JMIR Publications

ABSTRACT

Background:

To date, non-occupational post-exposure prophylaxis (PEP) has been widely accepted as an safe and effective intervention for HIV in many countries, yet it remains an underutilized prevention strategy in China. Evidence indicated a high demand for PEP among Chinese MSM, but the uptake and access to PEP service are still limited. In an era of rapid development of web-based technology, online medical platforms in China holds great promise in facilitating PEP provision and delivery by addressing problems such as accessibility, convenience, privacy protection, and anti-discrimination by integrating online and offline resources. However, there is paucity of data concerning the uptake and outcomes of online PEP in China.

Objective:

Our study aimed to explore online PEP service delivery and assess PEP uptake and outcome through a web-based cross-sectional study.

Methods:

From January 2020 to June 2021, we conducted a retrospective web-based survey among those seeking online PEP services via the internet medical platform of "HeHealth" by using a structured questionnaire. Participants were surveyed on sociodemographic characteristics, sexual and drug-related behaviors, history of PrEP usage, and PEP uptake. Statistical analysis included descriptive analysis, Chi-squared test, and multivariable logistic regression. P values less than .05 were deemed statistically significant.

Results:

No HIV seroconversions were observed among 539 PEP users. Our sample demonstrated that a majority of participants seeking online PEP services were gay (397, 73.7%), single (470, 87.2%), having an education ＞12 years (493, 91.5%), and with an average monthly income ≥7000 RMB (50.8%). Sexual exposures accounted for 86.8% (468/539) with anal sex being most common indication (72.2%) for seeking PEP use. Among 539 participants, 327 (60.67%) sought online PEP for relatively low-risk exposures, while 212 (39.3%) were considered high-risk exposures. Nearly all (537, 99.6%) initiated PEP within 72 hours and 370 (68.7%) within 24 hours of exposure. Up to 451 (83.7%) individuals were prescribed a 3-drug regimen consisting of 3TC/TDF+DTG in 293 cases (54.4%), followed by FTC/TDF+DTG in 158 cases (29.3%). The adjusted model showed that greater odds of PrEP usage were associated with an age ≥35 years versus the age group 25-34 years (adjusted odds ratio [AOR] 2.04, 95% CI 1.24-3.37), having an education ≥ 17 years versus an education ≤12 years (AOR 3.14, 95% CI 1.29-7.62), with average monthly income at 7000-9999 RMB (AOR 2.20, 95% CI 1.05-4.62), 10000-19999 RMB (AOR 2.55, 95% CI 1.23-5.30), and ≥ 20000 RMB (AOR 2.60, 95% CI 1.09-6.23) versus ＜3000 RMB and having high-risk sexual behavior during PEP treatment (AOR 2.20, 95% CI 1.05, 3.69).

Conclusions:

Zero infection in this study demonstrated that online PEP could be a valuable risk-reduction option to improve the prevention service within China. Further research is needed to better facilitate PrEP transition among online PEP users.