Understanding the Uptake and Outcomes of Non-occupational Postexposure Prophylaxis Use Through an Online Medical Platform in China: Web-Based Cross-sectional Study (Preprint)

Abstract

BACKGROUND To date, non-occupational post-exposure prophylaxis (PEP) has been widely accepted as an safe and effective intervention for HIV in many countries, yet it remains an underutilized prevention strategy in China. Evidence indicated a high demand for PEP among Chinese MSM, but the uptake and access to PEP service are still limited. In an era of rapid development of web-based technology, online medical platforms in China holds great promise in facilitating PEP provision and delivery by addressing problems such as accessibility, convenience, privacy protection, and anti-discrimination by integrating online and offline resources. However, there is paucity of data concerning the uptake and outcomes of online PEP in China. OBJECTIVE Our study aimed to explore online PEP service delivery and assess PEP uptake and outcome through a web-based cross-sectional study. METHODS From January 2020 to June 2021, we conducted a retrospective web-based survey among those seeking online PEP services via the internet medical platform of "HeHealth" by using a structured questionnaire. Participants were surveyed on sociodemographic characteristics, sexual and drug-related behaviors, history of PrEP usage, and PEP uptake. Statistical analysis included descriptive analysis, Chi-squared test, and multivariable logistic regression. P values less than .05 were deemed statistically significant. RESULTS No HIV seroconversions were observed among 539 PEP users. Our sample demonstrated that a majority of participants seeking online PEP services were gay (397, 73.7%), single (470, 87.2%), having an education ＞12 years (493, 91.5%), and with an average monthly income ≥7000 RMB (50.8%). Sexual exposures accounted for 86.8% (468/539) with anal sex being most common indication (72.2%) for seeking PEP use. Among 539 participants, 327 (60.67%) sought online PEP for relatively low-risk exposures, while 212 (39.3%) were considered high-risk exposures. Nearly all (537, 99.6%) initiated PEP within 72 hours and 370 (68.7%) within 24 hours of exposure. Up to 451 (83.7%) individuals were prescribed a 3-drug regimen consisting of 3TC/TDF+DTG in 293 cases (54.4%), followed by FTC/TDF+DTG in 158 cases (29.3%). The adjusted model showed that greater odds of PrEP usage were associated with an age ≥35 years versus the age group 25-34 years (adjusted odds ratio [AOR] 2.04, 95% CI 1.24-3.37), having an education ≥ 17 years versus an education ≤12 years (AOR 3.14, 95% CI 1.29-7.62), with average monthly income at 7000-9999 RMB (AOR 2.20, 95% CI 1.05-4.62), 10000-19999 RMB (AOR 2.55, 95% CI 1.23-5.30), and ≥ 20000 RMB (AOR 2.60, 95% CI 1.09-6.23) versus ＜3000 RMB and having high-risk sexual behavior during PEP treatment (AOR 2.20, 95% CI 1.05, 3.69). CONCLUSIONS Zero infection in this study demonstrated that online PEP could be a valuable risk-reduction option to improve the prevention service within China. Further research is needed to better facilitate PrEP transition among online PEP users.