Oral pre-exposure prophylaxis (PrEP) effectively prevents HIV among men who have sex with men, but its adherence faces significant hindrances. We evaluated the effectiveness of real-time digital intervention in promoting oral PrEP adherence through a randomized controlled trial using electronic medication monitors. The trial was registered on the Chinese Clinical Trial Registry (ChiCTR1900025604) and randomized 442 MSM to intervention (247) or control group (195). At the 6-month follow-up, the intervention group exhibited significantly higher oral PrEP adherence than the control (83.1% vs. 59.8%; adjusted net difference: 21.0%, 95% confidence interval: 12.9-29.2%, p < 0.001), while no differences were detected in the number of male sexual partners, condomless anal intercourse prevalence, or substance use disorder, with consistent results across both daily and event-driven oral PrEP regimens. Therefore, digital intervention significantly increased oral PrEP adherence over 6 months in the daily and event-driven subgroups but demonstrated no effect on high-risk behaviors.

IMPORTANCE Evidence on HIV preexposure prophylaxis (PrEP) among Chinese men who have sex with men (MSM) is critical to guide its large-scale implementation in low- and middle-income countries. OBJECTIVE To evaluate incident HIV infection, adherence, safety, and changes in sexual behaviors among MSM using daily PrEP (D-PrEP) and event-driven PrEP (ED-PrEP) in 4 cities in China. DESIGN, SETTING, AND PARTICIPANTS This nonrandomized controlled trial was conducted among HIV-seronegative MSM from December 11, 2018, to November 30, 2020, in Beijing, Shenyang, Chongqing, and Shenzhen. Participants self-chose D-PrEP or ED-PrEP regimens at baseline and could switch regimens during the 12-month study period. HIV-negative MSM who declined to initiate PrEP (nonusers) in the same cities joined a separate parallel prospective cohort and served as control individuals. INTERVENTIONS PrEP consisted of coformulated tenofovir disoproxil fumarate, 300 mg, and emtricitabine, 200 mg. MAIN OUTCOMES AND MEASURES The main outcome was incident HIV infection. Poisson regression was used to obtain the HIV incidence rate ratio (IRR). RESULTS A total of 1530 MSM were included in the analysis (median age, 30 [IQR, 25-37] years). At baseline, 520 MSM chose D-PrEP (median age, 29 [IQR, 25-35] years) and 503 chose ED-PrEP (median age, 29 [IQR, 25-36] years). The median HIV Risk Index score was 18 (IQR, 12-22) among D-PrEP users and 18 (IQR, 11-22) among ED-PrEP users. Among 507 PrEP nonusers, the median age was 33 (IQR, 27-43) years, and the median HIV Risk Index score was 12 (IQR, 7-18). Although PrEP users had more baseline behaviors associated with HIV risk, the HIV incidence was lower among all PrEP users (adjusted IRR, 0.09 [95% CI, 0.04-0.21]), ED-PrEP users (adjusted IRR, 0.05 [95% CI, 0.01-0.22]), and D-PrEP users (adjusted IRR, 0.12 [95% CI, 0.04-0.33]) compared with PrEP nonusers. There was no difference in HIV incidence between D-PrEP users and ED-PrEP users (IRR, 0.33 [95% CI, 0.06-2.04]). Event-driven PrEP users consumed 40% fewer tablets than D-PrEP users during the study period. Adherence, defined as the proportion of self-reported days with sexual intercourse in which PrEP was taken according to prescription of at least 90%, increased over time among ED-PrEP users (from 57.4% to 77.8%; P < .001 for trend) and decreased over time among D-PrEP users (from 75.1% to 72.1%; P = .02 for trend). Daily PrEP users reported fewer adverse events than ED-PrEP users (193 of 520 [37.1%] vs 241 of 503 [47.9%]). CONCLUSIONS AND RELEVANCE The findings of this study suggest that D-PrEP and ED-PrEP regimens are associated with lower incidence of HIV and a good safety profile among high-risk MSM in China.

