Table_4_Awareness and Use of Post-exposure Prophylaxis for HIV Prevention Among Men Who Have Sex With Men: A Systematic Review and Meta-Analysis.DOCX

Background: The use of post-exposure prophylaxis (PEP) is effective in reducing HIV risk, but it is underused by men who have sex with men (MSM) due to certain psychological and sociostructural factors. This article assessed the awareness and use of PEP among MSM in an effort to increase the visibility and uptake of PEP among at-risk populations.
Methods: We conducted a systematic literature search of the PubMed, Web of Science, PsycINFO, and Google Scholar electronic databases. Studies were screened for inclusion, and relevant data were abstracted, assessed for bias, and synthesized. Pooled effect estimates were calculated using random effects meta-analysis, meta-regression and subgroup analysis, and a qualitative review and risk of bias assessment were performed (PROSPERO, CRD42019123815).
Results: Twenty eligible studies involving 12,579 MSM were included in the meta-analysis. The pooled estimate of the proportions of MSM who were aware of PEP was modest at 59.9% (95% CI: 50.5~68.7) and that of MSM who previously used PEP was very low at 4.9% (95% CI: 2.4~9.8). PEP awareness showed no clear change over time, while PEP use significantly changed over time. Multiple factors affected awareness, including educational attainment, race/ethnicity, levels of HIV stigma, access to condoms, and so on. Many factors could potentially impede or facilitate the use of PEP, such as income, lack of PEP information, and partnership.
Conclusion: We observed that PEP is an underused HIV prevention strategy among MSM and that once MSM become aware of PEP, the majority are willing to use it if they are supported appropriately in terms of a range of individual, social, and structural barriers.
Systematic Review Registration: http://www.cdr.york.ac.uk/prospero, PROSPERO [CRD42019123815].

研究背景：暴露后预防（post-exposure prophylaxis, PEP）可有效降低人类免疫缺陷病毒（HIV）感染风险，但男男性行为人群（men who have sex with men, MSM）因部分心理及社会结构层面因素，对该措施的使用仍存在不足。本研究旨在评估男男性行为人群对PEP的知晓与使用情况，以期提升高危人群对PEP的认知与应用率。
研究方法：本研究对PubMed、Web of Science、PsycINFO及Google Scholar四大电子数据库开展系统性文献检索。通过文献筛选确定纳入研究，提取相关数据并进行偏倚风险评估与证据合成。采用随机效应meta分析、meta回归及亚组分析计算合并效应量，并完成定性综述与偏倚风险评估（注册编号：PROSPERO, CRD42019123815）。
研究结果：本研究共纳入20项符合标准的研究，涉及12579名男男性行为人群。合并分析结果显示，知晓PEP的男男性行为人群占比为59.9%（95%置信区间：50.5~68.7），处于中等水平；而既往曾使用PEP的人群占比仅为4.9%（95%置信区间：2.4~9.8），处于极低水平。随时间推移，男男性行为人群对PEP的知晓率无显著变化，但PEP使用率则存在显著改变。多项因素可影响PEP知晓率，包括受教育程度、种族/民族、HIV污名化水平、安全套可及性等；而收入水平、PEP信息匮乏、伴侣关系等因素，则可能阻碍或促进PEP的使用。
研究结论：本研究发现，PEP作为HIV预防策略在男男性行为人群中仍存在应用不足的问题；而一旦该人群知晓PEP，在得到针对性支持以克服各类个体、社会及结构层面的障碍后，多数人群愿意使用PEP。
系统综述注册信息：http://www.cdr.york.ac.uk/prospero，PROSPERO [CRD42019123815]。