Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Oct 23, 2022
Date Accepted: Jan 11, 2023
Risk and Protective Profile of Men Who Have Sex with Men Using Mobile Voluntary HIV Counseling and Testing: A Latent Class Analysis
ABSTRACT
Background:
Mobile voluntary HIV counseling and testing (VCT) has been applied to improve outcomes in targeting risk populations and HIV positive rates for men who have sex with men (MSM). However, the HIV-positive outcome using this screening strategy has continued to decline in recent years. This may imply the unknown changes of HIV risk-taking and protective features jointly influencing the testing results. These changing patterns of key population remain unexplored.
Objective:
To identified the nuanced group classification of MSM who underwent mobile VCT using latent class analysis.
Methods:
A cross-sectional research design and purposive sampling were applied from May 21, 2019, to December 31, 2019. Participants were recruited through social networking platforms, including the most popular instant messenger application (Line app), geosocial network applications (GNS app) dedicated to MSM, and online communities. Mobile VCT was provided to them at an assigned time and place. Demographic characteristics and risk-taking and protective features of MSM were collected. Latent class analysis was used to identify discrete subgroups based on four risk-taking indicators, multiple sexual partner (MSP) and unprotected anal intercourse (UAI) within 3 months, history of recreational drug use and sexual transmitted diseases, and three protective indicators, experience of PEP and PrEP use, and regular HIV testing.
Results:
Overall, 1018 participants (mean age, 30.17 [SD=7.29] years) were included. A three-class model provided the best fit. Classes 1, 2, and 3 corresponded to highest risk (n=175, 17.2%), highest protection (n=121, 11.9%), and low risk and low protection (n=722, 70.9%), respectively. Class 1 participants were more likely to have multiple sexual partners (MSP) and unprotective anal intercourse (UAI) within three months, be older than 40 years (odds ratio [OR]: 2.197, 95% confidence interval [CI]: 1.357 to .558, p=.001), and to have HIV-positive results (OR: 5.11, 95% CI: 2.368 to 10.958, p<.001) and CD4 count less than 350 /μL (OR:17.50, 95% CI: 1.223 to 250.357, p=.035); Class 2 participants were more likely to adopt bio-medical preventions, and have a marital experience (OR: 2.55, 95% CI: 1.033 to 6.277, p=.042).
Conclusions:
LCA helped derive a classification of risk-taking and protection subgroups among MSM who underwent mobile VCT. These results may inform policies of precisely recognizing those who had higher risk-taking features of undiagnosed target groups, including MSM engaging in MSP and UAI within three months, and those older than 40 years. These results may help tailor HIV prevention and testing programs. Clinical Trial: This research did not apply the trial registration.
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