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Liu Y, Wei S, Cheng Z, Xian Y, Liu X, Yang J, Liu Y, Yu M, Chen Z, Chen J, Ma J, Cui Z, Li C. Correlates of oral pre-exposure prophylaxis cessation among men who have sex with men in China: implications from a nationally quantitative and qualitative study. BMC Public Health 2024; 24:1765. [PMID: 38956521 PMCID: PMC11221119 DOI: 10.1186/s12889-024-19182-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 06/18/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Several studies have demonstrated the population-level effectiveness of oral PrEP in reducing the risk of HIV infection. However, oral PrEP utilization among MSM in China remains below 1%. While existing literature has primarily focused on oral PrEP preference and willingness, there is limited exploration of the underlying factors contributing to oral PrEP cessation in China. This study aims to fill this gap by investigating the factors associated with oral PrEP cessation among MSM in China. METHODS Assisted by MSM community organizations, we collected 6,535 electronic questionnaires from 31 regions across China, excluding Taiwan, Hong Kong, and Macau. The questionnaire focused on investigating MSM's awareness, willingness, usage, and cessation of oral PrEP. Additionally, 40 participants were randomly chosen for key informant interviews. These qualitative interviews aimed to explore the reasons influencing MSM discontinuing oral PrEP. RESULTS We eventually enrolled 6535 participants. Among the 685 participants who had used oral PrEP, 19.70% (135/685) ceased oral PrEP. The results indicated that individuals spending > ¥1000 on a bottle of PrEP (aOR = 2.999, 95% CI: 1.886-4.771) were more likely to cease oral PrEP compared to those spending ≤ ¥1000. Conversely, individuals opting for on-demand PrEP (aOR = 0.307, 95% CI: 0.194-0.485) and those using both daily and on-demand PrEP (aOR = 0.114, 95% CI: 0.058-0.226) were less likely to cease PrEP compared to those using daily PrEP. The qualitative analysis uncovered eight themes influencing oral PrEP cessation: (i) High cost and low adherence; (ii) Sexual inactivity; (iii) Lack of knowledge about PrEP; (iv) Trust in current prevention strategies; (v) Poor quality of medical service and counseling; (vi) PrEP stigma; (vii) Partner and relationship factors; (viii) Access challenges. CONCLUSIONS The cessation of oral PrEP among MSM in China is associated with various factors, including the cost of oral PrEP medication, regimens, individual perception of HIV risk, stigma, and the quality of medical services. It is recommended to provide appropriate regimens for eligible MSM and develop tailored combinations of strategies to enhance PrEP awareness and acceptance among individuals, medical staff, and the MSM community. The findings from this study can support the refinement of HIV interventions among MSM in China, contributing to efforts to reduce the burden of HIV in this population.
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Affiliation(s)
- Yuanyuan Liu
- Department of Epidemiology and Biostatistics, Tianjin Medical University, Tianjin, China
| | - Siyue Wei
- Department of Epidemiology and Biostatistics, Tianjin Medical University, Tianjin, China
| | - Zhaoyu Cheng
- Department of Epidemiology and Biostatistics, Tianjin Medical University, Tianjin, China
| | - Yidan Xian
- Department of Epidemiology and Biostatistics, Tianjin Medical University, Tianjin, China
| | - Xuan Liu
- Department of Epidemiology and Biostatistics, Tianjin Medical University, Tianjin, China
| | - Jie Yang
- Shenlan" Public Health Counseling Service Center, Tianjin, China
| | - Yan Liu
- Shenlan" Public Health Counseling Service Center, Tianjin, China
| | - Maohe Yu
- STD & AIDS Control and Prevention Section, Tianjin Center for Disease Control and Prevention, Tianjin, China
- Tianjin Key Laboratory of Pathogenic Microbiology of Infectious Disease, Tianjin Centers for Disease Control and Prevention, Tianjin, 300011, China
| | - Zhongdan Chen
- HIV/Hepatitis, STI/TB, World Health Organization Representative Office in China, 401 Dongwai Diplomatic Building 23, DongzhimenwaiDajie, Chaoyang District, Beijing, 100600, China
| | - Jiageng Chen
- Department of Epidemiology and Biostatistics, Tianjin Medical University, Tianjin, China
| | - Jun Ma
- Department of Epidemiology and Biostatistics, Tianjin Medical University, Tianjin, China
| | - Zhuang Cui
- Department of Epidemiology and Biostatistics, Tianjin Medical University, Tianjin, China
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Changping Li
- Department of Epidemiology and Biostatistics, Tianjin Medical University, Tianjin, China.
