High Acceptance of HIV Self-testing Among PrEP Recipients before COVID-19 Era: A Cross-sectional Analysis from PrEP Demonstration Project of MSM in China

High Acceptance of HIV Self-testing Among PrEP Recipients before COVID-19 Era: A Cross-sectional Analysis from PrEP Demonstration Project of MSM in China | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research article High Acceptance of HIV Self-testing Among PrEP Recipients before COVID-19 Era: A Cross-sectional Analysis from PrEP Demonstration Project of MSM in China Jing Zhang, Wei-ming Tang, Xia Jin, Hong-yi Wang, Zhen-xing Chu, and 16 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-36752/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract 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 Infectious Diseases HIV self-testing Pre-exposure prophylaxis men who have sex with men Background World Health Organization (WHO) and Center for Disease Control and Prevention (CDC) ( 1 ) recommend users of oral pre-exposure prophylaxis (PrEP) to test for HIV quarterly, to avoid resistance to antiretroviral therapy (ART) by breakthrough infections ( 2 ). Medicine compliance to PrEP is barely 60% among users worldwide( 3 ). Mutations that impact the efficacy of first-line ART can develop within 2 weeks of PrEP being administered every day to HIV-infected individuals ( 4 ). Although the number of cases of resistance to anti-HIV-1 drugs during PrEP is small ( 5 – 8 ) it remains one of the main concerns for HIV key populations for PrEP acceptance ( 9 , 10 ). In real world settings, even testing HIV every 3 months at facility-based HIV testing service is implausible among PrEP recipients. There were 75% of PrEP recipients missed their facility-based testing after PrEP initiation ( 11 ) and had difficulty attending one during PrEP ( 12 ) ( 13 ). Moreover, among HIV key populations such as men who have sex with men (MSM), there is only 38.0–65.1% had tested for HIV in the past 6–12 months worldwide, and only 47.0–83.6% had ever been tested for HIV in their lifetime ( 14 – 19 ). It is crucial to explore innovative HIV testing strategies to pair PrEP implementation. In recent few years, HIV self-testing (HIVST) has changed the course of HIV testing among HIV key populations by reaching more first-time testers ( 18 , 20 ) and increasing the HIV-testing frequency ( 21 , 22 ) among them, especially in resource-limited settings ( 23 , 24 ). HIVST allows people to take an HIV test and discover their result in their home or other private location ( 25 ). In 2016, the WHO published the first global guidelines on HIVST, in which HIVST was recommended as an additional approach to HIV-testing services ( 26 ). Seventy-seven countries have adopted HIVST policies, while many others are currently developing them currently ( 27 ). HIVST has been offered to the HIV-negative partners of HIV-discordant couples and women at risk who were on PrEP to use between quarterly clinic visits ( 28 ) or biannual clinic visits ( 29 ). HIVST has demonstrated high acceptance, high use, and ease of use among PrEP recipients in the settings mentioned above ( 28 , 30 ). Higher preference for HIVST than facility-based HIV testing during PrEP among female sex workers has been documented in one setting ( 31 ). However, HIVST uptake among MSM and its correlates are not known. COVID-19 is still in a pandemic stage. Social distancing is still a primary to preventing the spread of SARS-COVI-2, causing a severe impact on maintaining the routinely traditional clinical-based HIV testing ( 32 ). Therefore, the need to develop HIVST in the COVID-19 era has become increasingly prominent. The CDC recommends that HIVST services be provided to PrEP users when other options are not available ( 33 ). But so far there is no report of PrEP MSM's willingness to apply HIVST. This study is of great significance for the promotion of the application of HIVST among PrEP users. We aimed to assess acceptance of HIVST among PrEP candidates and explore its correlates, including demographics, HIV-testing history, preference for PrEP regimen, HIV-related behaviour. This study will shed light in the utility of HIVST in the era of PrEP, and provide evidence for paired HIV-testing strategy with PrEP implementation. Methods Design, setting and procedures This cross-sectional study was conducted between December 2018 and September 2019 and leveraged the China Real-world study of Oral Pre-exposure Prophylaxis (CROPrEP) project for participant recruitment (clinical trial reference number here). The study sites were general hospitals equipped with HIV voluntary counselling and testing clinics (VCTs) and HIV treatment clinics with physicians specialising in infectious diseases in four