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Introduction <p>In China, men who have sex with men (MSM) face a higher risk of HIV infection, while oral pre-exposure prophylaxis (PrEP) serves as an effective method of prevention. However, maintaining high adherence to PrEP remains a major challenge. This study examined longitudinal adherence trajectories, identified key influencing factors, and assessed the impact of mobile-based reminders.</p> Methods <p>A longitudinal investigation of PrEP implementation among MSM population was conducted in Western China between November 2019 and June 2023. We randomized 446 MSM into two groups: one receiving mobile phone reminders and the other not as part of the intervention. Participants assigned to the reminder group received daily mobile reminders and were instructed to take oral PrEP each day. Follow-up visits were conducted every 12&#xa0;weeks over a total duration of 60&#xa0;weeks. The growth mixture model (GMM) was applied to identify latent classes and adherence trajectories over time, while a multinomial logistic regression model was employed to examine factors associated with different adherence patterns.</p> Results <p>Three distinct adherence trajectories were identified using GMM: Intermediate adherence group (N = 34, 7.62%), Low adherence ascending group (N = 126, 28.25%), and High adherence decline group (N = 286, 64.13%). MSM with mobile-based reminders had higher levels of adherence (OR = 2.155, 95% CI = 1.339–3.471, <i>P</i> = 0.001). High levels of HIV knowledge score (OR = 2.331, 95% CI = 1.401–3.877, <i>P</i> = 0.001), having been tested for HIV (OR = 1.809, 95% CI = 1.001–3.268, <i>P</i> = 0.049), and having multiple male sexual partners (OR = 2.481, 95% CI = 1.042–5.907, <i>P</i> = 0.049) were also significantly associated with high adherence.</p> Conclusions <p>PrEP adherence among MSM were shown to improve with the use of mobile-based reminder interventions. Accurate identification of adherence trajectories and their determinants can enable healthcare providers to better prioritize individuals requiring support and implement more targeted preventive strategies.</p> Policy Implications <p>The results contributed insights into technology-enabled adherence improvement and offered implications for PrEP intervention strategies.</p>

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Exploring Typology and Determinants of Pre-exposure Prophylaxis Adherence Trajectories Among Men Who Have Sex with Men in Western China

  • 期刊论文

  • 发表日期：

    2026年2月18日

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  • Bing Lin,
  • Jing He,
  • Jiaxiu Liu,
  • Pinyi Chen,
  • Xiaoni Zhong

摘要

Introduction

In China, men who have sex with men (MSM) face a higher risk of HIV infection, while oral pre-exposure prophylaxis (PrEP) serves as an effective method of prevention. However, maintaining high adherence to PrEP remains a major challenge. This study examined longitudinal adherence trajectories, identified key influencing factors, and assessed the impact of mobile-based reminders.

Methods

A longitudinal investigation of PrEP implementation among MSM population was conducted in Western China between November 2019 and June 2023. We randomized 446 MSM into two groups: one receiving mobile phone reminders and the other not as part of the intervention. Participants assigned to the reminder group received daily mobile reminders and were instructed to take oral PrEP each day. Follow-up visits were conducted every 12 weeks over a total duration of 60 weeks. The growth mixture model (GMM) was applied to identify latent classes and adherence trajectories over time, while a multinomial logistic regression model was employed to examine factors associated with different adherence patterns.

Results

Three distinct adherence trajectories were identified using GMM: Intermediate adherence group (N = 34, 7.62%), Low adherence ascending group (N = 126, 28.25%), and High adherence decline group (N = 286, 64.13%). MSM with mobile-based reminders had higher levels of adherence (OR = 2.155, 95% CI = 1.339–3.471, P = 0.001). High levels of HIV knowledge score (OR = 2.331, 95% CI = 1.401–3.877, P = 0.001), having been tested for HIV (OR = 1.809, 95% CI = 1.001–3.268, P = 0.049), and having multiple male sexual partners (OR = 2.481, 95% CI = 1.042–5.907, P = 0.049) were also significantly associated with high adherence.

Conclusions

PrEP adherence among MSM were shown to improve with the use of mobile-based reminder interventions. Accurate identification of adherence trajectories and their determinants can enable healthcare providers to better prioritize individuals requiring support and implement more targeted preventive strategies.

Policy Implications

The results contributed insights into technology-enabled adherence improvement and offered implications for PrEP intervention strategies.