Exploring Exposure Factors Associated with PrEP Regimen Choice Among MSM in Beijing and Chengdu, China Restricted; Files Only

Abstract

Background: Pre-exposure prophylaxis (PrEP) is a highly effective medication to prevent HIV transmission, especially among gay, bisexual, and other men who have sex with men (MSM), which is a key population disproportionately affected by HIV in China. Both daily and on-demand PrEP regimens are available, yet limited research has examined factors influencing regimen choice among Chinese MSM. This study focuses on understanding factors associated with PrEP regimen selection among MSM in Beijing and Chengdu, two major metropolitan cities in China. 

Methods: A cross-sectional online survey was conducted in December 2023, with participants recruited from the geosocial networking app Blued. Eligible participants were HIV-negative or of unknown status, aged 18 or older, and residents of Beijing or Chengdu. Of the 1,008 MSM respondents, 260 reported current PrEP use and were included in the analysis. A number of domains were included in the analysis including sociodemographic characteristics, sexual behaviors, HIV knowledge, mental health, and PrEP-related stigma. Logistic regression models were used to examine factors associated with preference for daily vs. on-demand PrEP. 

Results: Among PrEP users, 84% reported using on-demand PrEP, and 16% used daily PrEP. Multivariable analysis showed that higher education (AOR = 0.14 for college vs. associate degree or lower) and greater HIV knowledge (AOR = 0.67, 95% CI: 0.52–0.86) were significantly associated with on-demand PrEP use. Conversely, higher anxiety levels were associated with daily PrEP use (AOR = 1.22, 95% CI: 0.80–1.85), though this result did not reach statistical significance. 

Conclusions: This study reveals a strong preference for on-demand PrEP among MSM in Beijing and Chengdu, influenced by education level, HIV knowledge, and mental health status. That the majority of PrEP users selected on-demand instead of daily PrEP is different from studies conducted in many other areas of the world, in which daily PrEP regimens are the predominant preferred method. Together, these findings suggest that PrEP decision-making is shaped not only by behavioral risk, but also by psychosocial factors and area-level influences such as culture or healthcare access. 

Table of Contents

Table of Contents

Abstract ........................................................................................................................................................... 7

Introduction..................................................................................................................................................... 9

Methods.......................................................................................................................................................... 12

Results............................................................................................................................................................ 15

Discussion....................................................................................................................................................... 17

Table 1. Characteristic of Chinese MSM with Different PrEP use Regimen, 2023 (N=260) ........................................ 21

Table 2. Descriptive analysis of the PHQ-4 and its subscales, 2023 (N=260) ........................................................... 23

Table 3. Associations Between Daily versus On-Demand PrEP Regimen and sociodemographic and HIV risk factors

among MSM in China, 2023 (N=260) .................................................................................................................. 24

References ....................................................................................................................................................... 25

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	M.S.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	MSM PrEP Regimen AIDS Epidemiology PrEP HIV
Committee Chair / Thesis Advisor	Siegler, Aaron, Emory University
Committee Members	Ning, Kunru, Emory University Huang, Wenting, Emory University

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