Acceptability of HIV pre-exposure prophylaxis in China: A systematic review and meta-analysis

Yuan, Defu; Yin, Yue-Ping; Chen, Jianshuang; Lu, Jing; Zhou, Ying; Fu, Gengfeng; Wang, Bei

doi:10.1177/09564624211042308

Cited by 6 publications

(4 citation statements)

References 65 publications

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“…The mean score for perceived acceptability of PrEP was at a moderate level (3.9 on a 7-point scale), with more than 40% of participants showing a low level of acceptability. Compared with a pooled estimate of 66.8% acceptability in China 29 , the acceptability in our study was lower, suggesting a need to find other ways to improve the acceptance of PrEP. Through Bayesian networks, this study illustrated the complex relationship between the acceptability of PrEP and its influencing factors.…”

Section: Discussioncontrasting

confidence: 99%

Application of Bayesian networks to identify factors influencing acceptability of HIV pre-exposure prophylaxis in Guilin, China

Zhou

Shi

Assanangkornchai

et al. 2022

Sci Rep

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Pre-exposure prophylaxis (PrEP) is an effective strategy to prevent uninfected individuals from contracting human immunodeficiency virus (HIV), however it must be acceptable to stakeholders in order to be effective. This study aimed to assess the acceptability of PrEP and related influencing factors. A cross-sectional survey was conducted among female sex workers (FSW), people who inject drugs (PWID), and men who have sex with men (MSM) using respondent driven sampling. Factors influencing PrEP acceptability were estimated using ordinal logistic regression and Bayesian networks. The survey included 765 eligible participants. The mean score of the perceived acceptability index was 3.9 (SD = 1.97). Multivariable logistic regression analysis revealed a higher acceptance of PrEP was associated with elder age, having other medical insurance, higher perceived utility of PrEP in facilitating prevention of HIV, higher perceived ease of use, higher perceived risk of increased risk behavior, higher perceived privacy problem in using PrEP, higher perceived comparative advantage over condom use, higher perceived comparative advantage of having sex when the urge arises, and higher perceived image of PrEP user as having sexual risky behavior, as public-minded and as health-conscious. The Bayesian network model showed perceived ease of use, perceived image of user as health-conscious, and perceived comparative advantage of having sex when the urge arises were directly associated with acceptability of PrEP. If these three factors were at a high level, 74.6% of the participants would have a high level of acceptability of PrEP. Effective education strategies to promote the acceptance of PrEP are needed. Implementation strategies should incorporate more inclusive messaging and build positive publicity for PrEP to reduce the stigma that PrEP use indicates risky behavior.

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Section: Discussioncontrasting

confidence: 99%

Application of Bayesian networks to identify factors influencing acceptability of HIV pre-exposure prophylaxis in Guilin, China

Zhou

Shi

Assanangkornchai

et al. 2022

Sci Rep

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“…The primary outcomes of this study were HIV testing uptake and willingness to use PrEP/PEP among MSM in China. According to previous studies [2,8,9], the proportion of having HIV testing and willingness to use PrEP/PEP were 60% and 70% among MSM in China, respectively. Therefore, the sample size was estimated as 267 and 171 MSM with two-sided α set to 0.05 and d set to 0.1 × p. In summary, this study should recruit at least 267 MSM.…”

Section: Discussionmentioning

confidence: 99%

“…In China, only 61.2% of MSM have tested for HIV and confirmed their HIV status in 2022 [2]. A Chinese meta-analysis estimated that the acceptability of PrEP varied widely across the country in China, ranging from 19.1% to 94.6%, with a pooled estimate of 66.8% (95% CI: 62.0%-71.3%) [8]. A cross-sectional study in China showed that 67.2% of MSM were aware of PEP, 76.0% were willing to use PEP, and 2.3% had ever used PEP [9].…”

Section: Introductionmentioning

confidence: 99%

Associations between perceived and actual risk of HIV infection and HIV prevention services uptake among men who have sex with men in Shandong province, China: a cross-sectional study

