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Article(id=1241102735848828975, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241102730337505325, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202404106, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1712419200000, receivedDateStr=2024-04-07, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773831550799, onlineDateStr=2026-03-18, pubDate=1721836800000, pubDateStr=2024-07-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773831550799, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773831550799, creator=13701087609, updateTime=1773831550799, updator=13701087609, issue=Issue{id=1241102730337505325, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='14', pageStart='2497', pageEnd='2688', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773831549486, creator=13701087609, updateTime=1773831697291, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241103350322745680, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241102730337505325, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241103350322745681, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241102730337505325, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2634, endPage=2641, ext={EN=ArticleExt(id=1241102736255676502, articleId=1241102735848828975, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Trajectories of HIV testing frequency and its association with pre-/post-exposure prophylaxis use among men who have sex with men, Guangxi, China, columnId=1228016573156360233, journalTitle=Modern Preventive Medicine, columnName=Disease Control and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the association between HIV testing frequency and pre - / post-exposure prophylaxis (PrEP/PEP) use among individuals at risk of HIV.

Methods

Utilizing a follow-up cohort of men who have sex with men (MSM) conducted in five cities (Nanning, Liuzhou, Guilin, Yulin, and Beihai) in Guangxi Province, China, we employed a group-based trajectory model (GBTM) to analyze the developmental trajectories of HIV testing frequency among MSM. Furthermore, we conducted logistic regression analysis to examine the factors associated with different trajectory groups of HIV testing frequency and their relationship with the utilization of PrEP/PEP before and after HIV exposure.

Results

The analysis included a total of 327 MSM participants, with an average age of 27.722±8.137 years. Based on evaluation criteria such as the Bayesian information criterion, GBTM identified three trajectory groups of HIV testing frequency: low-frequency group (73.87%), medium-frequency group (19.75%), and high-frequency group (6.37%). Comparing to the low-frequency group, MSM in the high-frequency group exhibited higher utilization rates of PrEP (9.49% vs. 55.56%) (χ2=32.02, P<0.001) and PEP (17.39% vs. 44.44%) (χ2=8.19, P<0.017). After controlling for relevant confounding factors, the low-frequency group and medium-frequency group showed of the used PrEP by OR=0.153 (95%CI:0.047-0.501, P=0.002) and OR=0.251 (95%CI:0.070-0.907, P=0.035), respectively, compared to the high-frequency group. Furthermore, regarding the frequency of HIV self-testing in the past year, as HIV testing frequency decreased, there was an increase in the frequency of HIV self-testing in the past year (low-frequency group OR=5.664, 95%CI:1.313-24.428, P=0.020) (medium-frequency group OR=5.087. 95%CI:1.082-23.926, P=0.039).

Conclusion

MSM who engage in higher-risk sexual behaviors are more likely to undergo regular and frequent HIV testing, and they are more proactive in using PrEP/PEP for HIV prevention. Compared with MSM with higher frequency of regular HIV testing, MSM with lower frequency of HIV testing showed higher rates of self-testing.

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目的

探讨HIV检测频率与HIV暴露前/后预防药物使用的关联。

方法

基于在广西五个城市（南宁、柳州、桂林、玉林和北海）开展的男男性行为者（MSM）随访队列，运用基于群组轨迹模型（group-based trajectory model, GBTM）识别MSM随访期间每三个月的HIV检测频率发展轨迹中可能存在相似的发展轨迹亚组，使用无序多分类logistic回归分析MSM的HIV检测频率发展轨迹组的相关因素及发展轨迹组与HIV暴露前/后预防药物使用的关联。

结果

共有327名MSM纳入分析，年龄为27.722±8.137岁。基于最优模型评价指标贝叶斯信息准则等，GBTM识别出3组HIV检测发展轨迹组，分别为低频率HIV检测组、中频率HIV检测组、高频率HIV检测组。相比于低频率HIV检测组，高频率HIV检测组MSM的HIV暴露前预防药物使用率（9.49% vs.55.56%）（χ2=32.02, P<0.001）、HIV暴露后预防药物使用率（17.39% vs. 44.44%）较高（χ2=8.19, P<0.017）。控制相关混杂因素发现，相比于高频率HIV检测组，低频率HIV检测组和中频率HIV检测组的MSM使用HIV暴露前预防药物的OR=0.153（95%CI：0.047~0.501, P=0.002）和OR=0.251（95%CI：0.070~0.907, P=0.035）。而在最近一年HIV自我检测频率方面，随着HIV检测频率的降低，HIV自我检测频率增多（低频率HIV检测组OR=5.664, 95%CI：1.313~24.428, P=0.020）（中频率HIV检测组 OR=5.087. 95%CI：1.082~23.926, P=0.039）。

结论

有更多高风险性行为的MSM表现出定期和频繁的HIV检测模式，并且更积极地利用PrEP/PEP来预防HIV。与定期HIV检测频率较高的MSM相比，HIV检测频率较低的MSM表现出更高的自我检测使用率。

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宁传艺，email:
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梁银霞（1997—），女，硕士，护师，研究方向：公共卫生护理

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梁银霞（1997—），女，硕士，护师，研究方向：公共卫生护理

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梁银霞（1997—），女，硕士，护师，研究方向：公共卫生护理

