基于结构方程模型的广西男男性行为者长效注射剂卡博特韦使用意愿及影响因素研究The willingness and influencing factors of using long-acting injectable cabotegravir among men who have sex with men in Guangxi based on a structural equation model
刘露,阮玉华,陈世文,刘君辉,汤洪洋,黄腾达,江宇,裴恒妍,韦玉霞,陈怡,谢艺红
摘要(Abstract):
目的 了解广西MSM长效注射剂卡博特韦(CAB-LA)使用意愿及影响因素,为今后CAB-LA在我国的推广应用提供科学依据。方法 采用横断面调查的方法于2022年3-7月招募MSM进行面对面问卷调查,分析CABLA使用意愿并基于结构方程模型分析其使用意愿的影响因素及其作用路径和效应。结果 共调查1 006名MSM,年龄为18~24岁占34.0%,未婚占80.5%,本科及以上学历占40.0%。研究对象CAB-LA使用意愿为79.8%;18~24岁年龄组、近6个月男性性伴数多、自我感知HIV感染风险较高和使用过口服PrEP的MSM对CAB-LA使用意愿更高。结构方程模型显示,年龄、月收入、婚姻状况、近6个月经公共场所寻找男性性伴、近6个月男性性伴数、近1个月有固定男性性伴、自我感知HIV感染风险、对抗反转录病毒药物(ARVs)疗效看法和口服PrEP使用经历是CAB-LA使用意愿的影响因素,总效应分别为-0.127、-0.069、0.071、0.077、0.112、0.092、0.114、0.067和0.088;其中近6个月经公共场所寻找男性性伴通过近6个月男性性伴数产生间接作用,近6个月男性性伴数通过自我感知HIV感染风险和口服PrEP使用经历产生间接作用,口服PrEP使用经历通过对ARVs疗效看法产生间接作用。结论 广西MSM对CABLA的使用意愿较高,尤其是年轻、多性伴、自我感知HIV感染风险高和使用过口服PrEP的MSM,可作为我国今后CAB-LA试点和推广工作的重点人群。
关键词(KeyWords): 男男性行为者;长效注射剂卡博特韦;使用意愿;影响因素;结构方程模型
基金项目(Foundation): 国家自然科学基金(82260670)~~
作者(Author): 刘露,阮玉华,陈世文,刘君辉,汤洪洋,黄腾达,江宇,裴恒妍,韦玉霞,陈怡,谢艺红
DOI: 10.13419/j.cnki.aids.2023.10.05
参考文献(References):
- [1]SAUNDERS J,GILL O N,DELPECH V,et al.Minimum dataset for monitoring national human immunodeficiency virus pre-exposure prophylaxis(HIV Pr EP) programmes:a fivenation consensus,2019[J].Euro Surveill,2021,26(23):2001595.DOI:10.2807/1560-7917.
- [2]World Health Organization.Guideline on When to Start Antiretroviral Therapy and on Pre-Exposure Prophylaxis for HIV[EB/OL].(2015-09-01)[2023-03-25].https://www.who.int/publications/i/item/9789241509565.
- [3]徐俊杰,黄晓婕,刘昕超,等.中国HIV暴露前预防用药专家共识[J].中国艾滋病性病,2020,26(11):1265-1271.DOI:10.13419/j.cnki.aids.2020.11.34.
- [4]石安霞,DONO,张志华,等.男男性行为人群HIV暴露前预防需求与使用障碍研究[J].中华流行病学杂志,2020,41(3):343-348.DOI:10.3760/cma.j.issn.0254-6450.2020.03.012.
- [5]贾雯雯,林玉玺,廖玫珍,等.山东省MSM暴露前预防知晓和使用情况及其影响因素[J].中国艾滋病性病,2022,28(12):1381-1387.DOI:10.13419/j.cnki.aids.2022.12.09.
- [6]刘思辰,于飞,薛珲,等.七城市男男性行为者HIV暴露前后预防用药知晓和使用影响因素[J].中国艾滋病性病,2022,28(7):810-815.DOI:10.13419/j.cnki.aids.2022.07.11.
- [7]US Food and Drug Administration.FDA Approves First Injectable Treatment for HIV Pre-Exposure Prevention[EB/OL].(2021-12-20)[2023-03-25].https://www.fda.gov/news-events/press-announcements/fda-approves-first-injectable-treatment-hivpre-exposure-prevention.
- [8]LANDOVITZ RJ,DONNELL D,CLEMENT ME,et al.Cabotegravir for HIV Prevention in Cisgender Men and Transgender Women[J].N Engl J Med,2021,385(7):595-608.DOI:10.1056/NEJMoa2101016.
- [9]DELANY-MORETLWE S,HUGHES JP,BOCK P,et al.Cabotegravir for the prevention of HIV-1 in women:results from HPTN 084,a phase 3,randomised clinical trial[J].Lancet,2022,399(10337):1779-1789.DOI:10.1016/S0140-6736(22) 00538-4.