Lin,

Li,

Liao

et al. 2024

BMC Public Health

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Background Associations between perceived and actual risk of HIV infection and HIV prevention services uptake are inconclusive. This study aimed to evaluate the discrepancy between the perceived and actual HIV risk, and quantify the associations between perceived and actual risk of HIV infection and three HIV prevention services utilization among men who have sex with men (MSM) in Shandong province, China. Methods A cross-sectional study was conducted in Shandong province in June 2021. Participants were eligible if they were born biologically male, aged 18 years or older, had negative or unknown HIV status, and had sex with men in the past year. Participants were recruited online. The discrepancy between their perceived and actual risk of HIV infection was evaluated by calculating the Kappa value. Bayesian model averaging was used to assess the associations between perceived and actual risk of HIV infection and HIV prevention services uptake. Results A total of 1136 MSM were recruited, most of them were 30 years old or younger (59.9%), single (79.5%), with at least college education level (74.7%). Most participants (97.4%) perceived that they had low risk of HIV infection, and 14.1% were assessed with high actual risk. The discrepancy between their perceived and actual risk of HIV infection was evaluated with a Kappa value of 0.076 (P < 0.001). HIV testing uptake had a weak association with perceived high HIV prevalence among social networks (aOR = 1.156, post probability = 0.547). The perceived high HIV prevalence among national MSM was positive related to willingness to use PrEP (aOR = 1.903, post probability = 0.943) and PEP (aOR = 1.737, post probability = 0.829). Perceived personal risk (aOR = 4.486, post probability = 0.994) and perceived HIV prevalence among social networks (aOR = 1.280, post probability = 0.572) were related to history of using PrEP. Perceived personal risk (aOR = 3.144, post probability = 0.952), actual risk (aOR = 1.890, post probability = 0.950), and perceived risk among social networks (aOR = 1.502, post probability = 0.786) were related to history of using PEP. Conclusions There is discordance between perceived and actual personal risk of HIV infection among MSM in China. HIV risk assessment and education on HIV prevalence among MSM should be strengthened to assist high-risk populations aware their risk accurately and hence access HIV prevention services proactively.

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“…While previous studies have indicated PrEP is highly acceptable among Chinese GBMSM [ 4 ], fewer than 6,000 people in China were currently using PrEP in April 2021 [ 5 ]. In 2020, about 30% of the new HIV infections in China are transmitted via male-to-male sex activities, and in some major cities GBMSM account for more than 75% of all new HIV infections [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

An instant messaging mobile phone application for promoting HIV pre-exposure prophylaxis uptake among Chinese gay, bisexual and other men who have sex with men: A mixed methods feasibility and piloting randomized controlled trial study

Li,

Xiong,

Maman

et al. 2023

PLoS ONE

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Background Mobile health (mHealth) is a promising intervention mode for HIV prevention, but little is known about its feasibility and effects in promoting pre-exposure prophylaxis (PrEP) uptake among Chinese gay, bisexual and other men who have sex with men (GBMSM). Methods We evaluated an instant messaging application using a WeChat-based mini-app to promote PrEP uptake among GBMSM via a mixed-methods design that includes a 12-week, two-arm randomized controlled pilot trial and in-depth progress interviews in Guangzhou, China. Primary outcomes include the number of PrEP initiations, individual-level psychosocial variables related to PrEP initiation, and usability of the PrEP mini-app. Results Between November 2020 and April 2021, 70 GBMSM were successfully enrolled and randomized into two arms at 2:1 ratio (46 to the intervention arm, 24 to the control arm). By the end of 12-week follow-up, 22 (31.4%) participants completed the initial consultation and lab tests for PrEP, and 13 (18.6%) filled their initial PrEP prescription. We observed modest but non-significant improvements in participants’ intention to use PrEP, actual PrEP initiation, PrEP-related self-efficacy, stigma, and attitudes over 12 weeks when comparing the mini-app and the control arms. Qualitative interviews revealed the key barriers to PrEP uptake include anticipated stigma and discrimination in clinical settings, burden of PrEP care, and limited operating hours of the PrEP clinic. In-person clinic navigation support was highly valued. Conclusions This pilot trial of a mobile phone-based PrEP mini-app demonstrated feasibility and identified limitations in facilitating PrEP uptake among Chinese GBMSM. Future improvements may include diversifying the content presentation in engaging media formats, adding user engagement features, and providing off-line in-clinic navigation support during initial PrEP visit. More efforts are needed to understand optimal strategies to identify and implement alternative PrEP provision models especially in highly stigmatized settings with diverse needs. Trial registration Trial registration: The study was prospectively registered on clinicaltrials.gov (NCT04426656) on 11 June, 2020.

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Acceptability of HIV pre-exposure prophylaxis in China: A systematic review and meta-analysis

Cited by 6 publications

References 65 publications

Application of Bayesian networks to identify factors influencing acceptability of HIV pre-exposure prophylaxis in Guilin, China

Application of Bayesian networks to identify factors influencing acceptability of HIV pre-exposure prophylaxis in Guilin, China

Associations between perceived and actual risk of HIV infection and HIV prevention services uptake among men who have sex with men in Shandong province, China: a cross-sectional study

An instant messaging mobile phone application for promoting HIV pre-exposure prophylaxis uptake among Chinese gay, bisexual and other men who have sex with men: A mixed methods feasibility and piloting randomized controlled trial study

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