HIV Non-Occupational Postexposure Prophylaxis (nPEP) Awareness, Usage, Willingness, and Promotion in China: A Cross-Sectional Study Among Five Key Populations

Background: In China, the 13th Five Year Action Plan for HIV/AIDS Containment and Prevention is examining the feasibility of non-occupational post-exposure prophylaxis (nPEP) as a national strategy for HIV prevention. We investigated nPEP usage and willingness and related socio-demographic and behavioural factors. Methods: We conducted a cross-sectional study in 10 cities in China from November 2018 to September 2019, using convenience sampling to recruit participants aged 18 years and over, self-reporting HIV status as either negative or unknown, providing written informed consent and participating voluntarily from five key populations. Findings: Our analysis included data from 2022 participants with a mean age of 35 years (SD = 11.62). There were 57 (2.82%) having used nPEP, 857 (42.38%) participants hearing of nPEP, 1348 (66.67%) willing to use nPEP in future exposure, and 1728 (85.46%) endorsing nPEP promotion. Socio-demographic and behavioural factors related to both nPEP usage and willingness included populations (p < 0.0001, p < 0.001 respectively), age (p < 0.05, p < 0.01 respectively), education (p < 0.05, p < 0.001 respectively), nPEP knowledge (p < 0.01, p < 0.0001 respectively), and receiving conventional HIV prevention services (p < 0.05, p < 0.05 respectively). 26% nPEP users used nPEP medication for more than once and more than 90% of them reported willingness to use nPEP again in future exposure. Medical reliability and trust was an emerging challenge. Interpretation: The key populations in China need nPEP services, particularly older and illiterate individuals with poor knowledge of nPEP, and those from FSWs and drug users. The implementation of nPEP services is an important step to access high-risk individuals for intensive and tailored HIV prevention and intervention.  Funding: China National Key Research and Development Program and National Science and Technology Major Project, and the i Guardian Platform of the People's Medical Publishing House. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: All study procedures were approved by the Ethics Review Committee of Public Health at Shandong University (IRB No:20180904).