臺灣男性間性行為者之暴露愛滋病毒前預防性投藥照護留診情形：使用行為態度與其他相關因素之探討

Abstract

背景：人類免疫缺乏病毒 (Human Immunodeficiency Virus, HIV) 防治之關鍵族群為男性間性行為者 (Men who have sex with men, MSM)。隨著愛滋病毒暴露前預防性投藥 (Pre-exposure prophylaxis, PrEP) 之廣泛應用，臺灣於 2016 年開始 PrEP 計畫，並開始有研究針對MSM 之 PrEP 知識、接受度及使用程度進行探討，但卻較少討論 PrEP 照護留診。 目的：本研究欲了解參與臺灣 PrEP 計畫的 MSM 之特徵與留診情形，並進一步探討PrEP 使用行為態度其他相關因素對完整留診的影響。 方法：本研究使用 2018–2021 年臺灣疾病管制署之 PrEP 計畫作為資料來源，並以 MSM 為對象。若 MSM 追蹤一年之留診率達 100%，將視為完整留診。以雙變項與多元邏輯斯迴歸分析了解PrEP 使用行為態度、其他相關因素，與完整留診之關聯。 結果：於 150 位之研究對象中，多數為 25–34 歲 (68.0%)、具大專以上教育程度 (68.7%)，及具性傳染病診斷史 (34.7%)。此外，平均年度留診率為 79.3 %，其中 54.0% 達完整留診；PrEP 使用行為態度則偏中立 (Mean = 17.1, SD = 3.6)。根據多變項分析結果，完整留診與行為態度並無顯著關聯 (OR = 1.0, 95% CI: 0.9-1.1)，但與自認同性戀 (OR = 5.0, 95% CI: 1.5-16.9) 及具性傳染病診斷史 (OR = 0.4, 95% CI: 0.2-0.9) 呈顯著相關。 結論：臺灣 MSM 之 PrEP 留診情形仍有進步空間，且完整留診與 PrEP 使用行為態度之間並無關聯。另，建議針對自認雙性戀或曾診斷性傳染病之 MSM ，應提供能降低偏見、提升動機之介入方案。

Background: Men who have sex with men (MSM) are the key population of HIV prevention in Taiwan. According to the recommendation of World Health Organization to incorporate pre-exposure prophylaxis (PrEP) into the comprehensive HIV prevention methods, Taiwan Centers for Disease Control (CDC) also launched the demonstration project of PrEP in 2016. Since then, considerable progress has been made in improving the awareness, acceptability, and utilization of PrEP among MSM in Taiwan. However, there is still a paucity of studies on PrEP care retention among MSM in Taiwan. Objectives: This study aims to assess PrEP care retention among MSM who participated in Taiwan PrEP project. In addition, this study examined the associations of behavioral attitudes towards PrEP use and other associated factors with the retention in PrEP care. Methods: Data were from the ‘HIV Testing and Pre-Exposure Prophylaxis Project’ conducted by Taiwan CDC between 2018 and 2021. Complete retention in PrEP care was defined as achieving 100% of one-year retention rate. Bivariate and multivariate analyses were then used to examine the associations of behavioral attitudes towards PrEP use and other associated factors with complete retention. Results: The results showed that the majority of 150 MSM who participated Taiwan PrEP project were aged 25–34 (68.0%), had an education level higher than college (68.7%), and had been diagnosed with STIs (34.7%). Moreover, the average yearly retention rate among MSM were 79.3%, including 54.0% who achieved complete retention, and the attitudes toward PrEP use were neutral (Mean = 17.1, SD = 3.6). According to the bivariate and multivariate analyses, complete retention was not associated with attitudes toward PrEP use (OR = 1.0, 95% CI: 0.9-1.1), but was associated with homosexual identity (OR = 5.0, 95% CI: 1.5-16.9) and STIs diagnosis history (OR = 0.4, 95% CI: 0.2-0.9). Conclusion: PrEP care retention among MSM in Taiwan still has room for improvement, and complete retention is not associated with behavioral attitudes toward PrEP use. Moreover, interventions to enhance motivation and eliminate stigma are suggested to provide for MSM identified as bisexual or with STIs diagnoses history.