The Disparities of PrEP Adherence Among Men Who Have Sex With Men Between the Global South and the Global North: An Updated Determinantal Global Meta-Analysis.

IF 2.9 3区医学 Q3 IMMUNOLOGY

JAIDS Journal of Acquired Immune Deficiency Syndromes Pub Date : 2025-05-01 DOI:10.1097/QAI.0000000000003635

Haoyi Wang, Marit Delnoij, Hanne M L Zimmermann, Kai J Jonas

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引用次数: 0

Abstract

Background: Suboptimal adherence to pre-exposure prophylaxis (PrEP) limits its global impact, with current evidence mostly from the Global North and lacking Global South perspectives. This meta-analysis synthesizes the rates and determinants of suboptimal adherence to oral PrEP among men who have sex with men (MSM) in both regions.

Methods: We searched for literature describing PrEP adherence and its determinants among MSM globally up until October 2024 to conduct a meta-analysis on the rate and determinants of suboptimal adherence in both regions. The definition of (sub-)optimal adherence was study based.

Results: We included 82 studies in the meta-analysis, with 24, 53, and 5 stemmed from the Global South, North, and global multicenter studies, respectively. Oral PrEP suboptimal adherence is prevalent among MSM PrEP users globally (rate = 0.33, 95% confidence interval [CI]: 0.28 to 0.38) with a significantly higher rate ( P = 0.021) in the Global South (rate = 0.41, 95% CI: 0.33 to 0.50) than in the Global North (rate = 0.29, 95% CI: 0.23 to 0.35). In the Global South, older age (OR = 0.57, 95% CI: 0.37 to 0.87), alcohol use (OR = 1.28, 95% CI: 1.02 to 1.60), and presenting depressive symptoms (OR = 1.47, 95% CI: 1.01 to 2.16) were associated with suboptimal adherence. In the Global North, MSM self-identified as Black (OR = 2.27, 95% CI: 1.31 to 3.95) or Other (OR = 1.36, 95% CI: 1.02 to 1.81), having a university degree (OR = 0.50, 95% CI: 0.34 to 0.73), and presenting depressive symptoms (OR = 2.26, 95% CI: 1.35 to 3.78) were associated with suboptimal adherence. On-demand PrEP users globally demonstrated a higher likelihood of suboptimal adherence (OR = 1.59, 95% CI: 1.18 to 2.14).

Conclusions: Suboptimal adherence to oral PrEP is prevalent among MSM globally, particularly higher in the Global South. Regional differences in determinants highlight the need for tailored interventions. Tailored interventions are required to address mental health with tailored efforts to younger MSM in the Global South, while interventions in the Global North should be tailored to specific subgroups.

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全球南方和全球北方之间男男性行为者坚持PrEP的差异：一项最新的决定性全球荟萃分析。

背景：PrEP的次优依从性限制了其全球影响，目前的证据主要来自全球北方，缺乏全球南方的观点。本荟萃分析综合了这两个地区的男男性行为者中口服PrEP未达到最佳依从性的比率和决定因素。方法：我们检索了截至2024年10月全球MSM中描述PrEP依从性及其决定因素的文献，对这两个地区的次优依从率和决定因素进行了荟萃分析。（次）最佳依从性的定义是基于研究的。结果：我们在meta分析中纳入了82项研究，其中分别有24项、53项和5项来自全球南方、北方和全球多中心研究。口服PrEP在全球MSM PrEP使用者中普遍存在（率=0.33,95%CI:0.28-0.38），与全球北方（率=0.29,95%CI:0.23-0.35）相比，全球南方（率=0.41,95%CI:0.33-0.50）的发生率（p=0.021）显著较高。在南半球，年龄较大（OR=0.57, 95%CI:0.37-0.87）、饮酒（OR=1.28, 95%CI:1.02-1.60）和出现抑郁症状（OR=1.47, 95%CI:1.01-2.16）与依从性不佳相关。在全球北方，男男性行为者自我认定为黑人（OR=2.27, 95%CI:1.31-3.95）或其他（OR=1.36, 95%CI:1.02-1.81），拥有大学学位（OR=0.50, 95%CI:0.34-0.73），并有抑郁症状（OR=2.26, 95%CI:1.35-3.78）与次优依从性相关。全球按需prep用户显示出更高的次优依从性可能性（OR=1.59, 95%CI:1.18-2.14）。结论：口服PrEP的不理想依从性在全球MSM中普遍存在，特别是在全球南方。决定因素的区域差异突出表明需要采取有针对性的干预措施。需要有针对性的干预措施来解决精神卫生问题，为全球南方的年轻男男性行为者提供针对性的努力，而全球北方的干预措施则应针对具体的子群体。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JAIDS Journal of Acquired Immune Deficiency Syndromes 医学-传染病学

CiteScore

5.80

自引率

5.60%

发文量

490

审稿时长

3-6 weeks

期刊介绍： JAIDS: Journal of Acquired Immune Deficiency Syndromes seeks to end the HIV epidemic by presenting important new science across all disciplines that advance our understanding of the biology, treatment and prevention of HIV infection worldwide. JAIDS: Journal of Acquired Immune Deficiency Syndromes is the trusted, interdisciplinary resource for HIV- and AIDS-related information with a strong focus on basic and translational science, clinical science, and epidemiology and prevention. Co-edited by the foremost leaders in clinical virology, molecular biology, and epidemiology, JAIDS publishes vital information on the advances in diagnosis and treatment of HIV infections, as well as the latest research in the development of therapeutics and vaccine approaches. This ground-breaking journal brings together rigorously peer-reviewed articles, reviews of current research, results of clinical trials, and epidemiologic reports from around the world.