication adherence during oral PrEP among MSM in western China is not high.positive expectations to the efficacy of the drugs is facilitator while worries about the side effects and thinking taking medicine is inconvenient are barriers of medication adherence,which suggests that providing them correct information about this drug,informing them of possible side effects,and helping them during the follow-ups are urgently needed.(2)The cohort retention in this clinical trial is not high.MSM who are older,had higher positive expectations to efficacy at baseline have higher cohort retention.Future study should focus on younger MSM,so as to improve cohort retention.