[Study on utilization patterns of HIV pre-exposure prophylaxis services and influence path of medication compliance in male population].

Objective

To explore the utilization patterns of HIV pre-exposure prophylaxis (PrEP) service and the influence path of medication compliance in male population, and to provide a reference for optimizing the PrEP medication service strategy in China.

Methods

A cross-sectional study design was adopted. From June to October 2023, in the three provincial capital cities of Kunming, Zhengzhou and Guangzhou where PrEP was piloted, relying on the Center for Disease Control and Control, social organizations of men who had sex with men and designated hospitals of each city, a snowball sampling method was used to recruit male individuals aged 18 years and above with PrEP medication experience as the research subjects. The recruitment sample size was 306 people. The information such as their sociodemographic characteristics, PrEP service utilization patterns, medication compliance and influence paths were collected. The latent category analysis (LCA) was used to identify its PrEP service utilization patterns, and partial least squares path model was used to analyze the influence paths of PrEP medication compliance to calculate the path coefficient (β) and the moderating effect of PrEP medication compliance was analyzed using the multiple linear regression model [to calculate the slope (k)].The statistical analysis was performed using R 4.4.2 software.

Results

A total of 290 subjects were included, with an age of (29.7±7.2) years. The majority of them were unmarried (89.7%) and had engaged in homosexual behavior (88.6%). Regarding the utilization patterns of PrEP medication services for the subjects, according to LCA, they were classified into three categories: category 1 (online initiation-loss to follow-up type), category 2 (health institution-full process management type), and category 3 (digital closed-loop-strong follow-up type), accounting for 31.3% (91/290), 37.7% (109/290), and 31.0% (90/290) respectively. The PrEP medication compliance was classified as poor, good, and moderate.The analysis of the influencing paths of PrEP medication adherence revealed that the positive influencing paths included different cities → different purchasing channels (β=0.599, 95%CI: 0.527-0.668), different purchasing channels → service satisfaction (β=0.482, 95%CI: 0.381-0.573), the frequency of safe sex use in the past 6 months → the risk motivation for unprotected sexual behavior (β=0.373, 95%CI: 0.263-0.482), liver and kidney function tests and follow-up service utilization → service satisfaction (β=0.337, 95%CI: 0.256-0.416). The analysis of moderating effects showed that category 2 (health institution-full process management type) had a strong moderating effect on the influence path from service satisfaction of the research subjects to PrEP medication adherence (k=1.483, P<0.001).

Conclusions

The utilization pattern of PrEP medication services had a differentiated impact on the PrEP medication compliance of the male population. Different cities, different purchasing channels, service satisfaction, risk motives for sexual behavior, liver and kidney function tests, and follow-up services were the positive influencing variables of PrEP medication compliance. This study provided a reference basis for promoting PrEP services from standardization to personalized and precise intervention.