major cities in China: The YouAn Hospital of Capital Medical University in Beijing, The First Affiliated Hospital of China Medical University in Shenyang, The Chongqing Public Health Medical Center of Southwest University in Chongqing, and The Third People’s Hospital of Shenzhen. Participant recruitment was conducted offline and online using convenient samples and snowballing (i.e., chain referral sampling) by: (i) distribution of posters and brochures in the HIV VCTs at the four study sites for MSM who arrived for counselling and testing; (ii) postings in MSM chat groups and on the study sites’ official WeChat™ and Tencent QQ™ accounts (two of the most widely used social media applications in China); (iii) outreach events run by community-based organisations (CBOs) in bars, public baths and parks that provided study information, and MSM peer referral. All individuals who were interested in the recruitment advertisement of CROPrEP online and offline, needed to registered for and attend to an on-site screening appointment for eligibility of the CROPrEP trial. This on-site screening provides free testing for HIV infection and syphilis for adult MSM and transgender women. After providing written informed consent, participants willing to enrol underwent consultations with physicians and laboratory testing. The information of demographic, HIV related risk behaviour, HIV testing history and acceptance of HIVST was collected. Measures Data were collected through self-administrated questionnaires on each participants’ smartphone. Participants were surveyed for acceptance to use free HIVST kits between each quarterly clinic visit, previous experience of facility-based HIV testing, and HIVST (frequency of using each type of testing service, as well as the reasons for using and not using them), their preference for PrEP regimens (daily or on-demand), demographics (age, education level, marital status, monthly income), HIV-related risk behaviour in the past 3 months (frequency of homosexual anal intercourse, and existence of condom-less anal intercourse). The levels of acceptance of HIVST were defined as “very willing to accept”, “willing to accept”, “unwilling to accept” and “very unwilling to accept”. Statistical analyses We conducted statistical analysis by SPSS v20.0 (IBM. Armonk, NY, USA). Demographics, preference for PrEP regimen, history of HIV testing, and level of acceptance of HIVST among all participants were described using numbers and percentages. Univariable and multivariable ordinal logistic regression analyses was used to assess the predictors of an increased level of acceptance to use HIVST between each quarterly clinic visit. Variables with P < 0.2 in the univariable analysis were included in the multivariable model. Variables in the final model were selected with an entry procedure. Model fitness was assessed by the goodness-of-fit statistics. Odds ratio and adjusted odds ratios were calculated by a general linear model. P < 0.05 in the multivariate analysis was the cut-off for a significant difference. Results A total of 1222 men participated in on-site screening and completed the relevant screening programs. Among these men, the median age was 30-year-old (Interquartile rang, IQR 25–36) and 79.4% (970/1222) had education level as undergraduate and above. There was 68.3% (835/1222) of them had unprotected anal intercourse during the previous 3 months. Among all participants, 48.5% (592/1222) preferred daily medication and 51.5% (630/1222) preferred event-driven medication (Table 1 ). Table 1 Characteristics of PrEP candidates in four major cities of China, 2018–2019 (N = 1222) Variable Number (%) Preference of PrEP regimen Daily 592 (48.5) On-demand 630 (51.5) Age (years) [Median, IQR] 30 (25–36) 19–25 319 (26.1) 26 and above 903 (73.9) Education level Senior high and below 252 (20.6) Undergraduate and above 970 (79.4) Monthly income (US dollars) 0–857 649 (53.1) ≥858 573 (46.9) Marital status Single 662 (54.2) Married with a female, in a stable relationship with a male, Divorced or widowed 560 (45.8) Frequency of homosexual intercourse in the previous 3 months Every day 15 (1.2) Every week 434(35.5) Every month 591(48.4) Less than once a month 182 (14.9) Had condom-less anal intercourse in the previous 3 months Yes 835 (68.3) No 387 (31.7) Have heard of/known about HIVST Yes 1145 (93.6) No 77 (6.4) Have used HIVST before Yes 910 (74.5) No 312 (25.5) Have used a facility-based HIV testing before Yes 901 (73.7) No 321 (26.3) Times of using HIVST in the past year [Median, IQR] 3 (2–5) Times of using facility-based HIV testing in the past year [Median, IQR] 2 (1–4) Previous experience of HIV facility-based testing and HIVST A total of 1145 participants (93.6%) reported that they had heard of HIVST, and 910 participants (74.5%) had used HIVST previously. The median number of times HIVST was used in the previous year was three (IQR 2–5). There were 321 participants (26.3%) had never used facility-based HIV testing before. The main reason given for the 321 participants who had never used facility-based HIV testing was that they undertook HIVST (49.2%, 158/321). The median number of times participants who undertook facility-based HIV testing in the past year was two (IQR 1–4). (Table 1 ). Acceptance of HIVST during PrEP and motives Of 1222 participants, 1184 (96.9%) accept HIVST during PrEP. Of these, 77.5% (947/1222) were very willing to accept, 19.4% (237/1222) were willing to accept, 2.4% (29/1222) were unwilling to accept, and 0.7% (9/1222) were very unwilling to accept HIVST to use between quarterly clinic visits during PrEP. The main motives for acceptance of HIVST were “good privacy for HIV testing” (69.1%, 818/1184) and “ease of use” (68.9%, 816/1184). The main reasons for non-acceptance of HIVST were “fear of inaccuracy of the results of HIVST” (41.1%, 16/38) and “fear of needles/blood” (34.2%, 13/38) (Table 2 ). Table 2 Acceptance of HIVST and reasons among PrEP candidates in China, 2018–2019 Variable Number (%) Acceptance to use HIVST between each quarterly clinic visit of PrEP (N = 1222) Very willing to 947 (77.5) Willing to 237 (19.4) Unwilling to 29 (2.4) Very unwilling to 9 (0.7) Reasons for acceptance (N = 1184) Good privacy 818 (69.1) Easy to use 816 (68.9) Prevents drug resistance 150 (12.7) Getting testing results is quick 611 (51.6) Less pain 151 (12.8) Other 3 (0.3) Reasons for non-acceptance (N = 38) Afraid of needle/blood 13 (34.2) Worry about the accuracy of HIVST 16 (41.1) HIVST is not easy to use 6 (15.8) It is unnecessary for HIVST as long as there is facility-based testing 10 (26.3) I am not high-risk 3 (7.9) Afraid of a positive result of HIVST 6 (15.8) Afraid other people would see me using HIVST and think I am HIV-positive 6 (15.8) Other 2 (5.3) Correlation of increased acceptance of HIVST during PrEP Univariable ordinal logistic regression analysis revealed several factors to be correlated with an increased level of acceptance of HIVST (P < 0.05): daily PrEP regimen; education level; monthly income; number of using facility-based HIV testing in the previous year; number of the times HIVST had been used in the previous year. The multivariable ordinal logistic regression analysis revealed the significant and independent predictors of higher acceptance of HIVST use during PrEP. Participants who preferred daily PrEP were 1.8-times (95% CI: 1.3–2.4) more likely to have higher acceptance of HIVST than those who preferred on-demand PrEP (P < 0.001). Compared with those with an education level of senior high school or below, men having an education level of undergraduate and above were 2.6-times (95% CI: 1.1–2.1) more likely to have higher acceptance of HIVST (P = 0.023). Compared with people who had monthly income lower than 858 USD, men with monthly income above 858 were 0.7-times (95% CI: 0.5–0.9) more likely to have higher acceptance of HIVST (P = 0.017). Compared with people who had ≥ 2 facility-based HIV tests in the previous year, those who did not were 1.4-times (95% CI: 1.1–1.9) more likely to have higher acceptance of HIVST (P = 0.014). Compared with people who had ≥ 3 HIVSTs in the previous year, those who did not were 0.3-times (95% CI: 0.2–0.4) more likely to have higher acceptance of HIVST (P < 0.001) (Table 3 ). Table 3 Univariable and multivariable ordinal logistic regression models for predicting increased level of acceptance to use HIVST during PrEP among PrEP candidates in China, 2018–2019 (N = 1222) Discussion We exam the acceptance of HIVST among PrEP candidates and its correlates in a multicentre oral PrEP demonstration project in China. The median times of HIVST and facility-based HIV testing in the past year of these candidates were 3 and 2 respectively. Nearly all (96.9%) of the PrEP candidates accepted HIVST. Men with a preference for daily PrEP and had used facility-based HIV testing less than twice in the previous year were more likely to have higher level of acceptance of HIVST. This result showed the necessity and feasibility of offering HIVST service during PrEP. The rate of acceptance of HIVST is high among PrEP candidates of MSM, which is in accordance with previous studies of sero-discordant couples and females using PrEP in Africa ( 28 – 31 , 34 ). This high rate can be explained by the fact that HIVST had already became a main way of HIV testing among these MSM. Among these PrEP candidates, the median number of HIVST use in the previous year had already outnumbered