This study compared the immunogenicity of inactivated SARS-CoV-2 vaccines between people living with HIV (PLWH) and HIV-negative individuals. We recruited 120 PLWH and 53 HIV-negative individuals aged 18–59 years who had received an inactivated SARS-CoV-2 vaccine in two Chinese cities between April and June 2021. Blood samples were tested for immunogenicity of the inactivated SARS-CoV-2 vaccines. The prevalence and severity of adverse events associated with SARS-CoV-2 vaccines were similar between PLWH and HIV-negative individuals. The seropositivity of neutralizing activity against authentic SARS-CoV-2, of the total amount of antibody (total antibody) and of S-IgG were 71.3%, 81.9%, and 92.6%, respectively, among fully vaccinated PLWH. Among all participants, PLWH had lower neutralizing activity, total antibody, S-IgG, and T-cell-specific immune response levels, compared to HIV-negative individuals, after controlling for types of vaccine, time interval between first and second dose, time after receiving the second dose, and sociodemographic factors. PLWH with a longer interval since HIV diagnosis, who received their second dose 15–28 days prior to study commencement, and who had an interval of ≥21 days between first and second dose had higher neutralizing activity levels. The immunogenicity of the inactivated SARS-CoV-2 vaccines was lower among PLWH as compared to HIV-negative individuals. Vaccination guideline specific for PLWH should be developed.

People living with HIV (PLWH), if infected with Coronavirus Disease 2019 (COVID-19), had an increased risk of mortality compared to people without HIV infection. They are considered as a priority group to receive COVID-19 vaccination. This cross-sectional online survey investigated the prevalence of and factors associated with COVID-19 vaccination uptake among 2740 PLWH aged 18–65 years in eight Chinese metropolitan cities between January and February 2021. As validated by requesting participants to send an image of receipt hiding personal identification, 6.2% of PLWH had taken up COVID-19 vaccination. Participants living in cities where individuals could make an appointment to receive COVID-19 vaccination reported significantly higher uptake than those living in cities without such allowance (11.0 vs. 2.9%, p < 0.001). Being a member of priority groups to receive vaccination, concerning about the side effects of COVID-19 vaccination and its interaction with HIV treatment, and exposing to information on the Internet/social media supporting PLWH to receive COVID-19 vaccination were significantly associated with COVID-19 vaccination uptake in both groups of participants. Receiving advice from the staff of community-based organizations supporting COVID-19 vaccination was associated with higher uptake among participants living in cities where individuals could make an appointment to receive such vaccination, while a shortage in COVID-19 vaccine supply was associated with a lower uptake among participants living in other cities. Our findings presented a snapshot of COVID-19 vaccination uptake among PLWH in the early phase of vaccine rollout in China. It provided a knowledge basis to formulate interventions promoting COVID-19 vaccination for PLWH.

BACKGROUND:HIV infection is a significant independent risk factor for both severe COVID-19 presentation at hospital admission and in-hospital mortality. Available information has suggested that people living with HIV and AIDS (PLWHA) could benefit from COVID-19 vaccination. However, there is a dearth of evidence on willingness to receive COVID-19 vaccination among PLWHA.OBJECTIVE:The aim of this study was to investigate willingness to receive COVID-19 vaccination among a national sample of PLWHA in China.METHODS:This cross-sectional online survey investigated factors associated with willingness to receive COVID-19 vaccination among PLWHA aged 18 to 65 years living in eight conveniently selected Chinese metropolitan cities between January and February 2021. Eight community-based organizations (CBOs) providing services to PLWHA facilitated the recruitment. Eligible PLWHA completed an online survey developed using a widely used encrypted web-based survey platform in China. We fitted a single logistic regression model to obtain adjusted odds ratios (aORs), which involved one of the independent variables of interest and all significant background variables. Path analysis was also used in the data analysis.RESULTS:Out of 10,845 PLWHA approached by the CBOs, 2740 completed the survey, and 170 had received at least one dose of the COVID-19 vaccine. This analysis was performed among 2570 participants who had never received COVID-19 vaccination. Over half of the participants reported willingness to receive COVID-19 vaccination (1470/2570, 57.2%). Perceptions related to COVID-19 vaccination were significantly associated with willingness to receive COVID-19 vaccination, including positive attitudes (aOR 1.11, 95% CI 1.09-1.12; P<.001), negative attitudes (aOR 0.96, 95% CI 0.94-0.97; P<.001), perceived support from significant others (perceived subjective norm; aOR 1.53, 95% CI 1.46-1.61; P<.001), and perceived behavioral control (aOR 1.13, 95% CI 1.11-1.14; P<.001). At the interpersonal level, receiving advice supportive of COVID-19 vaccination from doctors (aOR 1.99, 95% CI 1.65-2.40; P<.001), CBO staff (aOR 1.89, 95% CI 1.51-2.36; P<.001), friends and/or family members (aOR 3.22, 95% CI 1.93-5.35; P<.001), and PLWHA peers (aOR 2.38, 95% CI 1.85-3.08; P<.001) was associated with higher willingness to receive COVID-19 vaccination. The overall opinion supporting COVID-19 vaccination for PLWHA on the internet or social media was also positively associated with willingness to receive COVID-19 vaccination (aOR 1.59, 95% CI 1.31-1.94; P<.001). Path analysis indicated that interpersonal-level variables were indirectly associated with willingness to receive COVID-19 vaccination through perceptions (β=.43, 95% CI .37-.51; P<.001).CONCLUSIONS:As compared to PLWHA in other countries and the general population in most parts of the world, PLWHA in China reported a relatively low willingness to receive COVID-19 vaccination. The internet and social media as well as interpersonal communications may be major sources of influence on PLWHA's perceptions and willingness to receive COVID-19 vaccination.

