Low willingness to pay for pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in China

Cao, Wangnan; Sun, Shengzhi; Peng, Liping; Gu, Jing; Hao, Chun; Li, Jibin; Dong, Wei; Gilmour, Stuart; Li, Jinghua

doi:10.1186/s12889-020-08488-w

Cited by 18 publications

(11 citation statements)

References 26 publications

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“…PrEP is offered as an alternative to other HIV preventive strategies and in various forms (daily or on-demand oral PrEP and long-acting injectable PrEP) to meet varying individual needs. Although the hypothetical willingness of PrEP use was high among Chinese MSM if provided for free [ 23 ], it is worth noting that PrEP remains inaccessible to most for different reasons, including lack of a supporting national guideline, constrained resources allocated to PrEP, limited trained health professionals in providing PrEP, and high out-of-pocket costs (30% of an average monthly salary) [ 31 , 32 ]. An increased PrEP awareness may enable MSM to talk more openly about HIV status.…”

Section: Discussionmentioning

confidence: 99%

HIV Serostatus Disclosure Among Men Who Have Sex with Men in China in the Era of U=U and PrEP

Cao

Sun

et al. 2021

AIDS Behav

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Given the recent evidence on “Undetectable = Untransmittable” (U=U) and pre-exposure prophylaxis (PrEP), the present study aimed to investigate HIV disclosure behaviors and their associations with sexual risk behaviors and U=U and PrEP awareness among men who have sex with men (MSM) in China. A cross-sectional survey was conducted among 689 MSM recruited through a gay-friendly non-governmental organization located in Chengdu, China in 2018–2019. Information was collected by a structured self-administrated questionnaire. The enrolled sample included 554 (80.4%) participants who were HIV-negative and 135 (19.6%) participants with an unknown HIV status. In terms of disclosure, 41.4% of participants informed all partners about their HIV status all the time (informing behavior), while 30.4% asked all partners about their HIV status all the time (asking behavior). Only one-fifth knew about U=U, but this was not statistically associated with either informing or asking behavior. Half (50.5%) had heard of PrEP but this was not statistically associated with either informing or asking behavior. Common barriers to informing and asking behaviors were lower risk perception of HIV infection, a history of sexually transmitted infections, engagement in receptive sex, and a history of sex with casual partners. We found that both U=U and PrEP awareness and HIV serostatus disclosure were infrequent and not associated in this study of Chinese MSM. These data indicate huge information gaps among MSM in China.

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Section: Discussionmentioning

confidence: 99%

HIV Serostatus Disclosure Among Men Who Have Sex with Men in China in the Era of U=U and PrEP

Cao

Sun

et al. 2021

AIDS Behav

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“…Nevertheless, willingness varies across countries, which may limit the general application of existing studies. In addition, due to the sociodemographic, cultural, economic and structural factors that are likely to affect the acceptability of PrEP among MSM [ 3 , 18 , 19 ], it is important to understand how to implement PrEP according to local settings.…”

Section: Introductionmentioning

confidence: 99%

Willingness to use HIV pre-exposure prophylaxis and associated factors among men who have sex with men in Liuzhou, China

Ashuro

Feng

et al. 2021

AIDS Res Ther

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Background HIV pre-exposure prophylaxis (PrEP) is a key component of HIV combination prevention strategies and has the potential to decrease the incidence of HIV in men who have sex with men (MSM). This study aimed to evaluate levels of PrEP acceptability and explore factors associated with willingness to use PrEP among MSM in Liuzhou, China. Methods Between November 2017 and May 2019, a cross-sectional survey was conducted among 829 MSM. The study participants were recruited through a nonprobability sampling method. The participants’ demographics, HIV/AIDS knowledge, sexual behaviors, drug use and HIV test history were collected. Multivariate logistic regression was performed to identify factors associated with willingness to use PrEP. Results A total of 829 MSM completed the survey, and 30.28% (95% CI 27.3–33.4) were willing to use PrEP. In multivariate logistic regression, factors associated with a higher willingness to use PrEP included Zhuang or Han ethnic origin, recruitment through peer introduction or gay venues, pursuit of a higher education level, previous HIV testing and oral sex with a man. Conversely, having casual sex in the past 6 months was associated with a lower willingness to use PrEP. Conclusions MSM in Liuzhou reported a relatively low level of willingness to use PrEP. The results indicate the need for effective education, targeted intervention, and implementation strategies to promote PrEP acceptance among MSM.