that of facility-based HIV testing. There were three-quarters of the PrEP candidates had used HIVST previously and nearly all of them have heard about HIVST before. The self-reported major reasons of this acceptance were good privacy, easy to use and getting testing results quickly. Also, this study was conducted before the COVID-19 pandemic, which indicates possibility of a higher acceptance of HIVST during the pandemic. This high acceptance of HIVST also suggests a method to maintain this ongoing PrEP trial, since the quarantine against COVID-19 is still required. Above results suggest feasibility to provide HIVST to MSM PrEP users. This study also indicates necessity to provide HIVST to MSM PrEP users. The WHO recommends general MSM test for HIV every half year ( 35 ) and PrEP users test HIV at a facility-based testing service at least every quarter ( 36 ). However, there were more than a quarter of the PrEP candidates had never used any facility-based HIV testing before, which indicates potential hardship in maintaining their attendance to facility-based HIV testing during PrEP. Missed attending facility-based testing and difficulty in attending clinical visits leads to interruption and discontinuation of PrEP ( 12 ) ( 13 ). Fortunately, PrEP candidates with less than two facility-based HIV testing in the past year were more likely to accept HIVST. Providing PrEP users with HIVST can serve as additional options for HIV testing. Preference for daily regimen of PrEP is also correlated with higher acceptance of HIVST during PrEP. This study allowed PrEP candidates to choose their regimen between daily and on-demand ( 37 ). Real-world studies have shown that, compared to those who chose on-demand PrEP, MSM chose daily PrEP were having more HIV-related risk behaviour ( 38 , 39 ). Resistance to ART is more likely to occur with a higher selection pressure of the drug ( 4 ). Considering the higher exposure to HIV infection and generally low adherence to PrEP among MSM, with daily administration of PrEP to a HIV-infected person, mutations that affect the efficacy of first-line ART can develop in 2 weeks ( 4 ). Providing HIVST for daily users of PrEP could meet their needs. Nevertheless, challenges in supervision for on-demand PrEP must be addressed because non-daily use of PrEP becomes more common outside of controlled research settings ( 8 ). This study has both strengths and limitations. This study explored acceptance of HIVST among MSM PrEP users for the first time, revealing the high necessity and feasibility to paired PrEP with HIVST. However, since fourth generation of HIVST, which could can detect both HIV antibodies and p24 antigens, we provided the third generation HIVST to PrEP candidates. The high acceptance of HIVST reported in this study indicates better acceptance of fourth generation of HIVST among PrEP users in the future. Also, this study is a cross-sectional design, which cannot provide actual use in the follow-up and impact of HIVST usage on behaviour of PrEP users. The data of actual usage of HIVST and its impact on behaviour among PrEP users will be reported soon. Conclusions The MSM who participated in the first real-world PrEP trial in China had high acceptance to HIVST during PrEP. Inadequate facility-based HIV testing in the previous year and preference for daily PrEP was correlated with higher acceptance of HIVST. Providing HIVST to MSM PrEP users is feasible and necessary, especially during the time of social distancing and quarantine. List Of Abbreviations HIV, human immunodeficiency virus; HIVST, HIV self-testing; PrEP, pre-exposure prophylaxis; COVID-19, coronavirus disease 2019; MSM, men who have sex with men; CBO, community-based organization; Declarations Ethical approval and consent to participate The study protocol was approved by the ethics review board of the First Affiliated Hospital of China Medical University (IRB[2018]273) in Shenyang, China. Written informed consent was obtained from each participant before collecting study information or blood samples. Participants took part in the study voluntarily and had the right to refuse to answer any question. Participants had the right to withdraw from the study without penalty. The protocol for the CROPrEP trial has been published (37). This HIVST study among PrEP recipients was registered on Chinese Clinical Trial Registry (trial ID ChiCTR1800020374). Consent for publication Not applicable. Availability of data and materials The datasets used and analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This work was supported by the Mega-Projects of national science research (13rd Five-Year Plan [2017ZX10201101-002-007]), the Mega-Projects of national science research (12 th Five-Year