The Study On Adherence To Pre-exposure Prophylaxis Based On Oral Truvada Among Men Who Have Sex With Men

Objective: Men who have sex with men(MSM)has become high-risk groups among China’s AIDS prevention control.In the current situation of serious HIV infection in MSM,Pre-exposure prophylaxis(PrEP)as a new biomedical prophylaxis has been proven to be effective in preventing HIV from multiple clinical trials abroad,as well as a significant correlation between efficacy and adherence.At present,the less cognition of PrEP in MSM,and the limited research on PrEP in China.It is absent of large-scale research on oral Truvada as pre-exposure prevention and the blood concentration test under the social background of China.And it is difficult to determine the effectiveness of PrEP to prevent HIV and the true adherence.Therefore,public health departments are restricted to carry out propaganda and promotion of pre-exposure prevention for high-risk MSM population and to formulate relevant prevention and control strategies in China.We have there aims in the study as the follows: 1.To investigate the characteristics of social demography and behavior of MSM who choose daily and event-driven regimen.2.To investigate the adherence of PrEP and the difference of adherence between daily and event-driven regimen.3.To obtain the influence factors of adherence and the relevance between protective motivation factors and adherence.Method: From December 2018 to February 2019,To recruit eligible MSM by the methods of NGO and peer-driven in Shenyang,Beijing,Shenzhen and Chongqing.The subjects filled out the questionnaire by scanning the QR code.The information of demographic and high-risk sexual behavior and willingness to accept PrEP were collected through the questionnaire of willingness.According to the collected information,the MSM who initially met the conditions for participation in the study came to the site for screening.At the time of screening,the subjects were given a behavioral assessment and informed consent by face-to-face interviews,and the subjects filled out a baseline questionnaire and completed a physical examination.The study subjects were informed to come to get the medicine after the medical examination was qualified.The study subjects were followed up in the 1,3,6,9,12 months after taking the drug.In addition,the subjects were asked to fill out a weekly questionnaire,which mainly involved sexual behavior,medication and side effects one week before.Using "Gold Data" to collect questionnaire information and export Excel to establish a database,and SPSS20.0 was used for statistical analysis.The demographic and sexual behavior characteristics of MSM between daily and event-driven regimen were obtained by chi-square test.The difference of adherence between the daily and event-driven regimen was analyzed by the generalized estimation model.The difference of demographic and behavioral characteristics between good and poor adherence was obtained by chi-square test.And the influencing factors of adherence were analyzed by univariate and multivariate logistic regression analysis.In addition,the correlation between protective motivation and adherence was analyzed by chi-square test.There was significant statistical difference when the bilateral p < 0.05 was taken as the statistical analysis.Results: 1.Of the 110 currently recruited MSM,40.9%(45/110)chose the daily regimen,and 59.1%(65/110)chose the event-driven regimen.The results of chi-square test showed that the daily regimen groups had the following characteristics: the more numbers of male sexual partners in the last three months,the higher frequency of sexual behavior,the more proportion of drunken sex,and the higher proportion of sexually transmitted diseases in the last six months.2.Of the 110 MSM,96 participated in at least one weekly follow-up.The total duration of medication was 22.26(±9.67)days.The overall adherence was 90.23%,including 92.08% in daily group and 87.45% in event-driven group.The adherence of daily group was significantly higher than event-driven group(p < 0.001)by the analysis of generalized estimation model.The results of chi-square analysis showed that the better adherence group MSM have the characters: the higher cognitive level of AIDS-related knowledge,and the proportion of sex roles as "inserted party" and the lower rate of side effects.After adjusting for the mixed factors of age,nationality,education,income and living condition,The results of multivariate logistic regression showed that the cognitive level of AIDS-related knowledge was more than 7(vs.≤ 7,AOR= 2.18,95%CI= 0.92-5.12,P= 0.075),enema behavior occurred in the last half year(vs.not,AOR= 3.11,95%CI= 0.94-10.25,P= 0.063),No side effects were considered before taking the drug(vs.Yes,AOR=4.09,95CI=1.30-12.86,P=0.016);No side-effect(including dizziness,nausea,abdominal pain,etc.)occurred(vs.Yes,AOR=2.43,95%CI=1.00-5.91,P=0.049)were the independent influencing of adherence.3.The factors of protective motivation are divided into the risk degree of AIDS infection,the benefit of taking medicine,the cost of taking medicine,social support and self-efficacy.It was found that 74.9%(72/96)of MSM thought their risk of infection was moderate or below;However,86.4%(81/96)MSM thought that the risk of HIV infection was moderate or above,and 73.9%(71/96)MSM thought that the proportion of gay people infected with HIV was higher.92.7(89/96)of MSM believed that pre-exposure prophylaxis had more benefits for himself;72.9%(70/96)thought that taking drugs could reduce their worry about HIV infection,89.6%(86/96)thought that medication could improve their relationship with their sexual partners to a moderate degree.Only 11.5%(11/96)of MSM thought that taking the drug had a greater side effect.More than half of MSM thought their boyfriends/regular partners and people who were important to themselves would support taking PrEP drugs,and 74.3%(79/96)of MSM had confidence in their pre-exposure prophylaxis.And most of the MSM will be combined with the advice of doctors to determine their own medication.The results of chi-square test show that good adherence versus poor has the following characteristics: MSM who considered that he was at higher risk of infection,he would have the support of boyfriend or sex partner and had more confidence in PrEP.Secondly,the higher proportion of MSM with poor adherence thought that the side effects caused by PrEP.Conclusion: 1.The MSM of the daily regimen had more sexual partners and higher frequency of sexual behavior than that of the event-driven regimen.That is,the MSM with higher risk of sexual behavior was more willing to choose the daily regimen.2.The adherence of MSM was high,and the adherence of daily regimen is higher than event-driven group.3.The MSM with higher AIDS cognitive level,self-perceived infection risk and confidence of PrEP will have higher adherence.The main obstacle that affects the adherence is the worries of side effect.