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“…The comparison of daily versus event-driven PrEP use in this analysis allows for insights into the potential increased impact on cost-effectiveness. Willingness-to-pay by national governments and the ability of consumers to cover out-of-pocket expenses [ 49 ] will be a major factor in determining the feasibility of implementing and scaling PrEP, especially in countries where only branded PrEP is commonly available [ 50 ]. Nevertheless, offering event-driven PrEP as an option for MSM, in addition to daily dosing could potentially be more cost-effective, based on the results of event-driven PrEP alone.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness and impact of pre-exposure prophylaxis to prevent HIV among men who have sex with men in Asia: A modelling study

et al. 2022

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Introduction More than 70% of new HIV infections in Asia occurred in eight countries in 2020: Cambodia, China, India, Indonesia, Myanmar, Nepal, Thailand, and Vietnam—with a rising incidence among men who have sex with men (MSM). The World Health Organization (WHO) recommends pre-exposure prophylaxis (PrEP) for those at risk of acquiring HIV, yet wide-scale implementation of PrEP, on a daily or event-driven basis, has been limited in Asia. Methods The Optima HIV model was applied to examine the impact of scaling-up PrEP over five-years to cover an additional 15% of MSM compared with baseline coverage, a target deemed feasible by regional experts. Based on behavioral survey data, we assume that covering 15% of higher-risk MSM will cover 30% of all sexual acts in this group. Scenarios to compare the impact of generic-brand daily dosing of PrEP with generic event-driven dosing (15 days a month) were modelled from the start of 2022 to the end of 2026. Cost-effectiveness of generic versus branded PrEP was also assessed for China, the only country with an active patent for branded, higher cost PrEP. The impact on new HIV infections among the entire population and cost per HIV-related disability-adjusted life year (DALY) averted were estimated from the beginning of 2022 to the end of 2031 and from 2022 to 2051. Results If PrEP were scaled-up to cover an additional 15% of MSM engaging in higher-risk behavior from the beginning of 2022 to the end of 2026 in the eight Asian countries considered, an additional 100,000 (66,000–130,000) HIV infections (17%) and 300,000 (198,000–390,000) HIV-related DALYs (3%) could be averted over the 2022 to 2031 period. The estimated cost per HIV-related DALY averted from 2022 to 2031 ranged from US$600 for event-driven generic PrEP in Indonesia to US$34,400 for daily branded PrEP in Thailand. Over a longer timeframe from 2022 to 2051, the cost per HIV-related DALY averted could be reduced to US$100–US$12,700. Conclusion PrEP is a critical tool to further reduce HIV incidence in highly concentrated epidemics. Implementing PrEP in Asia may be cost-effective in settings with increasing HIV prevalence among MSM and if PrEP drug costs can be reduced, PrEP could be more cost-effective over longer timeframes.

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Low willingness to pay for pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in China

Cited by 18 publications

References 26 publications

HIV Serostatus Disclosure Among Men Who Have Sex with Men in China in the Era of U=U and PrEP

HIV Serostatus Disclosure Among Men Who Have Sex with Men in China in the Era of U=U and PrEP

Willingness to use HIV pre-exposure prophylaxis and associated factors among men who have sex with men in Liuzhou, China

Cost-effectiveness and impact of pre-exposure prophylaxis to prevent HIV among men who have sex with men in Asia: A modelling study

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