PrEP use and willingness cascades among GBMSM in 15 Asian countries/territories: an analysis of the PrEP APPEAL survey

IF 4.6 1区 医学 Q2 IMMUNOLOGY
Gede Benny Setia Wirawan, Heather-Marie Schimdt, Curtis Chan, Doug Fraser, Jason J. Ong, Michael Cassell, Lei Zhang, Warittha Tieosapjaroen, Nittaya Phanuphak, Weiming Tang, Nicky Suwandi, Kimberly A. Green, Timothy Dobbins, Benjamin R. Bavinton
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Abstract

Introduction

Despite the high HIV incidence among gay, bisexual and other men who have sex with men (GBMSM) and the demonstrated effectiveness of HIV pre-exposure prophylaxis (PrEP), PrEP is not accessible at scale across Asia. To help inform future scaling efforts, our study aimed to examine PrEP use and willingness to use among GBMSM to identify opportunities and target groups for upscaling PrEP.

Methods

The PrEP APPEAL survey was a cross-sectional survey, promoted through online advertising and community organizations, from May to November 2022. Eligible participants were adult GBMSM who self-identified as HIV negative residing in Asia. We constructed two cascades: PrEP use (comprising awareness, lifetime use and current use of PrEP) and PrEP willingness among participants who were aware of PrEP but had never used it (comprising HIV exposure risk, willingness in PrEP and willingness to pay for PrEP). Multivariable logistic regression models identified factors associated with lifetime PrEP use and PrEP willingness.

Results

Of 15,339 participants, 1440 were excluded due to missing data, leaving 13,899 for analysis. Most lived in large or capital cities (68.3%) and in lower-middle-income countries (45.1%). The median age was 30 (25−36) years old. For the PrEP use cascade, 82.2% (n = 11,427/13,899) of participants were aware of PrEP, 35.0% (n = 4000/11,427) had used it before and 70.1% (n = 2803/4000) of them were currently on PrEP. For the PrEP willingness cascade, 54.8% of (n = 4068/7427) PrEP-naïve participants engaged in one or more behaviours with a higher risk of HIV acquisition, 73.7% (n = 2996/4068) of them expressed willingness to use PrEP and 83.0% (n = 2487/2996) of them were willing to pay for PrEP. Multivariable logistic regression models identified system-level (PrEP availability, accessibility and affordability) predictors of PrEP use. Individual-level behaviours associated with higher HIV acquisition risks were associated with PrEP use and willingness.

Conclusions

While PrEP uptake was suboptimal, there was high awareness and willingness in PrEP among GBMSM. This is encouraging for future scale-up efforts. Future PrEP programmes should address system-level barriers to support PrEP uptake.

Abstract Image

导言:尽管男同性恋、双性恋和其他男男性行为者(GBMSM)中的艾滋病发病率很高,而且艾滋病暴露前预防疗法(PrEP)的有效性已得到证实,但在整个亚洲,PrEP 仍未大规模普及。为了帮助为今后的推广工作提供信息,我们的研究旨在调查男男性行为者中 PrEP 的使用情况和使用意愿,以确定推广 PrEP 的机会和目标群体。 方法 PrEP APPEAL调查是一项横断面调查,于2022年5月至11月期间通过网络广告和社区组织进行推广。符合条件的参与者是居住在亚洲的自认为 HIV 阴性的成年 GBMSM。我们构建了两个级联:PrEP使用情况(包括对PrEP的认知、终生使用和当前使用情况)和了解PrEP但从未使用过的参与者的PrEP意愿(包括HIV暴露风险、PrEP意愿和PrEP付费意愿)。多变量逻辑回归模型确定了与终生使用 PrEP 和 PrEP 意愿相关的因素。 结果 在 15,339 名参与者中,有 1440 人因数据缺失而被排除,剩下 13,899 人用于分析。大多数人居住在大城市或省会城市(68.3%)和中低收入国家(45.1%)。年龄中位数为 30(25-36)岁。在 PrEP 使用级联中,82.2% 的参与者(n = 11,427/13,899 人)知道 PrEP,35.0% 的参与者(n = 4000/11,427 人)曾经使用过 PrEP,70.1% 的参与者(n = 2803/4000 人)目前正在使用 PrEP。在 PrEP 意愿级联中,54.8%(n = 4068/7427)的 PrEP 未接受者有一种或多种感染 HIV 风险较高的行为,73.7%(n = 2996/4068)的参与者表示愿意使用 PrEP,83.0%(n = 2487/2996)的参与者愿意支付 PrEP 费用。多变量逻辑回归模型确定了系统层面(PrEP 的可用性、可及性和可负担性)的 PrEP 使用预测因素。与较高艾滋病毒感染风险相关的个人行为与 PrEP 的使用和意愿有关。 结论 虽然 PrEP 的使用率并不理想,但艾滋病毒感染者中对 PrEP 的认知度和使用意愿都很高。这对于未来的推广工作是令人鼓舞的。未来的 PrEP 计划应解决系统层面的障碍,以支持 PrEP 的采用。
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来源期刊
Journal of the International AIDS Society
Journal of the International AIDS Society IMMUNOLOGY-INFECTIOUS DISEASES
CiteScore
8.60
自引率
10.00%
发文量
186
审稿时长
>12 weeks
期刊介绍: The Journal of the International AIDS Society (JIAS) is a peer-reviewed and Open Access journal for the generation and dissemination of evidence from a wide range of disciplines: basic and biomedical sciences; behavioural sciences; epidemiology; clinical sciences; health economics and health policy; operations research and implementation sciences; and social sciences and humanities. Submission of HIV research carried out in low- and middle-income countries is strongly encouraged.
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