Men who have sex with men (MSM) have high HIV incidence and prevalence burdens but relatively low HIV testing rates. Literature showed insufficient evidence on the efficacy of Social media (WeChat) based HIV self-testing (HIVST) kits distribution approaches among MSM and their sexual partners. This study evaluated an Social media (WeChat) based HIVST distribution intervention in increasing HIV testing uptake among MSM and their sexual partners in China. The study used a 12-month stepped-wedge randomized controlled trial design and an online survey mode. MSM who were HIV-negative or with unknown HIV status were recruited through social media marketing and outreaches by community opinion leaders between August and December 2018 in Shenyang, Beijing, Chongqing, and Shenzhen. Participants were randomly allocated to four groups, which were intervened by sequence. The intervention group received free HIVST kits on top of the control condition that participants received standard education and care. Participants were followed up from January to December 2019. Generalized linear models were used to assess HIV testing coverage and frequency difference between the intervention and the control stage. Each group enrolled 140 eligible MSM with a total of 560 participants. Twelve participants were diagnosed with HIV infections, and 4 of them were in the follow-up period. Participants in the intervention stage were nine times likely to receive an HIV test than in the control stage (85.6% vs. 39.2%, risk ratio [RR]=9.21, 95%CI 5.92~14.33). The intervention also increased participants’ HIV testing frequency (1.48 vs. 0.59 times, risk difference [RD]=0.89, 95%CI 0.82~0.96). Moreover, the intervention increased HIV testing proportion (49.0% vs. 30.1%, RR=2.23, 95%CI 1.46~3.40) and mean HIV testing frequency (0.69 vs. 0.35 times, RD=0.26, 95%CI 0.15~0.38) among participants sexual partners who received HIVST through secondary distribution. An Social media (WeChat) based HIVST distribution intervention effectively increased HIV testing coverage and frequency in MSM and their sexual partners. Future programs could apply this approach in HIV education and testing efforts to reduce HIV incidence. This study was registered at the Chinese Clinical Trials website (http://www.chictr.org.cn/index.aspx) with the registration tracking number of ChiCTR1800019453 on November 12, 2018. RR2-10.2196/17788