Plan [2012ZX10001006-001-010]), National Natural Science Foundation of China (81872674), the Mega-Projects of national science research (2018ZX10101001-001-003). The funders had no role in the study design, data collection and analysis, interpretation of data, writing the manuscript, decision to publish, or preparation of the paper. Authors’ contributions Conceived and designed the experiment: JZ, JJX, HS; performed the study and experiments: JZ, JX, HYW, ZXC, QHH, XJH, YKC, HW, XQH, YL, LKZ, ZLH, RTB, SCL, HL, HBD, YJJ, WQG; drafted the study report: JZ, JJX, WMT. All authors reviewed and approved the final report. Acknowledgements The authors would like to thank the community-based organizations of Sunshine at Shenyang, YouAn-Tian Yuan Studio at Beijing, Chongqing Red Ribbon AIDS Care Center at Chongqing and 258 Rainbow Workshop at Shenzhen for their help with recruiting and maintaining the participants. We would also like to thank all of the participants for being in our study. References US Public Health Service. PREEXPOSURE PROPHYLAXIS FOR THE PREVENTION OF HIV INFECTION IN THE UNITED STATES-2017 UPDATE: A CLINICAL PRACTICE GUIDELINE. 2017. CDC recommends pill to protect against HIV - CBS News. Available at https://www.cbsnews.com/news/cdc-recommends-pill-to-protect-against-hiv/ . Accessed on 3rd Sep, 2019. Yun K, Xu JJ, Zhang J, Li JM, Hu QH, Chu ZX, et al. Female and younger subjects have lower adherence in PrEP trials: a meta-analysis with implications for the uptake of PrEP service to prevent HIV. Sex Transm Infect. 2018;94(3):163-8. Hurt CB, Eron JJ, Jr., Cohen MS. Pre-exposure prophylaxis and antiretroviral resistance: HIV prevention at a cost? Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2011;53(12):1265-70. Delaugerre C, Rodriguez C, Capitant C, Nere ML, Mercier-Darty M, Carette D, et al. Drug resistance among patients who acquired HIV infection in a preexposure prophylaxis trial. Aids. 2018;32(16):2353-61. Lehman DA, Baeten JM, McCoy CO, Weis JF, Peterson D, Mbara G, et al. Risk of drug resistance among persons acquiring HIV within a randomized clinical trial of single- or dual-agent preexposure prophylaxis. J Infect Dis. 2015;211(8):1211-8. Liegler T, Abdel-Mohsen M, Bentley LG, Atchison R, Schmidt T, Javier J, et al. HIV-1 drug resistance in the iPrEx preexposure prophylaxis trial. J Infect Dis. 2014;210(8):1217-27. Volk JE, Nguyen DP, Hare CB, Marcus JL. HIV Infection and Drug Resistance with Unsupervised Use of HIV Pre-Exposure Prophylaxis. AIDS Res Hum Retroviruses. 2018;34(4):329-30. Golub SA, Gamarel KE, Rendina HJ, Surace A, Lelutiu-Weinberger CL. From Efficacy to Effectiveness: Facilitators and Barriers to PrEP Acceptability and Motivations for Adherence Among MSM and Transgender Women in New York City. AIDS patient care and STDs. 2013;27(4):248-54. Idoko J, Folayan MO, Dadem NY, Kolawole GO, Anenih J, Alhassan E. "Why should I take drugs for your infection?": outcomes of formative research on the use of HIV pre-exposure prophylaxis in Nigeria. BMC public health. 2015;15:12. Zucker J, Carnevale C, Richards P, Slowikowski J, Borsa A, Gottlieb F, et al. Predictors of Disengagement in Care for Individuals Receiving Pre-exposure Prophylaxis (PrEP). J Acquir Immune Defic Syndr. 2019;81(4):e104-e8. Scott HM, Spinelli M, Vittinghoff E, Morehead-Gee A, Hirozawa A, James C, et al. Racial/ethnic and HIV risk category disparities in preexposure prophylaxis discontinuation among patients in publicly funded primary care clinics. Aids. 2019;33(14):2189-95. Rolle CP, Onwubiko U, Jo J, Sheth AN, Kelley CF, Holland DP. PrEP Implementation and Persistence in a County Health Department Setting in Atlanta, GA. AIDS and behavior. 2019;23(Suppl 3):296-303. Zou H, Hu N, Xin Q, Beck J. HIV testing among men who have sex with men in China: a systematic review and meta-analysis. AIDS and behavior. 2012;16(7):1717-28. Yi S, Tuot S, Chhoun P, Brody C, Pal K, Oum S. Factors associated with recent HIV testing among high-risk men who have sex with men: a cross-sectional study in Cambodia. BMC public health. 2015;15:743. Khawcharoenporn T, Mongkolkaewsub S, Naijitra C, Khonphiern W, Apisarnthanarak A, Phanuphak N. HIV risk, risk perception and uptake of HIV testing and counseling among youth men who have sex with men attending a gay sauna. AIDS research and therapy. 2019;16(1):13. Stromdahl S, Hoijer J, Eriksen J. Uptake of peer-led venue-based HIV testing sites in Sweden aimed at men who have sex with men (MSM) and trans persons: a cross-sectional survey. Sex Transm Infect. 