Depression And Its Effect On Adherence To Using Pre-Exposure Prophylaxis Among Men Who Have Sex With Men

Objective: The worldwide AIDS epidemic has stabilized,but men who have sex with men(MSM)remain at higher risk of HIV infection and are one of the key populations to HIV infection.As a new biomedical preventive measure,Pre-exposure Prophylaxis(PrEP)has been approved in many countries.Results from numerous studies have supported its efficacy and safety,but the efficacy is highly dependent on adherence.Mental health conditions,especially depression,are also known barriers to healthcare engagement and medication adherence.Some studies have shown that depression is closely associated with ART adherence.Meanwhile,there is a high prevalence of depression in MSM.At present,foreign studies about the effect of depression on PrEP adherence are limited and the results are inconsistent.Researches about PrEP in China are only just beginning.Therefore,it is urgent to clarify the effect of depression in MSM on drug adherence and to carry out targeted psychological intervention to improve drug adherence and enhance the protective effect.We have three aims in this study as follows: 1.describing the prevalence of depression and the difference of depression in MSM on the baseline.2.describing the prevalence of depression and the risk factors for depression.3.investigating the PrEP adherence and analyze the effect of depression on adherence.Methods: MSM in HIV negative were recruited from four sites in Shenyang,Beijing,Shenzhen,and Chongqing through the internet and on-site HIV voluntary counseling and testing clinics,and eligible MSM participants were screened for baseline investigation to obtain the rate of depression.The participants enrolled in the group were asked to follow up at the 1st,3rd,6th,9th,and 12 th months.The condition of depression(according to the Hospital Anxiety and Depression Scale,HADS)and adherence(self-reported whether had missing doses)were collected at each follow-up,and then the prevalence of depression and adherence were calculated.Using chi-square test to analyze the baseline characteristics of depression and non-depression;chi-square trend test to analyze the relationship among the prevalence of depression,medication adherence,and follow-up time;generalized estimated equation model to analyze the factors influencing the prevalence of depression and the impact of depression on medication adherence.SPSS 25.0 was used for analysis,all analysis is the two-side test,p<0.05.Results: 1.The basic characteristics of the MSM population in the study: 1023 MSM were included in the baseline.6.9%(72/1023)of the participants had depressive symptoms.The chi-square test showed that the MSM with depressive symptoms had the following characteristics: lower education(below high school: 29.6% vs.18.0%),lower monthly income(monthly income <4000 yuan: 47.9% vs.31.7%),a higher proportion of group sex behavior(32.4% vs.20.0%),very higher self-perceived risk of HIV infection(16.9% vs.6.9%),a lower proportion of people who agree that the decision to take medicine is entirely up to themselves,lower efficacy and higher cost of taking medicine,and less social / drug support(all P<0.05).2.A total of 4467 people participated in the five follow-ups.The prevalence of depressive symptoms increased from 6.9% at baseline to 10.2% in the 12 th month,by chi-square trend test,there was a statistically significant difference between depressive symptoms and follow-up time,there was a linear correlation.The results of multivariate GEE model findings that education level of below high school(vs.above university)(a OR=1.359,95%CI=1.024～1.802,P=0.033),monthly income ≦3999 yuan vs.>3999 yuan(a OR=1.295,95% CI=1.008～1.664,P=0.043),living conditions are unstable(vs.stable)(a OR=5.522,95% CI=2.851～10.695,P<0.001),sexual transmitted diseases symptoms(vs.none)(a OR=2.177,95% CI=1.451～3.266,P<0.001),thought themselves at higher HIV infection risk(vs.no risk)(a OR=1.586,95% CI=1.024～2.456,P=0.039),thought themselves at very higher HIV infection risk(vs.,no risk)(a OR=1.868,95% CI=1.109～3.145,P=0.019)were independent risk factor for depressive symptoms.Site(Beijing vs.Shenyang,a OR=0.495,95% CI=0.383～0.640,P< 0.001;Shenzhen vs.Shenyang,a OR=0.448,95 CI=0.280～0.719,P=0.001)was also a factor affecting depressive symptoms.3.The overall self-reported medication adherence was 74.2%.There was no significant difference in the chi-square trend test between follow-up times.Using the generalized estimated equation model to analyze the effect of depression on drug adherence,after adjusting for age,education,monthly income,marital status,and site,low PrEP adherence occurred higher often with depressive symptoms(when depression as a categorical variable: yes or no,a OR =1.272,95% CI=1.016～1.592,P=0.036,while elevated depression score was with lower adherence a OR=1.034,95% CI=1.013-1.055,P=0.001).Conclusion: 1.MSM with depressive symptoms at baseline were less confident in drug efficacy and more worried about the cost of taking medicine.We should strengthen the popularization of knowledge about taking medicine,reduce the worry of taking medicine and enhance their confidence in taking medicine.2.This study found that low education level,low monthly income,a living condition in unstable,had sexually transmitted diseases symptoms,higher self-cognition HIV infection risk were independent risk factors of depression.It is suggested that mental health guidance should be carried out for MSM with the above risk characteristics to reduce the incidence of depression and reduce the psychological burden.3.Depression might reduce the adherence with PrEP medication among MSM,suggesting that doctors should pay more attention to the MSM with depression and monitoring their medication adherence timely,and develop the necessary social and psychological counseling and intervention for the MSM population with depression to improve their compliance with medication.