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, NO.22, Qixiangtai Street, Tianjin, 300041, China.
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Liu Y, Liu X, Wei S, Cheng Z, Xian Y, Zhao Y, Ma J, Chen J, Chen Z, Yang J, Liu F, Yu M, Cui Z, Li C. Identifying patterns of sexual behaviors and PrEP uptake characteristics among MSM who were eligible for PrEP: A national cross-section study. J Virus Erad 2024; 10:100382. [PMID: 39015215 PMCID: PMC11250863 DOI: 10.1016/j.jve.2024.100382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 06/15/2024] [Indexed: 07/18/2024] Open
Abstract
Men who have sex with men (MSM) are at a high risk of HIV infection and should be offered effective preventive measures, such as pre-exposure prophylaxis (PrEP). However, PrEP uptake among eligible MSM was not as high as desired. Diverse research findings on how risky sexual behaviors affect PrEP uptake highlight the necessity for a comprehensive investigation. Understanding the interconnectedness of different sexual behaviors is crucial for evaluating their impact on PrEP uptake among eligible MSM. Using a proportional sampling method, we recruited 5877 MSM aged 16 years and above in mainland China according to PrEP eligibility criteria. Through latent class analysis (LCA), three distinct sexual behavior patterns were identified among eligible MSM. Demographic variances and PrEP uptake among the three distinct sexual behavior patterns were examined using chi-squared tests and multinomial logistic regression. LCA revealed three patterns: low-risk (4,815 MSM), medium-risk (516 MSM), and high-risk (546 MSM). MSM aged 25 years or older with a monthly income of ≥¥8,000 were more likely to be in the medium-risk group. Those from areas with high HIV prevalence and engaging as "top" in anal sex were more likely to be in the medium- and high-risk groups. The medium- and high-risk groups had a higher willingness, uptake, and adherence rates for PrEP than the low-risk group. LCA is effective in identifying diverse sexual behavior patterns among MSM, aiding targeted interventions to enhance PrEP uptake. Addressing demographic variations and tailoring interventions for specific risk groups are crucial for promoting PrEP dissemination and reducing HIV infection risk in eligible MSM.
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Affiliation(s)
- Yuanyuan Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Xuan Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Siyue Wei
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Zhaoyu Cheng
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yidan Xian
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | | | - Jun Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Jiageng Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Zhongdan Chen
- HIV/Hepatitis/STI/TB, World Health Organization Representative Office in China, 401 Dongwai Diplomatic Building 23, DongzhimenwaiDajie, Chaoyang District, Beijing, 100600, China
| | - Jie Yang
- “Shenlan” Public Health Counseling Service Center, Tianjin, China
| | - Fengli Liu
- “Shenlan” Public Health Counseling Service Center, Tianjin, China
| | - Maohe Yu
- STD & AIDS Control and Prevention Section, Tianjin Center for Disease Control and Prevention, Tianjin, China
- Tianjin Key Laboratory of Pathogenic Microbiology of Infectious Disease, Tianjin Centers for Disease Control and Prevention, Tianjin, 300011, China
| | - Zhuang Cui
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
| | - Changping Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
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Ogaz D, Enayat Q, Brown JRG, Phillips D, Wilkie R, Jayes D, Reid D, Hughes G, Mercer CH, Saunders J, Mohammed H. Mpox Diagnosis, Behavioral Risk Modification, and Vaccination Uptake among Gay, Bisexual, and Other Men Who Have Sex with Men, United Kingdom, 2022. Emerg Infect Dis 2024; 30:916-925. [PMID: 38573160 PMCID: PMC11060451 DOI: 10.3201/eid3005.230676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
During the 2022 multicountry mpox outbreak, the United Kingdom identified cases beginning in May. UK cases increased in June, peaked in July, then rapidly declined after September 2022. Public health responses included community-supported messaging and targeted mpox vaccination among eligible gay, bisexual, and other men who have sex with men (GBMSM). Using data from an online survey of GBMSM during November-December 2022, we examined self-reported mpox diagnoses, behavioral risk modification, and mpox vaccination offer and uptake. Among 1,333 participants, only 35 (2.6%) ever tested mpox-positive, but 707 (53%) reported behavior modification to avoid mpox. Among vaccine-eligible GBMSM, uptake was 69% (95% CI 65%-72%; 601/875) and was 92% (95% CI 89%-94%; 601/655) among those offered vaccine. GBMSM self-identifying as bisexual, reporting lower educational qualifications, or identifying as unemployed were less likely to be vaccinated. Equitable offer and provision of mpox vaccine are needed to minimize the risk for future outbreaks and mpox-related health inequalities.