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Scientific Reports, 2023, 13(1): 554., articleTitle=Awareness and use of HIV pre-exposure prophylaxis and factors associated with awareness among MSM in Beijing, China, refAbstract=null), Reference(id=1241102753578152847, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735848828975, doi=null, pmid=null, pmcid=null, year=2021, volume=42, issue=10, pageStart=1840, pageEnd=1845, url=null, language=null, rfNumber=[23], rfOrder=35, authorNames=杨雪, 李杰, 王博, journalName=中华流行病学杂志, refType=null, unstructuredReference=杨雪，李杰，王博，等．男男性行为者对HIV非职业暴露后预防的认知及相关因素分析[J]．中华流行病学杂志，2021，42（10）：1840-1845., articleTitle=男男性行为者对HIV非职业暴露后预防的认知及相关因素分析, refAbstract=null), Reference(id=1241102753695593365, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735848828975, doi=null, pmid=null, pmcid=null, year=2021, volume=42, issue=10, pageStart=1840, pageEnd=1845, url=null, language=null, rfNumber=[23], rfOrder=36, authorNames=Yang X, Li J, Wang B, journalName=Chinese Journal of Epidemiology, refType=null, unstructuredReference=Yang X, Li J, Wang B, et al. 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Chinese Journal of Epidemiology, 2021, 42(10): 1840-1845., articleTitle=Cognition and related factors on the use of HIV non-occupational post-exposure prevention among men who have sex with men, refAbstract=null), Reference(id=1241102753796256665, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735848828975, doi=null, pmid=null, pmcid=null, year=2023, volume=29, issue=11, pageStart=1167, pageEnd=1171, url=null, language=null, rfNumber=[24], rfOrder=37, authorNames=徐杰, 张广, 董薇, journalName=中国艾滋病性病, refType=null, unstructuredReference=徐杰，张广，董薇．我国艾滋病病毒暴露前后预防措施的推广应用[J]．中国艾滋病性病，2023，29（11）：1167-1171., articleTitle=我国艾滋病病毒暴露前后预防措施的推广应用, refAbstract=null), Reference(id=1241102753909502875, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735848828975, doi=null, pmid=null, pmcid=null, year=2023, volume=29, issue=11, pageStart=1167, pageEnd=1171, url=null, language=null, rfNumber=[24], rfOrder=38, authorNames=Xu J, Zhang G, Dong W, journalName=Chinese Journal of AIDS & STD, refType=null, unstructuredReference=Xu J, Zhang G, Dong W. Promotion and application of preventive measures before and after HIV exposure inChina[J]. Chinese Journal of AIDS & STD, 2023, 29(11): 1167-1171., articleTitle=Promotion and application of preventive measures before and after HIV exposure inChina, refAbstract=null)], funds=[Fund(id=1241102746443641501, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735848828975, awardId=2023GXNSFFA026007, language=CN, fundingSource=广西自然科学基金项目杰出青年科学项目(2023GXNSFFA026007), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241102737576882379, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735848828975, xref=1., ext=[AuthorCompanyExt(id=1241102737581076685, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735848828975, companyId=1241102737576882379, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530007, China), AuthorCompanyExt(id=1241102737589465294, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735848828975, companyId=1241102737576882379, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.广西医科大学第二附属医院，广西 南宁 530007)]), AuthorCompany(id=1241102737685934293, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735848828975, xref=2., ext=[AuthorCompanyExt(id=1241102737694322903, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735848828975, companyId=1241102737685934293, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.广西医科大学护理学院)]), AuthorCompany(id=1241102739372044520, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735848828975, xref=3., ext=[AuthorCompanyExt(id=1241102739376238825, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735848828975, companyId=1241102739372044520, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.广西医科大学公共卫生学院)]), AuthorCompany(id=1241102739506262258, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735848828975, xref=4., ext=[AuthorCompanyExt(id=1241102739518845173, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735848828975, companyId=1241102739506262258, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=4.南宁市疾病预防控制中心)]), AuthorCompany(id=1241102739611119869, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735848828975, xref=5., ext=[AuthorCompanyExt(id=1241102739619508479, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735848828975, companyId=1241102739611119869, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=5.广西艾滋病防治研究重点实验室)])], figs=[ArticleFig(id=1241102745135018559, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735848828975, language=EN, label=Fig.1, caption=The grouping of HIV testing development trajectories among MSM and the distribution of MSM within the trajectory groups, figureFileSmall=Dm2EJn5gc+MGlnZJqNbNHA==, figureFileBig=65qoKKcbHQkwhaed1XyJRg==, tableContent=null), ArticleFig(id=1241102745260847689, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735848828975, language=CN, label=图1, caption=MSM的HIV检测发展轨迹分组及轨迹组内MSM的分布情况, figureFileSmall=Dm2EJn5gc+MGlnZJqNbNHA==, figureFileBig=65qoKKcbHQkwhaed1XyJRg==, tableContent=null), ArticleFig(id=1241102745516700253, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735848828975, language=EN, label=Table 1, caption=

