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Exploring the Intention to Use HIV Blood Self-Testing among Young Men Who Have Sex with Men in Taiwan from the Theory of Planned Behavior Perspective
HIV blood self-testing (HIV BST),Young men who have sex with men (YMSM),HIV testing experience,Theory of Planned Behavior (TPB),Taiwan,
|Publication Year :||2020|
|Abstract:||背景：根據近年台灣疾管署資料顯示，每年台灣HIV感染新發個案約有2,000人，其中較高比例為透過男性間性行為之途徑感染，並以年輕族群為主。而目前在台灣，估計僅有約84% 之HIV感染者知道自身感染狀態，與UNAIDS於2014年提出之「90-90-90」目標，仍有一段差距，而為達成此目標，篩檢在愛滋防治政策上即佔有重要的地位。近年來，台灣疾管署推出了「愛滋血液自我篩檢 (Finger-Stick Blood Self-Testing for HIV, HIV BST)」工具，希望能透過其具高準確度及能於自我選定之私密空間進行的特性，來提高篩檢比例。但，此篩檢工具在台灣的年輕男性間性行為者 (young men who have sex with men, YMSM) 之中的使用意圖，及相關影響因素仍屬未知。|
目的：本研究以計劃行為理論 (The Theory of Planned Behaviors, TPB) 為框架，針對台灣YMSM設計問卷，調查此族群使用HIV BST之意圖及可能的影響因素，並以HIV篩檢經驗進行分層分析，以供未來適性衛教發展及介入策略之實證參考依據。
方法：本研究係以過去回顧之文獻為基礎、計劃行為理論為框架設計量性問卷，問卷題項主要由TPB之三大構念（行為結果態度、主觀規範，及自覺行為控制）組成，並於2020年1月至3月間，針對台灣15–39歲之YMSM，以網路匿名自填式問卷收集調查資料，共有1,328位符合納入條件之YMSM納入分析。本研究透過探索性因素分析萃取出六個潛在因素，並透過HIV篩檢經驗進行分層分析，探討影響YMSM使用HIV BST 之意圖的相關因素。
結果：本研究發現，台灣的YMSM之HIV BST使用意圖，與以下因素相關：在過去沒有篩檢經驗的YMSM之中，若其在與HIV BST相關之有利情境下，有相對中度 (AOR=2.48)、高度 (AOR=5.77) 的自覺行為控制，其高意圖之勝算比會顯著較高；另外，在曾經接受過篩檢的YMSM之中，除了與HIV BST相關之有利情境下，有相對中度 (AOR=2.99)、高度 (AOR=4.92) 的自覺行為控制之外，若其自覺相對支持 (AOR=2.20) 的主觀規範，及在阻礙情境下有相對高度 (AOR=1.53) 之自覺行為控制，會發現其也有顯著較高的高意圖勝算比。
結論：本研究以TPB作為理論架構，發展問卷並測量台灣YMSM對於HIV BST使用意圖之相關因素。結果顯示，無論有無篩檢經驗，在與HIV BST相關之有利情境下的自覺行為控制為重要相關因子，另外，在曾經接受篩檢的YMSM中，發現了其他的重要因子：主觀規範，及在阻礙情境下的自覺行為控制。期望本研究之研究結果，能提供未來發展適性衛教及相關政策之實證參考依據。
Background: According to Taiwan CDC, about 2,000 new cases of HIV infection are diagnosed each year in Taiwan. The most common route of transmission has been unprotected sex between men who have sex with men (MSM), with the largest number of infections being reported in the younger age group. In addition, there are only 84% of people who living with HIV (PLWH) in Taiwan knew their status, suggesting that more needs to be done to meet the “90–90–90” goal set by the UNAIDS. To achieve the first “90” target, Taiwan CDC has promoted HIV finger-stick blood self-testing (HIV BST), which has been proven accurate and can be easily performed in any private place of one’s choosing. However, the intention to use HIV BST among young men who have sex with men (YMSM) in Taiwan has not yet been explored.
Objectives: Using the Theory of Planned Behavior (TPB) as a theoretical framework, this study aimed to explore the intention to use HIV BST among YMSM in Taiwan, separately by their HIV testing experience.
Methods: Informed by the literature and TPB, the questionnaire included items measuring the three TPB constructs—Attitude toward the Behavior (ATB), Subjective Norm (SN), and Perceived Behavioral Control (PBC). Data from 1,328 HIV-negative YMSM ages 15–39 years in Taiwan were collected through an anonymous online survey conducted between January and March 2020. Six TPB factors were extracted by exploratory factor analysis and formed factor-based subscales, whose scores were trichotomized and dummy-coded. Data were then stratified by HIV testing experience and multivariate logistic regression was performed to examine the factors associated with high HIV BST intention among YMSM in Taiwan.
Results: Among YMSM without HIV testing experience, those who perceived intermediate (AOR=2.48) and high (AOR=5.77) PBC under facilitating conditions related to HIV BST were significantly more likely to have higher HIV BST intention. By contrast, among ever-tested YMSM, high HIV BST intention was found to be significantly associated with perceiving intermediate (AOR=2.99) and high (AOR=4.92) PBC under facilitating conditions related to HIV BST, supportive SN (AOR=2.20), and high PBC under constraining conditions (AOR=1.53).
Conclusions: This TPB-based study showed that PBC under facilitating conditions related to HIV BST was an important factor that could increase HIV BST intention among YMSM. Specifically, among ever-tested YMSM, SN and PBC under constraining conditions were also found to be linked to HIV BST intention. These findings could inform the development of tailored health promotion programs and related policies in the future.
Keywords: HIV blood self-testing (HIV BST); Young men who have sex with men (YMSM); HIV testing experience; Theory of Planned Behavior (TPB); Taiwan
|Appears in Collections:||健康行為與社區科學研究所|
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