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Coukan F, Sullivan A, Mitchell H, Jaffer S, Williams A, Saunders J, Atchison C, Ward H. Impact of national commissioning of pre-exposure prophylaxis (PrEP) on equity of access in England: a PrEP-to-need ratio investigation. Sex Transm Infect 2024; 100:166-172. [PMID: 38508708 DOI: 10.1136/sextrans-2023-055989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/13/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVES HIV pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV acquisition. In England, NHS availability was limited to participants of the PrEP Impact Trial until late 2020. Some key populations at greater risk of HIV were under-represented in the trial suggesting inequities in trial PrEP access. We used the PrEP-to-need ratio (PnR; number of PrEP users divided by new HIV diagnoses) to investigate whether PrEP access improved following routine commissioning in October 2020 and identify populations most underserved by PrEP. METHODS Aggregated numbers of people receiving ≥1 PrEP prescription and non-late new HIV diagnoses (epidemiological proxy for PrEP need) were taken from national surveillance data sets. We calculated the PnR across socio-demographics during Impact (October 2017 to February 2020; pre-COVID-19 pandemic) and post-commissioning PrEP era (2021) in England. RESULTS PnR increased >11 fold, from 4.2 precommissioning to 48.9 in 2021, due to a fourfold reduction in non-late new HIV diagnoses and near threefold increase in PrEP users. PnR increased across genders, however, the men's PnR increased 12-fold (from 5.4 precommissioning to 63.9 postcommissioning) while the women's increased sevenfold (0.5 to 3.5). This increasing gender-based inequity was observed across age, ethnicity and region of residence: white men had the highest PnR, increasing >13 fold (7.1 to 96.0), while Black African women consistently had the lowest PnR, only increasing slightly (0.1 to 0.3) postcommissioning, suggesting they were the most underserved group. Precommissioning, the PnR was 78-fold higher among white men than Black women, increasing to 278-fold postcommissioning. CONCLUSIONS Despite the overall increase in PrEP use, substantial PrEP Impact trial inequities widened postcommissioning in England, particularly across gender, ethnicity and region of residence. This study emphasises the need to guide HIV combination prevention based on equity metrics relative to the HIV epidemic. The PnR could support the optimisation of combination prevention to achieve zero new HIV infections in England by 2030.