Basic characteristics of the study subjects [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量描述变量描述
年龄（）27.722±8.137最近6个月性伴个数
居住地0~1131(40.06)
南宁市99(30.28)2~5162(49.54)
广西自治区内（除南宁市）194(59.33)>534(10.40)
广西自治区内外34(10.40)最近6个月有无毒品后性行为
民族从未248(75.84)
汉族212(64.83)极少51(15.60)
壮族98(29.97)经常20(6.12)
其他17(5.20)每次8(2.45)
文化程度最近6个月是否有保护性行为
初中及以下16(4.89)否143(49.65)
高中/中专57(17.43)是145(50.35)
大专111(33.94)最近6个月有无HIV阳性伴侣
本科127(38.84)否230(70.34)
研究生及以上16(4.89)是43(13.15)
月收入（元）不知道54(16.51)
<1 50059(18.04)最近6个月是否有安全套破裂
1 500~3 00068(20.80)否237(72.48)
3 001~5 00096(29.36)是90(27.52)
5 001~8 00079(24.16)是否听说过PrEP
>8 00125(7.65)是256(78.29)
婚姻情况否71(21.71)
未婚293(89.60)是否听过PEP
已婚23(7.03)是320(97.86)
离异或丧偶11(3.36)否7(2.14)
性取向研究期间使用过PrEP
同性恋221(67.58)是45(13.76)
双性恋84(25.69)否282(86.24)
不确定22(6.73)研究期间是否使用过PEP
最近一年HIV自我检测频率是65(19.88)
0169(51.68)否262(80.12)
1~2117(35.78)
≥341(12.54)
), ArticleFig(id=1241102745608974947, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735848828975, language=CN, label=表1, caption=

研究对象基本特征[n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量描述变量描述
年龄（）27.722±8.137最近6个月性伴个数
居住地0~1131(40.06)
南宁市99(30.28)2~5162(49.54)
广西自治区内（除南宁市）194(59.33)>534(10.40)
广西自治区内外34(10.40)最近6个月有无毒品后性行为
民族从未248(75.84)
汉族212(64.83)极少51(15.60)
壮族98(29.97)经常20(6.12)
其他17(5.20)每次8(2.45)
文化程度最近6个月是否有保护性行为
初中及以下16(4.89)否143(49.65)
高中/中专57(17.43)是145(50.35)
大专111(33.94)最近6个月有无HIV阳性伴侣
本科127(38.84)否230(70.34)
研究生及以上16(4.89)是43(13.15)
月收入（元）不知道54(16.51)
<1 50059(18.04)最近6个月是否有安全套破裂
1 500~3 00068(20.80)否237(72.48)
3 001~5 00096(29.36)是90(27.52)
5 001~8 00079(24.16)是否听说过PrEP
>8 00125(7.65)是256(78.29)
婚姻情况否71(21.71)
未婚293(89.60)是否听过PEP
已婚23(7.03)是320(97.86)
离异或丧偶11(3.36)否7(2.14)
性取向研究期间使用过PrEP
同性恋221(67.58)是45(13.76)
双性恋84(25.69)否282(86.24)
不确定22(6.73)研究期间是否使用过PEP
最近一年HIV自我检测频率是65(19.88)
0169(51.68)否262(80.12)
1~2117(35.78)
≥341(12.54)
), ArticleFig(id=1241102745743192687, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735848828975, language=EN, label=Table 2, caption=

2~5 category trajectory model parameters

, figureFileSmall=null, figureFileBig=null, tableContent=
分组数多项式函数类型aBIC平均后验概率（%）类别概率
211-1 784.89096.128/94.38184.814/15.186
222-1 790.49196.600/91.67984.489/15.511
233-1 797.50796.602/91.68084.491/15.509
3111-1 780.42192.134/79.599/92.97773.875/19.753/6.373
3222-1 784.43494.542/85.093/94.33978.537/16.626/4.837
3333-1 794.88294.739/83.644/94.86478.180/16.958/4.862
42222-1 781.13192.894/79.944/87.625/95.13074.054/17.710/3.598/4.638
43 333-1 792.80881.791/92.060/91.088/96.34119.084/72.285/3.707/4.924
522 222-1 769.85391.013/92.947/81.500/99.520/94.6443.077/73.336/18.297/1.709/3.581
533 333-1 783.54781.767/91.642/92.977/88.511/93.44618.430/70.342/3.853/3.098/4.277
), ArticleFig(id=1241102745873216116, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735848828975, language=CN, label=表2, caption=

2～5类别轨迹模型参数

, figureFileSmall=null, figureFileBig=null, tableContent=
分组数多项式函数类型aBIC平均后验概率（%）类别概率
211-1 784.89096.128/94.38184.814/15.186
222-1 790.49196.600/91.67984.489/15.511
233-1 797.50796.602/91.68084.491/15.509
3111-1 780.42192.134/79.599/92.97773.875/19.753/6.373
3222-1 784.43494.542/85.093/94.33978.537/16.626/4.837
3333-1 794.88294.739/83.644/94.86478.180/16.958/4.862
42222-1 781.13192.894/79.944/87.625/95.13074.054/17.710/3.598/4.638
43 333-1 792.80881.791/92.060/91.088/96.34119.084/72.285/3.707/4.924
522 222-1 769.85391.013/92.947/81.500/99.520/94.6443.077/73.336/18.297/1.709/3.581
533 333-1 783.54781.767/91.642/92.977/88.511/93.44618.430/70.342/3.853/3.098/4.277
), ArticleFig(id=1241102746003239549, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735848828975, language=EN, label=Table 3, caption=