2019;95(8):575-9. Tun W, Vu L, Dirisu O, Sekoni A, Shoyemi E, Njab J, et al. Uptake of HIV self-testing and linkage to treatment among men who have sex with men (MSM) in Nigeria: A pilot programme using key opinion leaders to reach MSM. J Int AIDS Soc. 2018;21 Suppl 5:e25124. Diez M, Bleda MJ, Varela JR, Ordonana J, Azpiri MA, Vall M, et al. Trends in HIV testing, prevalence among first-time testers, and incidence in most-at-risk populations in Spain: the EPI-VIH Study, 2000 to 2009. Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin. 2014;19(47):20971. Zhang C, Li XH, Brecht ML, Koniak-Griffin D. Can self-testing increase HIV testing among men who have sex with men: A systematic review and meta-analysis. Plos One. 2017;12(11):19. Jamil MS, Prestage G, Fairley CK, Grulich AE, Smith KS, Chen M, et al. Effect of availability of HIV self-testing on HIV testing frequency in gay and bisexual men at high risk of infection (FORTH): a waiting-list randomised controlled trial. The lancet HIV. 2017;4(6):E241-E50. Johnson CC, Kennedy C, Fonner V, Siegfried N, Figueroa C, Dalal S, et al. Examining the effects of HIV self-testing compared to standard HIV testing services: a systematic review and meta-analysis. Journal of the International Aids Society. 2017;20:10. Maheswaran H, Clarke A, MacPherson P, Kumwenda F, Lalloo DG, Corbett EL, et al. Cost-Effectiveness of Community-based Human Immunodeficiency Virus Self-Testing in Blantyre, Malawi. Clin Infect Dis. 2018;66(8):1211-21. Cambiano V, Ford D, Mabugu T, Mavedzenge SN, Miners A, Mugurungi O, et al. Assessment of the Potential Impact and Cost-effectiveness of Self-Testing for HIV in Low-Income Countries. J Infect Dis. 2015;212(4):570-7. CDC. Centers for Disease Control and Prevention. Self-Testing. Available at https://www.cdc.gov/hiv/testing/self-testing.html . Accesed at 13th Jan, 2020. WHO. Guidelines on HIV self-testing and partner notification Supplement to consolidated guidelines on HIV testing services. Availabe at https://www.who.int/hiv/pub/vct/hiv-self-testing-guidelines/en/ . Accessed on 13th Jan, 2020. 2016. WHO. HIV self-testing. Available at https://www.who.int/hiv/topics/self-testing/en/ . Accessed on 13th Jan, 2020. 2019. Ngure K, Heffron R, Mugo N, Irungu E, Njuguna N, Mwaniki L, et al. Uptake of HIV Self-testing among People Receiving PrEP in Kenya. Aids Research and Human Retroviruses. 2014;30:A70-A. Ortblad KF, Kearney JE, Mugwanya K, Irungu EM, Haberer JE, Barnabas RV, et al. HIV-1 self-testing to improve the efficiency of pre-exposure prophylaxis delivery: a randomized trial in Kenya. Trials. 2019;20:10. Ngure K, Heffron R, Mugo N, Thomson KA, Irungu E, Njuguna N, et al. Feasibility and acceptability of HIV self-testing among pre-exposure prophylaxis users in Kenya. Journal of the International Aids Society. 2017;20:8. Ortblad KF, Chanda MM, Musoke DK, Ngabirano T, Mwale M, Nakitende A, et al. Acceptability of HIV self-testing to support pre-exposure prophylaxis among female sex workers in Uganda and Zambia: results from two randomized controlled trials. BMC infectious diseases. 2018;18:8. Jiang H, Zhou Y, Tang W. Maintaining HIV care during the COVID-19 pandemic. The lancet HIV. 2020;7(5):e308-e9. CDC. Self-test. Available at https://www.cdc.gov/hiv/testing/self-testing.html . Accessed on 15th May, 2020. . 2020. Makyao N, Ramadhan DA, Urasa P, Subi DL, Chaula DZ, Kisendi R, et al. Lesson learnt from a combined HIV prevention using HIV self-testing and oral pre-exposure prophylaxis (PrEP) demonstration project in the United Republic of Tanzania. HIV medicine. 2019;20:245-. WHO. WHO. Consolidated guidelines on HIV testing services. Available at https://www.who.int/hiv/pub/guidelines/hiv-testing-services/en/ . Accessed on 13th Jan, 2020. . 2015. PREEXPOSURE PROPHYLAXIS FOR THE PREVENTION OF HIV INFECTION IN THE UNITED STATES – 2017 UPDATE 2017. Wang H, Zhang Y, Mei Z, Jia Y, Leuba SI, Zhang J, et al. Protocol for a multicenter, real-world study of HIV pre-exposure prophylaxis among men who have sex with men in China (CROPrEP). BMC infectious diseases. 2019;19(1):721. Molina J-M GJ, Beniguel L, Rojas-Castro D, Algarte-Genin M, Pialoux G et al. Incidence of HIV-infection in the ANRS Prévenir study in Paris region with daily or on-demand PrEP with TDF/FTC. 22nd International AIDS Conference (AIDS 2018); Amsterdam, 23–27 July 2018: International AIDS Society. Late breaker oral abstract WEAE0406LB ( http://programme.aids2018.org/Abstract/Abstract/13278 , accessed 19 December 2019). 2018. Zimmermann HM, Eekman SW, Achterbergh RC, Schim van der Loeff MF, Prins M, de Vries HJ, et al. Motives for choosing, switching and stopping daily or event‐driven pre‐exposure prophylaxis – a qualitative analysis. J Int AIDS Soc. 2019;22(10). Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-36752","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research article","associatedPublications":[],"authors":[{"id":711497,"identity":"a7eb8fec-0905-42cc-ae33-1502b99a3ae2","order_by":0,"name":"Jing Zhang","email":"","orcid":"","institution":"China Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jing","middleName":"","lastName":"Zhang","suffix":""},{"id":711498,"identity":"3e84a919-4d8b-4314-bd70-78b8fffe5b03","order_by":1,"name":"Wei-ming Tang","email":"","orcid":"","institution":"University of North Carolina at Chapel Hill","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Wei-ming","middleName":"","lastName":"Tang","suffix":""},{"id":711499,"identity":"5662d96b-10e6-4cc4-b4df-bcb188d13ae7","order_by":2,"name":"Xia Jin","email":"","orcid":"","institution":"China Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xia","middleName":"","lastName":"Jin","suffix":""},{"id":711500,"identity":"95006398-2788-448f-8e98-27874a1f097f","order_by":3,"name":"Hong-yi Wang","email":"","orcid":"","institution":"China Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hong-yi","middleName":"","lastName":"Wang","suffix":""},{"id":711501,"identity":"6ab777bf-2cb7-429b-a4df-e6cb611fbbfa","order_by":4,"name":"Zhen-xing Chu","email":"","orcid":"","institution":"China Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zhen-xing","middleName":"","lastName":"Chu","suffix":""},{"id":711502,"identity":"917c5916-b0a1-48ef-a8c4-49cd8eba9652","order_by":5,"name":"Qing-hai Hu","email":"","orcid":"","institution":"China Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Qing-hai","middleName":"","lastName":"Hu","suffix":""},{"id":711503,"identity":"f847b9d3-8903-40c5-9f26-7a080dc3a38b","order_by":6,"name":"Xiao-jie Huang","email":"","orcid":"","institution":"Capital Medical University Youan Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xiao-jie","middleName":"","lastName":"Huang","suffix":""},{"id":711504,"identity":"bf42912b-94b8-4789-9add-404d03eda286","order_by":7,"name":"Yao-kai Chen","email":"","orcid":"","institution":"Chongqing Public Health Medical Center","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yao-kai","middleName":"","lastName":"Chen","suffix":""},{"id":711505,"identity":"1d76bf5e-fd6d-4d0b-8dc6-80afd8c8b65a","order_by":8,"name":"Hui Wang","email":"","orcid":"","institution":"The Third People's Hospital of Shenzhen","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hui","middleName":"","lastName":"Wang","suffix":""},{"id":711506,"identity":"edaddbdb-d77c-400e-9df5-4da144e7a39f","order_by":9,"name":"Xiao-qing He","email":"","orcid":"","institution":"Chongqing Public Health Medical Center","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xiao-qing","middleName":"","lastName":"He","suffix":""},{"id":711507,"identity":"e2f9411d-7ce4-498d-88d6-0b932dd9c776","order_by":10,"name":"Yao Li","email":"","orcid":"","institution":"Chongqing Public Health Medical Center","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yao","middleName":"","lastName":"Li","suffix":""},{"id":711508,"identity":"34c89b15-8748-4b5d-95e3-969ab95798c0","order_by":11,"name":"Lu-kun Zhang","email":"","orcid":"","institution":"The Third People's Hospital of Shenzhen","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Lu-kun","middleName":"","lastName":"Zhang","suffix":""},{"id":711509,"identity":"cff80685-71ee-4855-a6fd-5479fad524eb","order_by":12,"name":"Zhi-li Hu","email":"","orcid":"","institution":"China Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zhi-li","middleName":"","lastName":"Hu","suffix":""},{"id":711510,"identity":"b166bf11-984d-4b0d-8c44-cef6f16215da","order_by":13,"name":"Ran-tong Bao","email":"","orcid":"","institution":"China Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ran-tong","middleName":"","lastName":"Bao","suffix":""},{"id":711511,"identity":"831206a6-c2e7-4bb4-8b6a-de66d2603c23","order_by":14,"name":"Shang-cao Li","email":"","orcid":"","institution":"China Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Shang-cao","middleName":"","lastName":"Li","suffix":""},{"id":711512,"identity":"071db962-5e2a-4375-bcca-90ab2b5fd459","order_by":15,"name":"Hang Li","email":"","orcid":"","institution":"China Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hang","middleName":"","lastName":"Li","suffix":""},{"id":711513,"identity":"630d148a-9184-4cd3-8d42-09e806f55051","order_by":16,"name":"Hai-bo Ding","email":"","orcid":"","institution":"China Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hai-bo","middleName":"","lastName":"Ding","suffix":""},{"id":711514,"identity":"c78a5805-b581-4a2b-8cee-1108a4580e49","order_by":17,"name":"Yong-jun Jiang","email":"","orcid":"","institution":"NHC Key Laboratory of AIDS Immunology","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yong-jun","middleName":"","lastName":"Jiang","suffix":""},{"id":711515,"identity":"922e0b9f-fe39-46a9-8bfe-73abe490e4b3","order_by":18,"name":"Wen-qing