Risk factors for PrEP and ART medication adherence challenges in cis-gender South African men who have sex with men in Johannesburg and Pretoria.

IF 2.2 4区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH International Health Pub Date : 2025-07-01 DOI:10.1093/inthealth/ihae090

Jacqueline Pienaar, Lindiwe Tsope, Mapaseka Mabena, Pontsho Komane, Maria Sibanyoni, Boitumelo Ramashala, Elizabeth Wahome, Charlene Denousse, Ankiza Gakunu, Elise M van der Elst, Danielle Giovenco, Don Operario, Eduard J Sanders

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Abstract

Background: Mental health challenges are common among men who have sex with men (MSM) in South Africa and may impact medication adherence.

Methods: We determined the prevalence and risk factors of medication adherence challenges among 160 pre-exposure prophylaxis (PrEP)- and 40 antiretroviral therapy (ART)-taking MSM registered at two key population clinics in Johannesburg and Pretoria in 2023. We used modified Poisson regression to estimate associations between participant characteristics and medication adherence challenges (missed dosage on ≥1 d in the last month).

Results: A total of 106 (53.5%) participants (57.6% on PrEP, 37.5% on ART; p=0.02) had medication adherence challenges and 61 (30.5%) participants (31.2% on PrEP, 27.5% on ART; p=0.23) met criteria for moderate to severe symptoms of depression (score ≥10 on the 9-item Patient Health Questionnaire). In multivariable analysis, predictors included PrEP use (adjusted prevalence ratio [aPR]=1.81 [95% confidence interval {CI} 1.21 to 2.73), clinic in Pretoria (aPR 1.43 [95% CI 1.08 to 1.89]), transactional sex (aPR 1.81 [95% CI 1.34 to 2.44]), moderate to severe depression (aPR 1.50 [95% CI 1.19 to 1.89]) and use of social media (aPR 1.45 [95% CI 1.05 to 2.00]).

Conclusions: Depression is common and may be an important risk factor for poor medication adherence among MSM in South Africa. Future research should leverage a longitudinal study design to inform potential interventions.

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在约翰内斯堡和比勒陀利亚发生男男性行为的南非顺性别男性中PrEP和ART药物依从性挑战的危险因素。

背景：精神健康挑战在南非男男性行为者（MSM）中很常见，并可能影响药物依从性。方法：我们确定了2023年在约翰内斯堡和比勒陀利亚两个重点人群诊所登记的160名暴露前预防（PrEP）和40名抗逆转录病毒治疗（ART）的男男性行为者的药物依从性挑战的患病率和危险因素。我们使用修正泊松回归来估计受试者特征与药物依从性挑战（最后一个月≥1天未给药）之间的关联。结果：共有106名参与者（53.5%），其中PrEP 57.6%, ART 37.5%；p=0.02)有药物依从性挑战，61名（30.5%）参与者(PrEP 31.2%, ART 27.5%；p=0.23)符合中度至重度抑郁症状的标准（9项患者健康问卷得分≥10）。在多变量分析中，预测因子包括PrEP使用（调整患病率比[aPR]=1.81[95%可信区间{CI} 1.21至2.73）、比勒陀利亚诊所（aPR 1.43 [95% CI 1.08至1.89]）、交易性行为（aPR 1.81 [95% CI 1.34至2.44]）、中度至重度抑郁症（aPR 1.50 [95% CI 1.19至1.89]）和社交媒体使用（aPR 1.45 [95% CI 1.05至2.00]）。结论：抑郁症是常见的，可能是南非男男性行为者服药依从性差的重要危险因素。未来的研究应该利用纵向研究设计来告知潜在的干预措施。

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来源期刊

International Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

4.50

自引率

0.00%

发文量

审稿时长

>12 weeks

期刊介绍： International Health is an official journal of the Royal Society of Tropical Medicine and Hygiene. It publishes original, peer-reviewed articles and reviews on all aspects of global health including the social and economic aspects of communicable and non-communicable diseases, health systems research, policy and implementation, and the evaluation of disease control programmes and healthcare delivery solutions. It aims to stimulate scientific and policy debate and provide a forum for analysis and opinion sharing for individuals and organisations engaged in all areas of global health.