Characteristics of different HIV testing trajectories[n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量低频率HIV检测组中频率HIV检测组高频率HIV检测组χ2值P
居住地χ2=4.760.313
南宁市73(28.85)17(30.36)9(50.00)
广西自治区内（除南宁市）152(60.08)33(58.93)9(50.00)
广西自治区外28(11.07)6(10.71)0(0.00)
民族-0.026
汉族169(66.80)37(66.07)6(33.33)
壮族70(27.67)16(28.57)12(66.67)
其他14(5.53)3(5.36)0(0.00)
文化程度-0.271
初中及以下16(6.32)0(0.00)0(0.00)
高中/中专44(17.39)9(16.07)4(22.22)
大专85(33.60)20(35.71)6(33.33)
本科99(39.13)21(37.50)7(38.89)
研究生及以上9(3.56)6(10.71)1(5.56)
月收入（元）-0.312
<1 50044(17.39)9(16.07)6(33.33)
1 500~3 00057(22.53)8(14.29)3(16.67)
3 001~5 00072(28.46)18(32.14)6(33.33)
5 001~8 00063(24.90)15(26.79)1(5.56)
>8 00117(6.72)6(10.71)2(11.11)
婚姻情况-0.835
未婚224(88.54)51(91.07)18(100.00)
已婚19(7.51)4(7.14)0(0.00)
离异或丧偶10(3.95)1(1.79)0(0.00)
性取向-0.919
同性恋173(68.38)35(62.50)13(72.22)
双性恋63(24.90)17(30.36)4(22.22)
不确定17(6.72)4(7.14)1(5.56)
最近一年HIV自我检测频率χ2=25.70<0.001
0143(56.52)20(35.71)6(33.33)
1~286(33.99)27(48.21)4(22.22)
≥324(9.49)9(16.07)8(44.44)
最近6个月性伴个数χ2=19.39<0.001
0~1113(44.66)16(28.57)2(11.11)
2~5120(47.43)32(57.14)10(55.56)
>520(7.91)8(14.29)6(33.33)
最近6个月有无毒品后性行为-0.013
从未201(79.45)38(67.86)9(50.00)
极少33(13.04)13(23.21)5(27.78)
经常13(5.14)5(8.93)2(11.11)
每次6(2.37)0(0.00)2(11.11)
最近6个月是否无保护性行为χ2=9.190.010
是102(46.79)28(53.85)15(83.33)
否116(53.21)24(46.15)3(16.67)
最近6个月有无HIV阳性伴侣-0.004
是25(9.88)11(19.64)7(38.89)
否182(71.94)40(71.43)8(44.44)
不知道46(18.18)5(8.93)3(16.67)
最近6个月是否有安全套破裂χ2=2.880.237
是66(26.09)16(28.57)8(44.44)
否187(73.91)40(71.43)10(55.56)
是否听说过PrEPχ2=3.570.168
是194(76.68)49(87.50)13(72.22)
否59(23.32)7(12.50)5(27.78)
是否听过PEP-1.000
是247(97.63)55(98.21)18(100.00)
否6(2.37)1(1.79)0(0.00)
研究期间是否使用PrEPχ2=32.02<0.001
是24(9.49)11(19.64)10(55.56)
否229(90.51)45(80.36)8(44.44)
研究期间是否使用过PEPχ2=8.190.017
是44(17.39)13(23.21)8(44.44)
否209(82.61)43(76.79)10(55.56)
), ArticleFig(id=1241102746103902853, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735848828975, language=CN, label=表3, caption=

不同HIV检测频次发展轨迹组特征[n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量低频率HIV检测组中频率HIV检测组高频率HIV检测组χ2值P
居住地χ2=4.760.313
南宁市73(28.85)17(30.36)9(50.00)
广西自治区内（除南宁市）152(60.08)33(58.93)9(50.00)
广西自治区外28(11.07)6(10.71)0(0.00)
民族-0.026
汉族169(66.80)37(66.07)6(33.33)
壮族70(27.67)16(28.57)12(66.67)
其他14(5.53)3(5.36)0(0.00)
文化程度-0.271
初中及以下16(6.32)0(0.00)0(0.00)
高中/中专44(17.39)9(16.07)4(22.22)
大专85(33.60)20(35.71)6(33.33)
本科99(39.13)21(37.50)7(38.89)
研究生及以上9(3.56)6(10.71)1(5.56)
月收入（元）-0.312
<1 50044(17.39)9(16.07)6(33.33)
1 500~3 00057(22.53)8(14.29)3(16.67)
3 001~5 00072(28.46)18(32.14)6(33.33)
5 001~8 00063(24.90)15(26.79)1(5.56)
>8 00117(6.72)6(10.71)2(11.11)
婚姻情况-0.835
未婚224(88.54)51(91.07)18(100.00)
已婚19(7.51)4(7.14)0(0.00)
离异或丧偶10(3.95)1(1.79)0(0.00)
性取向-0.919
同性恋173(68.38)35(62.50)13(72.22)
双性恋63(24.90)17(30.36)4(22.22)
不确定17(6.72)4(7.14)1(5.56)
最近一年HIV自我检测频率χ2=25.70<0.001
0143(56.52)20(35.71)6(33.33)
1~286(33.99)27(48.21)4(22.22)
≥324(9.49)9(16.07)8(44.44)
最近6个月性伴个数χ2=19.39<0.001
0~1113(44.66)16(28.57)2(11.11)
2~5120(47.43)32(57.14)10(55.56)
>520(7.91)8(14.29)6(33.33)
最近6个月有无毒品后性行为-0.013
从未201(79.45)38(67.86)9(50.00)
极少33(13.04)13(23.21)5(27.78)
经常13(5.14)5(8.93)2(11.11)
每次6(2.37)0(0.00)2(11.11)
最近6个月是否无保护性行为χ2=9.190.010
是102(46.79)28(53.85)15(83.33)
否116(53.21)24(46.15)3(16.67)
最近6个月有无HIV阳性伴侣-0.004
是25(9.88)11(19.64)7(38.89)
否182(71.94)40(71.43)8(44.44)
不知道46(18.18)5(8.93)3(16.67)
最近6个月是否有安全套破裂χ2=2.880.237
是66(26.09)16(28.57)8(44.44)
否187(73.91)40(71.43)10(55.56)
是否听说过PrEPχ2=3.570.168
是194(76.68)49(87.50)13(72.22)
否59(23.32)7(12.50)5(27.78)
是否听过PEP-1.000
是247(97.63)55(98.21)18(100.00)
否6(2.37)1(1.79)0(0.00)
研究期间是否使用PrEPχ2=32.02<0.001
是24(9.49)11(19.64)10(55.56)
否229(90.51)45(80.36)8(44.44)
研究期间是否使用过PEPχ2=8.190.017
是44(17.39)13(23.21)8(44.44)
否209(82.61)43(76.79)10(55.56)
), ArticleFig(id=1241102746208760460, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735848828975, language=EN, label=Table 4, caption=

