Pre-exposure Prophylaxis Adherence Of Men Who Have Sex With Multiple Men Based On Protection Motivation Theory

Objective: Men who have sex with multiple men(MSMM)are a high-risk group of HIV infection.Pre-exposure prophylaxis(PrEP)is an effective biological preventive measure to prevent HIV infection.However,the current research on PrEP adherence of MSMM based on protective motivation theory(PMT)has rarely been reported.Based on PMT,this study aimed to build a adherence protection motivation model from the perspective of social psychology,and explore the protection motivation influencing factors of PrEP adherence in MSMM population,so as to provide a reference for the effective prevention and precise intervention of HIV in this population.Methods: Data came from a 2-year follow-up cohort study of PrEP among MSM population in Western China.From April 2013 to March2015,non probability sampling method was used to recruit HIV-negative MSM in Chongqing,Sichuan,Guangxi and Xinjiang provinces.After the baseline survey,the subjects who met the inclusion exclusion criteria were randomly divided into the medication group and the blank control group(the blank control group was not the subject of this study,so it was excluded from the PrEP adherence analysis).Then,the study cohort was followed up every 12 weeks(week 12,24,36,48,60,72,84,96)to obtain the medication,behavior and psychological related data,with the longest longest follow-up period was 96 weeks.The PrEP adherence of MSMM population was mainly evaluated by the medication rate during the follow-up period.Amos 23.0 software was used to build the structural equation modeling(SEM)of adherence protection motivation to explore the structural relationship between the PrEP adherence and protection motivation factors in MSMM population.Logistic stepwise regression was used to measure the correlation strength of the influence of protection motivation factors on the PrEP adherence.Results:(1)General information: A total of 496 MSMM were included in the PrEP adherence study,and the reporting rate of multiple partners was 60.85%(496 / 815).The average age of MSMM was 30.09years(median level was 28 years).Among them,young MSMM under 30 years old accounted for 56.25%,urban MSMM accounted for 74.40%,Han nationality accounted for 89.11%,the employed accounted for 79.37%,still students at school accounted for 9.29%,unmarried MSMM accounted for71.37%,59.80% had a college / bachelor degree or above,and only 12.07%of MSMM had an average monthly income of 5000 RMB or above.(2)Comparison between MSMM and non MSMM: There werestatistical differences in demographic characteristics of age,nationality,educational level and occupation status between the two groups(P < 0.05).Compared with non-MSMM,MSMM were more dangerous in dual sexual roles(both "1" and "0" in the case of insertion anal sex with male partners),more casual sexual partners in the last six months,no condom use when having anal sex with male partners,always searching for sexual partners on the Internet in the last six months,having commercial sexual service behaviors,having sexually transmitted diseases(STD)diagnosed by doctors(P < 0.05).(3)PrEP adherence status: The study found that the medication adherence rate of MSMM population fluctuated in different follow-up periods,the PrEP medication adherence rate during the whole follow-up periods was 0.6624,the medication adherence rate was the lowest during the third follow-up period at 36 week(0.6374),and the medication adherence rate reached the highest at the 72-week follow-up(0.7292).Among them,299 were in the good adherence group(60.28%),and 197 were in the poor adherence group(39.72%).Univariate analysis found that PrEP adherence had statistically significant differences in demographic and behavioral characteristics such as medication patterns,employment status,condom use during anal sex,HIV knowledge scores(P <0.05).(4)Protection motivation score: The mean value of total protective motivation score of PrEP adherence in MSMM population was(2.40 ±0.42);two aspects of protective motivation: threat assessment score(2.12 ±0.55),response assessment score(2.79 ± 0.62);seven dimensions of protective motivation: severity(1.78 ± 0.60),susceptibility(1.83 ± 1.17),external reward(2.51 ± 1.02),internal reward(2.34 ± 1.05),self-efficacy(2.84 ± 0.75),response cost(2.36 ± 0.75),response benefit(3.16 ± 1.35).And the scores of 7 dimensions of protection motivation among MSMM with different social demographic characteristics were different,and the scores of severity were different in the characteristics of age group,educational level,employment status and average monthly income of MSMM(P < 0.05);the susceptibility scores of MSMM population with different household registration,marital status and average monthly income were different(P < 0.05);the scores of external reward of rural MSMM were higher than that of urban MSMM(P < 0.05),and the scores of self-efficacy of MSMM of different nationalities were different(P < 0.05);there were significant differences in the scores of response benefit in age group,household registration,nationality,education level and marriage status(P < 0.05),but there were no significant differences in the scores of internal reward and response cost among the social demographic characteristics(P > 0.05).Meanwhile,there was no significant difference in the scores of 7 dimensions of protection motivation between the daily medication group and the on-demand medication group(P > 0.05).(5)The relationship between protection motivation and PrEPadherence: The structural relationship and influence path between PrEP adherence and protective motivation were studied by SEM.It was found that the standardized path coefficients of the influence of susceptibility and response cost were 0.153(P = 0.004)and 0.261(P = 0.022)respectively,and no statistical significance was found for the path between other motivation factors and of adherence.Multivariate logistic regression analysis evaluated the effect intensity of protection motivation on the PrEP adherence,and the results showed that from the two aspects of protection motivation,the higher the threat assessment score(OR = 0.685),the less likely it is to have poor PrEP adherence.From the seven dimensions of protection motivation,the higher the susceptibility score(OR = 0.785),the higher the response cost score(OR = 0.639),the stronger the protection motivation,the less likely the possibility of poor adherence.At the same time,logistic regression results also showed that on-demand PrEP medication(OR = 0.670),college students(OR = 1.837),occasional condom use(OR = 1.621)and high HIV knowledge score(OR = 0.565)were the influencing factors of poor PrEP adherence in MSMM population.Conclusion:(1)In the west region of China,MSM usually have multiple sexual partners,and MSMM population has a high risk of HIV infection,but its PrEP adherence is not high.Therefore,effective measures should be taken to improve the PrEP adherence.(2)The protection motivation factors are closely related to PrEP adherence,but the protectionmotivation of MSMM is not strong,and the application of PMT intervention strategies in PrEP adherence research needs to be further explored.(3)The threat assessment aspect of protection motivation is the premise of using PrEP and adhering.Susceptibility and response cost are the key protection motivation factors that affect PrEP adherence.Enhance threat perception;improve susceptibility and control the response cost of taking drugs,which can effectively improve PrEP adherence in MSMM population.(4)Key interventions should be made for MSMM who are still students,have poor HIV knowledge and occasionally use condoms,and further explore the medication mode to improve PrEP adherence of MSMM population.