Table_5_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）在降低HIV感染风险方面效果显著，但由于部分心理及社会结构因素，男男性行为者（men who have sex with men, MSM）对其使用率偏低。本研究旨在提升高危人群对PEP的知晓度与使用率，故针对男男性行为者的PEP知晓情况与使用现状展开评估。
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。按照纳入标准筛选文献后，提取相关数据、进行偏倚风险评估并完成数据整合。采用随机效应meta分析、Meta回归及亚组分析计算合并效应量，同时开展定性综述与偏倚风险评估（研究注册号：PROSPERO, CRD42019123815）。
研究结果：本研究共纳入20项符合标准的研究，涉及12579名男男性行为者。合并分析结果显示，知晓PEP的男男性行为者占比为59.9%（95%置信区间：50.5~68.7），整体知晓率处于中等水平；而既往使用过PEP的男男性行为者占比仅为4.9%（95%置信区间：2.4~9.8），使用率极低。男男性行为者对PEP的知晓率随时间未出现显著变化，但其PEP使用率则随时间发生了显著改变。多项因素会影响PEP知晓率，包括受教育程度、种族/民族、HIV污名化程度、安全套可及性等。同时，诸多因素会对PEP的使用产生阻碍或促进作用，例如收入水平、PEP相关信息匮乏、伴侣关系等。
研究结论：本研究发现，PEP作为HIV预防策略在男男性行为者群体中使用率偏低；但一旦该群体知晓PEP，且在应对各类个体、社会及结构性障碍方面获得适当支持时，大部分人愿意使用PEP。
系统综述注册信息：http://www.cdr.york.ac.uk/prospero，PROSPERO [CRD42019123815]。