Disordered multiclassification regression analysis using PrEP/PEP for MSM groups with different HIV test trajectas

, figureFileSmall=null, figureFileBig=null, tableContent=
变量高频率HIV检测组低频率HIV检测组中频率HIV检测组
OR值（95%CI）POR值（95%CI）P
民族1.0000.401(0.164~0.982)0.0450.406(0.155~1.066)0.067
最近6个月性伴个数
0~1个1.00014.233(2.167~93.486)0.0065.258(0.717~38.544)0.102
2～5个4.071(1.069~15.504)0.0402.871(0.678~12.160)0.152
>5个1.0001.000
最近6个月有无阳性性伴
是1.0000.388(0.067~2.250)0.2911.293(0.183~9.139)0.797
否0.830(0.166~4.140)0.8201.779(0.293~10.797)0.531
不知道1.0001.000
最近一年自我检测频率
0次1.0004.950(1.341~18.267)0.0162.087(0.500~8.712)0.313
1～2次5.664(1.313~24.428)0.0205.087(1.082~23.926)0.039
≥3次1.0001.000
研究期间PrEP使用情况
　　　　　
是1.0000.153(0.047~0.501)0.0020.251(0.070~0.907)0.035
否1.0001.000
), ArticleFig(id=1241102746301035153, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102735848828975, language=CN, label=表4, caption=

MSM不同HIV检测发展轨迹与使用PrEP/PEP使用的无序多分类回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量高频率HIV检测组低频率HIV检测组中频率HIV检测组
OR值（95%CI）POR值（95%CI）P
民族1.0000.401(0.164~0.982)0.0450.406(0.155~1.066)0.067
最近6个月性伴个数
0~1个1.00014.233(2.167~93.486)0.0065.258(0.717~38.544)0.102
2～5个4.071(1.069~15.504)0.0402.871(0.678~12.160)0.152
>5个1.0001.000
最近6个月有无阳性性伴
是1.0000.388(0.067~2.250)0.2911.293(0.183~9.139)0.797
否0.830(0.166~4.140)0.8201.779(0.293~10.797)0.531
不知道1.0001.000
最近一年自我检测频率
0次1.0004.950(1.341~18.267)0.0162.087(0.500~8.712)0.313
1～2次5.664(1.313~24.428)0.0205.087(1.082~23.926)0.039
≥3次1.0001.000
研究期间PrEP使用情况
　　　　　
是1.0000.153(0.047~0.501)0.0020.251(0.070~0.907)0.035
否1.0001.000
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广西男男性行为者不同HIV检测轨迹使用HIV暴露前/后预防药物的影响因素
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梁银霞 1 , 彭洪滨 2 , 罗霞 2 , 莫金莉 1 , 田韦毅 2 , 王敏 1 , 张云 2 , 岑平 3, 4 , 宁传艺 2, 5
现代预防医学 | 疾病预防控制 2024,51(14): 2634-2641
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现代预防医学 | 疾病预防控制 2024, 51(14): 2634-2641
广西男男性行为者不同HIV检测轨迹使用HIV暴露前/后预防药物的影响因素
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梁银霞1, 彭洪滨2, 罗霞2, 莫金莉1, 田韦毅2, 王敏1, 张云2, 岑平3, 4, 宁传艺2, 5
作者信息
  • 1.广西医科大学第二附属医院，广西 南宁 530007
  • 2.广西医科大学护理学院
  • 3.广西医科大学公共卫生学院
  • 4.南宁市疾病预防控制中心
  • 5.广西艾滋病防治研究重点实验室

    • 梁银霞（1997—），女，硕士，护师，研究方向：公共卫生护理

通讯作者:

宁传艺，email:
Trajectories of HIV testing frequency and its association with pre-/post-exposure prophylaxis use among men who have sex with men, Guangxi, China
Yin-xia LIANG1, Hong-bin PENG2, Xia LUO2, Jin-li MO1, Wei-yi TIAN2, Min WANG1, Yun ZHANG2, Ping CEN3, 4, Chuan-yi NING2, 5
Affiliations
  • The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530007, China
出版时间: 2024-07-25 doi: 10.20043/j.cnki.MPM.202404106
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摘要
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目的

探讨HIV检测频率与HIV暴露前/后预防药物使用的关联。

方法

基于在广西五个城市（南宁、柳州、桂林、玉林和北海）开展的男男性行为者（MSM）随访队列，运用基于群组轨迹模型（group-based trajectory model, GBTM）识别MSM随访期间每三个月的HIV检测频率发展轨迹中可能存在相似的发展轨迹亚组，使用无序多分类logistic回归分析MSM的HIV检测频率发展轨迹组的相关因素及发展轨迹组与HIV暴露前/后预防药物使用的关联。