- [10]World Health Organization.Guidelines on long-acting injectable cabotegravir for HIV prevention[EB/OL].(2022-07-28)[2023-03-27].https://www.who.int/publications/i/item/9789240054097.
- [11]蓝光华,沈智勇,葛宪民,等.广西艾滋病综合防控与管理工作回顾与展望[J].中国临床新医学,2021,14(10):951-955.DOI:10.3969/j.issn.1674-3806.2021.10.01.
- [12]MEYERS K,WU Y,QIAN H,et al.Interest in Long-Acting Injectable Pr EP in a Cohort of Men Who have Sex with Men in China[J].AIDS Behav,2018,22(4):1217-1227.DOI:10.1007/s10461-017-1845-z.
- [13]中国疾病预防控制中心.艾滋病宣传教育核心知识知晓率问卷[EB/OL].(2018-04-04)[2023-03-27].https://www.ahcdc.cn/content/detail/5ac426b2e1ff8cdc21007fa8.html.
- [14]PENG L,CAO W,GU J,et al.Willingness to Use and Adhere to HIV Pre-Exposure Prophylaxis(Pr EP) among Men Who Have Sex with Men(MSM) in China[J].Int J Environ Res Public Health,2019,16(14):2620.DOI:10.3390/ijerph16142620.
- [15]MANSERGH G,KOTA KK,STEPHENSON R,et al.Preference for using a variety of future HIV pre-exposure prophylaxis products among men who have sex with men in three US cities[J].J Int AIDS Soc,2021,24(1):e25664.DOI:10.1002/jia2.25664.
- [16]GOEDEL WC,SCHNEIDER JA,HAMBRICK HR,et al.Are Anal Sex Roles Associated with Preferences for Pre-Exposure Prophylaxis Administration Modalities Among Men Who Have Sex with Men?[J].Arch Sex Behav,2018,47(7):2123-2133.DOI:10.1007/s10508-017-1083-5.
- [17]CHAN C,VACCHER S,FRASER D,et al.Preferences for Current and Future Pr EP Modalities Among Pr EP-Experienced Gay and Bisexual Men in Australia[J].AIDS Behav,2022,26(1):88-95.DOI:10.1007/s10461-021-03344-3.
- [18]YU S,CROSS W,LAM LLY,et al.Willingness,preferred ways and potential barriers to use pre-exposure prophylaxis for HIV prevention among men who have sex with men in China[J].BMJ open,2021,11(10):e053634.DOI:10.1136/bmjopen-2021-053634.
- [19]郭佳欢,康文婷,刘童童,等.不同男男性行为者对Pr EP使用意愿及影响因素分析[J].中国艾滋病性病,2022,28(12):1375-1380.DOI:10.13419/j.cnki.aids.2022.12.08.
- [20]张燕.中国西部男男性行为人群艾滋病暴露前预防用药的知晓及使用意愿动机模型研究[D].重庆:重庆医科大学,2011.
- [21]BINSON D,POLLACK LM,BLAIR J,et al.HIVtransmission risk at a gay bathhouse[J].J Sex Res,2010,47(6):580-588.DOI:10.1080/00224490903216755.
- [22]MA Q,XIA S,PAN X,et al.Rapid HIV antibody testing among men who have sex with men who visited a gay bathhouse in Hangzhou,China:a cross-sectional study[J].BMJ Open,2015,5(9):e008661.DOI:10.1136/bmjopen-2015-008661.
- [23]王毅,周万明,樊静,等.绵阳市不同寻找性伴场所男男性行为者HIV感染状况及社会行为特征[J].中国热带医学,2019,19(8):747-751.DOI:10.13604/j.cnki.46-1064/r.2019.08.08.
- [24]BLAIR KJ,TORRES TS,HOAGLAND B,et al.Pre-exposure prophylaxis use,HIV knowledge,and internalized homonegativity among men who have sex with men in Brazil:Across-sectional study[J].Lancet Reg Health Am,2022,6(6):100152.DOI:10.1016/j.lana.2021.100152.
- [25]LEVY ME,PATRICK R,GAMBLE J,et al.Willingness of community-recruited men who have sex with men in Washington,DC to use long-acting injectable HIV pre-exposure prophylaxis[J].PLo S One,2017,12(8):e0183521.DOI:10.1371/journal.pone.0183521.
- [26]TIMMINS L,SCHNEIDER JA,CHEN YT,et al.Sexual Identity,Sexual Behavior and Pre-exposure Prophylaxis in Black Cisgender Sexual Minority Men:The N2 Cohort Study in Chicago[J].AIDS Behav,2021,25(10):3327-3336.DOI:10.1007/s10461-021-03246-4.