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Affiliation(s)
- Flavien Coukan
- National Institute for Health Research Applied Research Collaboration North West London, Chelsea and Westminster Hospital, London, UK
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, UK
| | - Ann Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Imperial College London, London, UK
| | - Holly Mitchell
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, UK Health Security Agency, London, UK
| | | | | | - John Saunders
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, UK Health Security Agency, London, UK
- UCL Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, UK
| | - Christina Atchison
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, UK
- National Institute for Health Research Imperial Biomedical Research Centre, London, UK
| | - Helen Ward
- National Institute for Health Research Applied Research Collaboration North West London, Chelsea and Westminster Hospital, London, UK
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, UK
- National Institute for Health Research Imperial Biomedical Research Centre, London, UK
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Frem JA, Russell A, Nichols K, Buonsenno L, Tweed M, Fitzpatrick C, Darking M, Whetham J, Richardson D. PrEP2U: a novel community partnership HIV pre-exposure prophylaxis clinic. Sex Transm Infect 2023; 99:574. [PMID: 37532450 DOI: 10.1136/sextrans-2023-055880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023] Open
Affiliation(s)
- Jim Abi Frem
- Sexual health & HIV, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Annie Russell
- Sexual health & HIV, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Kayleigh Nichols
- Sexual health & HIV, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | | | | | - Colin Fitzpatrick
- Sexual health & HIV, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Mary Darking
- School of Humanities and Social Science Care, Health and Emotional Wellbeing Research and Enterprise Group, University of Brighton, Brighton, UK
| | - Jennifer Whetham
- Sexual health & HIV, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Daniel Richardson
- Sexual health & HIV, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
- Global Health & Infection, Brighton and Sussex Medical School, Brighton, UK
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Pilkington V, Quinn K, Campbell L, Payne L, Brady M, Post FA. Clinical Presentation of Mpox in People With and Without HIV in the United Kingdom During the 2022 Global Outbreak. AIDS Res Hum Retroviruses 2023; 39:581-586. [PMID: 37071153 DOI: 10.1089/aid.2023.0014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
Early UK surveillance data revealed that people living with HIV were overrepresented among cases of monkeypox (mpox). However, it remains unknown whether mpox infection is more severe in people living with well-controlled HIV. All laboratory-confirmed mpox cases presenting between May and December 2022 to one London hospital service were identified via pathology reporting systems. We extracted demographic and clinical data to allow comparison of clinical presentation and severity of mpox among people with and without HIV. We identified 150 people with mpox (median age 36 years, 99.3% male, 92.7% reporting sex with other men). HIV status was available for 144 individuals, 58 (40.3%) of whom were HIV positive (only 3/58 had CD4 cell counts <200 cells/mm3 and 5/58 had HIV RNA >200 copies/mL). People with HIV had similar clinical presentations to those without HIV, including indicators of more widespread disease, such as extragenital lesions (74.1% vs. 64.0%, p = .20) and nondermatological symptoms (87.9% vs. 82.6%, p = .38). People with HIV also experienced a similar time from onset of symptoms to discharge from all inpatient or outpatient clinical follow-up (p = .63) and total time under follow-up (p = .88) compared with people without HIV. A similar proportion of people with HIV required review in the hospital emergency department (36.2% vs. 25.6%, p = .17) or admission to hospital (19.0% vs. 9.3%, p = .09). There were no recorded deaths. In this cohort of people with mpox, there was a high prevalence of HIV coinfection, the majority of which was well-controlled. We find no evidence that people with well-controlled HIV experienced more severe mpox infection.
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Affiliation(s)
- Victoria Pilkington
- Department of Sexual Health and HIV, King's College Hospital NHS Foundation Trust, London, United Kingdom
- HIV Research Team, King's College London, London, United Kingdom
| | - Killian Quinn
- Department of Sexual Health and HIV, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Lucy Campbell
- Department of Sexual Health and HIV, King's College Hospital NHS Foundation Trust, London, United Kingdom
- HIV Research Team, King's College London, London, United Kingdom
| | - Lara Payne
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Michael Brady
- Department of Sexual Health and HIV, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Frank A Post
- Department of Sexual Health and HIV, King's College Hospital NHS Foundation Trust, London, United Kingdom
- HIV Research Team, King's College London, London, United Kingdom
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Richardson D, Tweed M, Nichols K, Finn R, Nicholson S, Darking M. PrEP2U: delivering HIV pre-exposure prophylaxis (PrEP) in partnership from a community setting. Sex Transm Infect 2023; 99:70. [PMID: 36163165 DOI: 10.1136/sextrans-2022-055610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/14/2022] [Indexed: 01/20/2023] Open
Affiliation(s)
- Daniel Richardson
- Sexual Health & HIV, University Hospitals Sussex NHS Foundation Trust, Brighton, UK .,Brighton and Sussex Medical School, Brighton, UK
| | - Marc Tweed
- Terrence Higgins Trust- South, Brighton & Hove, UK
| | - Kayleigh Nichols
- Sexual Health & HIV, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Rory Finn
- Terrence Higgins Trust- South, Brighton & Hove, UK
| | | | - Mary Darking
- School of Humanities and Social Science Care, Health and Emotional Wellbeing Research and Enterprise Group, University of Brighton, Brighton, UK
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