结果

共有327名MSM纳入分析，年龄为27.722±8.137岁。基于最优模型评价指标贝叶斯信息准则等，GBTM识别出3组HIV检测发展轨迹组，分别为低频率HIV检测组、中频率HIV检测组、高频率HIV检测组。相比于低频率HIV检测组，高频率HIV检测组MSM的HIV暴露前预防药物使用率（9.49% vs.55.56%）（χ2=32.02, P<0.001）、HIV暴露后预防药物使用率（17.39% vs. 44.44%）较高（χ2=8.19, P<0.017）。控制相关混杂因素发现，相比于高频率HIV检测组，低频率HIV检测组和中频率HIV检测组的MSM使用HIV暴露前预防药物的OR=0.153（95%CI：0.047~0.501, P=0.002）和OR=0.251（95%CI：0.070~0.907, P=0.035）。而在最近一年HIV自我检测频率方面，随着HIV检测频率的降低，HIV自我检测频率增多（低频率HIV检测组OR=5.664, 95%CI：1.313~24.428, P=0.020）（中频率HIV检测组 OR=5.087. 95%CI：1.082~23.926, P=0.039）。

结论

有更多高风险性行为的MSM表现出定期和频繁的HIV检测模式，并且更积极地利用PrEP/PEP来预防HIV。与定期HIV检测频率较高的MSM相比，HIV检测频率较低的MSM表现出更高的自我检测使用率。

HIV检测  /  男男性行为者  /  HIV暴露前/后预防药物  /  基于群组轨迹模型
Objective

To explore the association between HIV testing frequency and pre - / post-exposure prophylaxis (PrEP/PEP) use among individuals at risk of HIV.

Methods

Utilizing a follow-up cohort of men who have sex with men (MSM) conducted in five cities (Nanning, Liuzhou, Guilin, Yulin, and Beihai) in Guangxi Province, China, we employed a group-based trajectory model (GBTM) to analyze the developmental trajectories of HIV testing frequency among MSM. Furthermore, we conducted logistic regression analysis to examine the factors associated with different trajectory groups of HIV testing frequency and their relationship with the utilization of PrEP/PEP before and after HIV exposure.

Results

The analysis included a total of 327 MSM participants, with an average age of 27.722±8.137 years. Based on evaluation criteria such as the Bayesian information criterion, GBTM identified three trajectory groups of HIV testing frequency: low-frequency group (73.87%), medium-frequency group (19.75%), and high-frequency group (6.37%). Comparing to the low-frequency group, MSM in the high-frequency group exhibited higher utilization rates of PrEP (9.49% vs. 55.56%) (χ2=32.02, P<0.001) and PEP (17.39% vs. 44.44%) (χ2=8.19, P<0.017). After controlling for relevant confounding factors, the low-frequency group and medium-frequency group showed of the used PrEP by OR=0.153 (95%CI:0.047-0.501, P=0.002) and OR=0.251 (95%CI:0.070-0.907, P=0.035), respectively, compared to the high-frequency group. Furthermore, regarding the frequency of HIV self-testing in the past year, as HIV testing frequency decreased, there was an increase in the frequency of HIV self-testing in the past year (low-frequency group OR=5.664, 95%CI:1.313-24.428, P=0.020) (medium-frequency group OR=5.087. 95%CI:1.082-23.926, P=0.039).

Conclusion

MSM who engage in higher-risk sexual behaviors are more likely to undergo regular and frequent HIV testing, and they are more proactive in using PrEP/PEP for HIV prevention. Compared with MSM with higher frequency of regular HIV testing, MSM with lower frequency of HIV testing showed higher rates of self-testing.