BACKGROUND:Over half of men who have sex with men (MSM) use geosocial networking (GSN) apps to encounter sex partners. GSN apps' users have become a unique large subpopulation among MSM for interventions concerning HIV prevention and control. Pre-exposure prophylaxis (PrEP) is a promising measure for HIV prevention, especially for MSM, but its effectiveness largely depends on medication adherence. However, little is known about PrEP adherence among GSN apps' users, which is critical to addressing the overall optimization of PrEP compliance outside of clinical trials in the context of large-scale implementation.OBJECTIVE:The objective of this study is to understand the correlation between GSN apps' use and medication adherence among MSM receiving PrEP, with the aim to increase their awareness about PrEP use in order to increase adherence.METHODS:This study based on the China Real-world Oral intake of PrEP (CROPrEP) project, a multicenter, real-world study of Chinese MSM on daily and event-driven PrEP. Eligible participants completed a detailed computer-assisted self-interview on sociodemographic, GSN apps' use, and sexual behavior. Then participants were followed up for 12 months and assessed for various characteristics (eg, PrEP delivery, adherence assessment, PrEP coverage of sexual activities, and regimens switch). A generalized estimation equation was used to analyze the predictors of medication adherence and regimen conversion among GSN apps' users and nonusers.RESULTS:At baseline, 756 of the 1023 eligible participants (73.90%) reported primarily using GSN apps to seek sexual partners, and GSN apps' users are more likely to have high-risk behaviors such as multiple sex partners and condomless anal intercourse than other nonusers (all P<.05). During follow-up, GSN apps' users had a significantly low level of pill-counting adherence than nonusers (adjusted odds ratio [aOR] 0.8, 95% CI 0.6-1.0, P=.038). In the event-driven group, GSN apps' users had marginally lower levels of self-reported adherence (aOR 0.7, 95% CI 0.4-1.0, P=.060) and lower PrEP coverage of sexual practices (aOR 0.6, 95% CI 0.4-1.0, P=.038). Additionally, GSN apps' users seemed more likely to switch from event-driven to daily regimen (aOR 1.8, 95% CI 0.9-3.3, P=.084).CONCLUSIONS:GSN apps' users are highly prevalent among MSM, despite their higher sexual risk and lower adherence levels, suggesting that eHealth needs to be introduced to the GSN platform to promote PrEP adherence.TRIAL REGISTRATION:Chinese Clinical Trial Registry ChiCTR-IIN-17013762; https://tinyurl.com/yy2mhrv4.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):RR2-10.1186/s12879-019-4355-y.

Background: Social media key opinion leaders (SMKOLs) and community-based organizations (CBOs) are 2 leading delivery strategies for HIV self-testing (HIVST). This study compared respondent characteristics, linkage to care, antiretroviral treatment, and cost of HIVST among men who have sex with men (MSM) recruited via SMKOLs and CBOs in China. Methods: Between January and December 2018, SMKOLs distributed HIVST advertisements to MSM through WeChat public platforms; simultaneously, CBOs distributed HIVST program messages to local MSM. All participants were required to pay a deposit to apply for the HIVST kit and had their deposit refunded after completing an online survey and uploading HIVST results. Trained staff provided HIV referral services by telephone and WeChat. Results: One thousand seven hundred forty-three [63.0% (1743/2766)] and 1023 [37.0% (1023/2766)] individuals met criteria via SMKOLs and CBOs, respectively. MSM reached by SMKOLs had a lower HIV seropositive rate [2.1% (33/1561) vs. 12.5% (100/803)] and higher proportion received antiretroviral treatment [94.4% (31/33) vs. 29.0% (29/100)] compared with CBO-recruited MSM (allP< 0.05). The average number of HIVST respondents recruited by each investigator in SMKOL-strategy was higher than that of CBO-strategy (290 vs. 49). The SMKOLs had lower cost of per person tested (USD 13.18 vs. USD 101.21) and per newly identified HIV infection case (USD 632.66 vs. USD 812.70). Conclusions: SMKOLs have lower cost of per person tested, whereas CBOs can reach MSM subpopulations with higher HIV seropositive rates. Both recruitment methods are efficient and should be used as complementary HIVST delivery strategies to address low HIV testing coverage among Chinese MSM.

