Background: Longitudinal monitoring of PrEP use, STIs, and sex behaviors in Chinese PrEP users are limited. Here we reported self-reported newly diagnosed STIs and sex behaviors among MSM PrEP users in China, and identified potential influence from study sites, PrEP provision modes, and dosing strategies.
Methods: MSM in Guangzhou and Wuhan were recruited by online ads, clinic flyers, and community referrals. Behavioral survey data were collected at baseline and quarterly follow-ups over 6 months. MSM were prescribed oral PrEP by pick-up or mail delivery. Univariate and multivariate logistic regression with Firth’s correction was conducted in Stata 15.0. Notably, the 3-month follow-up in Wuhan took place in October-November 2022 during the city’s widest COVID-19 lockdown since early 2020.
Results: From September 2021 to December 2022, 775 MSM were enrolled and initiated PrEP (Table 1). Overall, 57 (8.6%) dropped out, including four adverse events and one HIV seroconversion. We detected significant between-city differences in PrEP and condom use habits at Month3 (n=520, 316 in Guangzhou, 204 in Wuhan): Compared to Guangzhou, participants in Wuhan reported a lower rate of newly diagnosed STI since baseline assessment (2.4% vs. 8.9%, p=0.003) and higher prevalence of “never using condoms in sex” at Month 3 (8.3% vs. 3.5%, p=0.02). Multivariate analyses indicated participants in Wuhan were more likely to choose mail-delivered PrEP (81.9% vs. 19.2%, aOR=18.5, 95%CI: 11.2-30.7) and on-demand dosing (72.5% vs. 24.6%, aOR=7.7, 95%CI: 4.7-12.8). Month6 follow-up data (n=232, Guangzhou only) showed the prevalence of having sex under substance influence slightly decreased from baseline (57.8%) but remained common (48.7%) at Month6. Neither PrEP dosing strategies nor provision modes were not found significantly associated with the occurrence of new STIs, never using condoms in sex, or sex under the influence of substance over time.
Conclusion: Remote PrEP is highly promising in facilitating PrEP scale-up in China, especially among individuals with limited healthcare during the “Zero-COVID” era, as overall study retention remained high with infrequent dropouts. Neither mail-delivered PrEP nor on-demand dosing was found significantly increasing risks of STIs or sex behavioral changes. Nevertheless, ongoing HIV/STIs testing among PrEP users remains critical in controlling the epidemic.