HIV testing  /  Men who have sex with men  /  HIV Pre-/post-exposure prophylaxis  /  Group-based trajectory model
梁银霞, 彭洪滨, 罗霞, 莫金莉, 田韦毅, 王敏, 张云, 岑平, 宁传艺. 广西男男性行为者不同HIV检测轨迹使用HIV暴露前/后预防药物的影响因素. 现代预防医学, 2024 , 51 (14) : 2634 -2641 . DOI: 10.20043/j.cnki.MPM.202404106
Yin-xia LIANG, Hong-bin PENG, Xia LUO, Jin-li MO, Wei-yi TIAN, Min WANG, Yun ZHANG, Ping CEN, Chuan-yi NING. Trajectories of HIV testing frequency and its association with pre-/post-exposure prophylaxis use among men who have sex with men, Guangxi, China[J]. Modern Preventive Medicine, 2024 , 51 (14) : 2634 -2641 . DOI: 10.20043/j.cnki.MPM.202404106
正文
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人类免疫缺陷病毒（Human Immunodeficiency Virus, HIV）感染在全球范围内仍然是一项严重的公共卫生挑战[1]。男男性行为者（Men who have sex with men, MSM）是我国HIV感染的高危人群之一[2]。截至2022年底，我国（不含港、澳、台地区）报告现存活艾滋病患者122.3万例，其中男性同性性传播为25.6%，感染比例逐年上升[3]。尽管HIV检测、HIV暴露前预防药物（HIV Pre-exposure Prophylaxis, PrEP）和HIV暴露后预防药物（nonoccupational Prophylaxis, nPEP）的使用对于控制HIV传播和提供早期治疗至关重要[4-6]，但有关MSM HIV检测频率和HIV预防药物使用的关联性的研究还相对有限。
基于群组轨迹模型（group-based trajectory model, GBTM）是近年来提出的研究变量随时间变化的发展轨迹的一种方法，它在处理纵向数据中具有一些独特优势，可识别总体中不同的发展轨迹，并研究轨迹与预测因素或结果间的联系[7]。因此，本研究基于《广西男男性行为人群HIV预防药物的使用及与性行为关联性的前瞻性队列研究》这一项队列研究，探索MSM的HIV检测频率的影响因素及其与PrEP/PEP使用之间的关联性。为制定更有效的HIV防控策略和提供更精准的干预措施提供科学依据，从而降低MSM的HIV感染风险，并促进艾滋病早期诊断和治疗的实施。
1　对象与方法
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1.1　研究对象
纳入标准：（1）生理男性；（2）过去6个月与男性发生过性行为；（3）年龄≥18岁；（4）HIV和梅毒快速检测抗体均为阴性；（5）过去一年进行过HIV检测；（6）提供知情同意者。排除标准：（1）有明显的心理、精神疾病或智力障碍，不能完成调查者；（2）有语言表达及交流障碍不能配合完成检测者。本研究经广西医科大学伦理委员会批准（编号：20210173）。
1.2　研究方法
2021年9月至2023年2月，以广西南宁市、桂林市、柳州市、玉林市及北海市的MSM社区组织场所作为研究现场。基线时，在当地MSM社区组织的协助下通过方便抽样招募研究对象；获得MSM的知情同意之后，由统一培训的研究人员对符合纳入标准的MSM进行一对一面对面或线上匿名访谈并填写调查问卷建立队列，并每三个月进行随访。
1.3　调查内容
基线调查内容：（1）社会人口学特征，包括年龄、居住地、民族、教育水平、每个月平均可支配金额等；（2）性行为特征，包括性伴个数，最近6个月是否有酒后性行为、毒品后性行为、HIV阳性伴侣等；（3）HIV检测情况，包括HIV现场检测频率、HIV自我检测频率等；（4）HIV暴露前/后预防用药的情况，包括最近6个月PEP、PrEP的知晓情况和使用情况。随访调查内容：（1）HIV检测情况，包括最近3个月HIV现场检测频率、HIV自我检测频率等；（2）HIV暴露前/后预防用药的情况，包括最近3个月PrEP/PEP用药的情况等。
1.4　统计学方法
采用EpiData 3.1建立调查问卷数据库，并进行一致性检验；使用SAS 9.4软件进行数据分析。通过GBTM识别MSM不同的HIV检测频率发展轨迹。由于HIV检测频率不是正态分布的数值变量，选择删截正态分布模型（censored normal model, CNORM）进行拟合。首先，结合贝叶斯信息准则（Bayesian information criteria, BIC）绝对值最小化原则确定待选的随访期间HIV检测频率轨迹组数；然后根据平均后验概率分配（Average posterior probability of assignment, AvePP）>70.0%进一步确定随访期间HIV检测频率轨迹组数；最后，在保证每组观察对象例数占全部例数≥5%的基础上，确定最终的随访期间HIV检测频率轨迹组数。同时结合每组样本量合理、符合理论解释的模型即为最优模型[7]。以最优分组作为因变量，通过χ2检验比较不同亚组间MSM的特征及与PrEP/PEP使用的差异；以“民族”作为协变量，并将单因素分析中P<0.01的变量纳入无序多分类logistic回归分析比较不同亚组间MSM的特征及与PrEP/PEP使用的关联性。检验水准α=0.05。
2　结果
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2.1　基本情况
本研究共纳入327名MSM，平均年龄（27.722±8.137）岁。有一半的MSM最近一年进行过HIV自我检测；基线有54名MSM既往使用过PEP，19名MSM既往使用过PrEP；研究期间共观察到有45人使用过PrEP，65人使用过PEP。详见表1。
2.2　不同HIV检测频率发展轨迹的GBTM模型分析
通过GBTM进行了2~5组的模型拟合，其中3组线性函数模型BIC值最低为-1 780.421模型拟合最优。根据2019年WHO的HIV检测指南建议有性行为的MSM建议每3～6个月进行一次HIV检测[8]，2020年我国《艾滋病病毒暴露后预防技术指南（试用）》建议服用PEP后的MSM至少3个月内进行3次HIV检测[6]，2023年我国《中国HIV暴露前预防用药专家共识》建议有HIV高危行为风险的MSM至少3～4个月进行1次HIV检测[5]。因此本研究将3组分别命名为低频率HIV检测组（73.88%，AvePP=92.13）、中频率HIV检测组（19.75%，AvePP=79.60）、高频率HIV检测组（6.37%，AvePP=92.98）。见表2和图1。
2.3　不同HIV检测频率发展轨迹组的特征