Background: Many Pre-exposure prophylaxis (PrEP) users have difficulty attending the quarterly facility-based HIV testing, which leads to the potential risk of drug resistance in the context of breakthrough infection with low drug compliance. We explored the acceptance of HIV self-testing (HIVST) service among PrEP recipients. Methods: MSM were recruited for the PrEP demonstration in four major cities in China from December 2018 to September 2019, provided with regimens of both daily and on-demand PrEP. Facility-based HIV testing was provided quarterly at clinic visits. Previous HIV testing history and acceptance of free HIVST kits to use between each quarterly clinic visit was collected. Correlates of levels of acceptance were analysed using multivariable ordinal logistic regression. Results: We recruited 1,222 MSM. among which 48.5% preferred daily PrEP and 51.5% preferred on-demand PrEP. There was 26.8% (321/1222) had never been to any facility-based HIV testing previously, and the self-reported major reason was that they had already routinely used HIVST. A quarter of the participants (74.5%, 910/1222) had used HIVST previously. There were 1184 MSM (96.9%) accepted to use HIVST between each quarterly clinic visits during PrEP usage, composing 947 ( 77.5%) very willing to, 237（19.4%）willing to, 29 (2.4%) unwilling to, and 9 (0.7%) very unwilling to. Participants preferred daily PrEP (vs. on-demand PrEP, aOR=1.8, 95% CI:1.3-2.4) and had less than 2 times of facility-based HIV testing in the past year (vs. ³2, aOR=1.4,95% CI:1.1-1.9) were more likely to have higher level of acceptance of HIVST. Conclusions: MSM had high acceptance of HIVST, especially among those preferred daily PrEP and with less facility-based HIV testing in the previous year. Offering HIVST services PrEP recipients is feasible and necessary. Above result is of great significance for promoting HIVST among PrEP users during COVID-19, improving awareness of their HIV infection status and ensuring compliance with medication. Future study should exam the impact of HIVST on HIV testing frequency among PrEP users. Trial registration: ChiCTR1800020374 on 27 th Dec 2018. http://www.chictr.org.cn/searchproj.aspx

Background Pre-exposure prophylaxis (PrEP) is an effective biomedical strategy to prevent transmission of HIV infection, although medication adherence remains a challenge. We present the protocol for a multicentre randomised controlled trial to measure the effectiveness of a real-time monitoring and just-in-time intervention on medication adherence among PrEP users in China. Methods Study participants will include 1000 men who have sex with men (MSM) from four cites in China (Shenyang, Beijing, Chongqing and Shenzhen) attending a tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) PrEP project as part of a real-world, prospective multicentre cohort study ( CROPrEP ). Participants will be randomised into the intervention and control arms in a 1:1 ratio. Participants in the intervention arm will be provided with remote real-time monitoring equipment that triggers twice just-in-time SMS (Short Messaging Service) medication reminders to PrEP users every half an hour when a scheduled dosage is missed, and followed with just-in-time SMS medication reminders to clinicians half an hour when there is no supplement after the second just-in-time SMS reminder to PrEP users. Clinicians will initiate individualised telephone intervention as soon as possible upon receipt of the just-in-time SMS missed dose alert. Those in the control arm will only receive generic weekly SMS reminders. The study will last 6 months. Participants will be seen at follow-up visits at three and 6 months. Trial outcomes to be measured include self-reported adherence assessed via questionnaire and pill counts, as well as drug concentration test results. Discussion Medication adherence is critical to achieve optimal benefits from PrEP. This study will be the first individualised behaviour intervention using real-time technology to increase adherence among MSM PrEP users globally. If found effective, a real-time monitoring and just-in-time intervention system may be utilized for improving adherence and thus effectiveness of global PrEP application. Trial registration This study registered at ClinicalTrials.gov ( ChiCTR1900025604 ) on September 2, 2019.

Around half of the men who have sex with men（MSM） have never been tested for human immunodeficiency virus（HIV）, even though the health authorities promoted a massive scale-up of HIV testing and counseling in health facilities [1] . HIV self-testing has been recommended by the World Health Organization as a user-friendly, convenient,rapid, and accurate approach to access HIV testing [2] .An internet-based provision of self-testing services may be critical to the rollout of HIV self-testing, but more research is needed.