高频率HIV检测组的MSM在壮族、最近6个月男性性伴>5个、最近6个月有毒品后性行为、最近6个月有过阳性性伴、最近6个月有过安全套破裂/滑脱/被恶意摘套、使用HIV暴露前预防药和HIV暴露后预防药的占比均高于低、中频率HIV检测组（P<0.05）。而在最近一年自我检测频率这一方面，低、中频率HIV组最近一年进行1～2次自我HIV检测、最近6个月每次戴套的人数占比高于高频率HIV检测组（P<0.05）。详见表3。
2.4　HIV检测频率发展轨迹与PrEP/PEP使用关系的无序多分类logistic回归分析
无序多分类logistic回归分析表明，在最近6个月性伴个数方面，以高频率HIV检测组和最近6个月性伴个数>5个为参照，低频率HIV检测组最近6个月只有0~1和2~5个性伴分别是高频率检测组14.233（95%CI:2.167~93.486, P=0.006）、4.071（95%CI:1.069~15.504, P=0.040）倍。而在最近一年HIV自我检测频率方面，中、低HIV检测频率组最近一年进行过1～2次自我HIV检测分别是高频率HIV检测的5.087（95%CI：1.082~23.926, P=0.039）、5.664（95%CI：1.313~24.428,P=0.020）倍。无序多分类logistic回归分析结果显示，与高频率HIV检测组相比，中、低频率HIV检测组的MSM在研究期间PrEP的使用逐渐降低（OR=0.256，95%CI：0.072~0.916，P=0.036）（OR=0.159，95%CI：0.049 ~0.514，P=0.002）。见表4。
3　讨论
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在全球范围内，HIV检测已成为终结HIV流行的重要策略[9]，近年来HIV检测覆盖率不断提高，与政府及卫生部门开展MSM健康教育、扩大HIV检测、扩大抗病毒治疗、提高MSM社会组织在艾滋病防治工作中的参与度和积极性有关。定期进行HIV检测是及时发现HIV感染者的最佳方法，但对频繁、自愿检测者的特点知之甚少[10]。本研究通过GBTM模型识别MSM中HIV检测频率的不同的发展轨迹，即高频率HIV检测组、中频率HIV检测组、低频率HIV检测组；并研究这三个组使用PrEP/PEP的影响因素。
本研究发现高频率HIV检测组的MSM与毒品使用、无保护性行为、有HIV阳性性伴等有关，与北京、镇江市的研究结果一致[11-12]；英国的研究也显示MSM更频繁的HIV检测与多性伴和无保护性行为相关[13]。这可能是因为MSM将HIV检测理解为对其性健康的常规检查，对于频繁进行HIV检测的MSM来说，检测的动机是意识到及时治疗的益处[14]。但也有研究表明肛交安全套使用与HIV检测频率无明显相关[15]。因此，HIV检测虽然可以在早发现、早治疗中起到积极作用，但是否能降低高危行为，有待研究。无序多分类logistic回归分析发现多性伴是高频率HIV检测组的关键危险因素，这与JIAO等的研究结果一致[10]。这提示公共卫生部门应注意若已确定的高危人群报告的HIV检测率较高，也许可以采取有针对性的行为干预或药物预防。
我们的研究还发现，中、低HIV检测频率组最近一年进行过1～2次自我HIV检测分别是高频率HIV检测的5.087、5.664倍，随着HIV检测频率的降低，HIV自我检测频率反而升高，提示低频率HIV检测组的MSM更愿意接受HIV自我检测。这可能与他们害怕性取向暴露受到歧视从而避免必要的检查或治疗有关[16]。这个结果也提示HIV自我检测作为一种新的HIV检测方式显示出了良好的接受度和巨大的发展潜力，未来可以有效扩大其在MSM群体中的筛查作用[17]。后续应加大开展HIV检测的干预力度，提高MSM的检测意识，促进早发现早治疗目标的实现。
在本研究中MSM的PEP和PrEP的知晓率高，但是使用率低，与刘思辰等的研究结果一致[18-20]，提示今后推广PEP和PrEP应注重人群差异，加强针对性宣传教育，提高HIV暴露前/后预防服务利用率。HIV检测、PrEP和PEP是目前预防控制HIV传播的重要方式[21]。
我国的一项研究结果提示接受过HIV检测的MSM的PrEP知晓率是未经过HIV检测的MSM的2.647倍，这些发现还支持使用HIV检测作为HIV生物医学预防和行为预防的切入点[22]。本研究发现高频率HIV检测组的MSM的PrEP和PEP使用率高于中、低频率HIV检测组的MSM，这与国内的研究结果一致[20,23]。控制混杂因素后，中、低频率HIV检测组PrEP的使用仅为高频率HIV检测组的0.251倍和0.153倍，这说明高频率检测组的MSM者可能自我感知感染风险大，更积极寻求其他进一步的防控措施加强自身防护。因此，考虑到PrEP是一种相对较新的HIV预防方法，卫生部门应针对咨询提供者和同伴教育者进行PrEP教育和转诊资源的培训，并与安全套使用、伴侣检测等一起构成重点人群防护HIV感染的重要屏障[24]。这可能有助于提高高危MSM对PrEP的认识和可及性。
本研究存在一定的局限性，第一，由于研究期间观察到的使用PrEP和PEP的人数较少，不能说明HIV检测与PrEP和PEP之间的因果关系；第二，GBTM的分类中高频率HIV检测组MSM样本量较少，可能影响结果的稳定性；第三，问卷调查收集自报信息，问题敏感，存在信息偏倚；因此本研究结果的外推需谨慎。
综上所述，进行定期高频率HIV检测的MSM存在更多的高危性行为，相关的卫生部门应重点关注这类人群，并以HIV检测作为切入点加强对PEP和PrEP的宣传和推广，控制HIV在MSM中的传播。
基金
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  • 广西自然科学基金项目杰出青年科学项目(2023GXNSFFA026007)
文献
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参考文献 引证文献
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2024年第51卷第14期
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doi: 10.20043/j.cnki.MPM.202404106
  • 接收时间：2024-04-07
  • 首发时间：2026-03-18
  • 出版时间：2024-07-25
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  • 收稿日期：2024-04-07
基金
广西自然科学基金项目杰出青年科学项目(2023GXNSFFA026007)
作者信息
    1.广西医科大学第二附属医院，广西 南宁 530007
    2.广西医科大学护理学院
    3.广西医科大学公共卫生学院
    4.南宁市疾病预防控制中心
    5.广西艾滋病防治研究重点实验室

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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
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species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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