Background: With China’s explosive internet growth, activities such as socializing and partner seeking among men who have sex with men (MSM) has also become Web based through popular services such as Blued. This creates a new mode of health promotion with the potential to instantly reach large numbers of MSM, including those who rarely access traditional offline testing facilities. Objective: This study aimed to assess the feasibility of the Easy Test in increasing access and uptake of HIV testing and treatment services among MSM and to identify demographic and behavioral predictors of program uptake to inform future implementation. Methods: A feasibility study of the Easy Test model was conducted from October 2017 to December 2017 in 14 Chinese provinces. Applicants who provided informed consent completed a self-administered questionnaire and submitted a US $5 deposit to have the free test kit delivered to their homes. Orders were then received, processed, and posted by volunteers from local community-based organizations. Once applicants submitted images of their test results, the deposit was refunded to the applicant. Those whose test results were deemed to be HIV-positive were then connected to a peer navigator to accompany the individual to follow-up medical services. A chi-squared trend test was used to assess the relationship between lifetime HIV testing volume and HIV prevalence. Logistic regression models were used to identify independent risk factors associated with two outcomes: (1) never having tested for HIV and (2) receiving an HIV-positive result. Results: A total of 879 individuals submitted Web-based requests for test kits. Their median age was 28 (interquartile range 24-34 years); 69.3% (609/879) had at least a college education, and 51.5% (453/879) had a monthly income between US $450 to $750; 77.7% (683/879) of the applicants submitted images of their test results, among whom 14.3% (98/683) had an HIV-positive result. Among the 42.9% (293/683) who were first-time testers, the HIV prevalence was 18.8% (55/293). Nearly three-quarters (71/98, 72.4%) of those with a positive test result were connected with a peer navigator and enrolled in treatment. Among the first-time testers, having multiple sexual partners (2-3 sexual partners: adjusted odds ratio [aOR] 2.44, 95% CI 1.08-5.50; 4 or above sexual partners: aOR 3.55, 95% CI 1.18-10.68) and reporting inconsistent condom use in the previous 3 months (aOR 7.95, 95% CI 3.66-17.26) were both associated with an HIV-positive result. An inverse dose response relationship between lifetime HIV testing volume and HIV prevalence was also observed in this study (χ23=55.0; P<.001). Conclusions: The Easy Test model reached a larger portion of first-time testers, many who reported higher risk sexual behaviors. This highlights the potential for an internet-based self-test model to increase access to HIV treatment services for HIV-positive MSM in China.

related YKP focusing on sex workers, people who use drugs, MSM, and Trans people.These findings support communitybased strategies in public health policies.Disclosure No significant relationships.

Objective To assess the characteristics and risk factors of MSM seeking for internet based HIV rapid testing for the first time.Methods Free HIV testing kits were delivered to MSM who intended to receive HIV testing promoted based on the website by the local community-based organization in Beijing.MSM had a self-test with the HIV rapid test kits received and upload the self-test result back to the website.Results 5072 HIV rapid test kits were delivered to MSM seeking for self-testing based on the internet between 2015 to 2016,among which 491 (9.7％) didn't report their self-test results back.Out of the 4581 MSM reported self-test results,680 were previously HIV positive or repeated receiving HIV testing by getting rapid test kits through internet;809 were ever tested but unaware of their testing results;and 3092 received their first HIV testing.The MSM using internet based self-testing included those with higher education,more sexual partners and inconsistent use of condoms in anal intercourse.MSM receiving HIV rapid testing for the first time had the HIV positive rate of 7.9％,and those with active anal sex last month (more than five times),less than 25 years,below the high-school education level and not use condoms during and sexual activities were closely related to HIV infection.Conclusion Internet based self-testing is effective to increase the accessibility and pertinence of HIV testing.

Background: There is growing need for research in China regarding posttest risk behavior differences among injecting drug users that explores the effect of various testing modes (nonvoluntary vs. voluntary) and other related factors on changes in posttest risk behaviors. Methods: One hundred seventy-two study subjects self-reported human immunodeficiency virus (HIV)-related personal risk behaviors including condom use rates and needle-sharing habits. Fisher exact test and multivariate regression analysis compared the impact of HIV testing mode on ongoing risk behaviors for HIV transmission. Results: The study found that those who received positive test results were 5.37 times more likely to increase condom use with regular sexual partners, that men were 8.8 times more likely than women to increase posttest condom use in commercial sexual activities. Needle-sharing behavior was significantly lower for subjects who tested HIV-positive (odds ratio [OR]: 4.5), who notified sexual partners of test results (OR: 0.03), and who had tested voluntarily (OR: 0.04). Conclusion: Based on the study results this report concludes that voluntary HIV testing and encouragement of partner notification of test results should be incorporated into China’s national testing strategy.