Geng","email":"","orcid":"","institution":"NHC Key Laboratory of AIDS Immunology","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Wen-qing","middleName":"","lastName":"Geng","suffix":""},{"id":711516,"identity":"0bc24fe8-2c37-4618-ab4a-0588e37cb295","order_by":19,"name":"Jun-jie Xu","email":"","orcid":"","institution":"China Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jun-jie","middleName":"","lastName":"Xu","suffix":""},{"id":711517,"identity":"71cd7e0a-b75e-49bd-bdf7-6220ca1d1b4e","order_by":20,"name":"Hong Shang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/0lEQVRIiWNgGAWjYBACAxDB2AAkmBkbDnxsAHMbDxCnhZ354MOZDQwSIC6RWvjZko15wVoYGPBqMWfvPfzy5w67PHlnHjNp2x02dbrth4G21NhE49Ji2XMuzZr3THKx4WGgltwzaRJmZxKBWo6l5TbgctiNHDNjxjbmxI3NIC1thyXMDgC1MDYcxqvF8GdbPUSLJUjL+YcEtRg/4G07nDifGeh9RpCWG4RsOXPGjJm37XjiBmZgIPe2pUluuwG0JQGfX473GH/82VadOL//YMOBn202/Gbn0x8++FBjg1MLELCBo8LgALJYAm7lIMD8AUTK4zF0FIyCUTAKRjgAADIBZuBMbd3TAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0001-5333-8943","institution":"NHC Key Laboratory of AIDS Immunology (China Medical University)","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Hong","middleName":"","lastName":"Shang","suffix":""}],"badges":[],"createdAt":"2020-06-19 22:11:53","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-36752/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-36752/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":13548006,"identity":"08944d1c-2cc0-4a2e-bda1-2568c1ce9e0c","added_by":"auto","created_at":"2021-09-17 02:15:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":517317,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-36752/v1/fd74a378-a822-4b81-8c1f-b8f0976e4726.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003eHigh Acceptance of HIV Self-testing Among PrEP Recipients before COVID-19 Era: A Cross-sectional Analysis from PrEP Demonstration Project of MSM in China\u003c/p\u003e","fulltext":[{"header":"Background","content":" \u003cp\u003eWorld Health Organization (WHO) and Center for Disease Control and Prevention (CDC) (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) recommend users of oral pre-exposure prophylaxis (PrEP) to test for HIV quarterly, to avoid resistance to antiretroviral therapy (ART) by breakthrough infections (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Medicine compliance to PrEP is barely 60% among users worldwide(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Mutations that impact the efficacy of first-line ART can develop within 2 weeks of PrEP being administered every day to HIV-infected individuals (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Although the number of cases of resistance to anti-HIV-1 drugs during PrEP is small (\u003cspan additionalcitationids=\"CR6 CR7\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) it remains one of the main concerns for HIV key populations for PrEP acceptance (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn real world settings, even testing HIV every 3 months at facility-based HIV testing service is implausible among PrEP recipients. There were 75% of PrEP recipients missed their facility-based testing after PrEP initiation (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) and had difficulty attending one during PrEP (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Moreover, among HIV key populations such as men who have sex with men (MSM), there is only 38.0\u0026ndash;65.1% had tested for HIV in the past 6\u0026ndash;12 months worldwide, and only 47.0\u0026ndash;83.6% had ever been tested for HIV in their lifetime (\u003cspan additionalcitationids=\"CR15 CR16 CR17 CR18\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). It is crucial to explore innovative HIV testing strategies to pair PrEP implementation.\u003c/p\u003e \u003cp\u003eIn recent few years, HIV self-testing (HIVST) has changed the course of HIV testing among HIV key populations by reaching more first-time testers (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) and increasing the HIV-testing frequency (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) among them, especially in resource-limited settings (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). HIVST allows people to take an HIV test and discover their result in their home or other private location (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). In 2016, the WHO published the first global guidelines on HIVST, in which HIVST was recommended as an additional approach to HIV-testing services (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Seventy-seven countries have adopted HIVST policies, while many others are currently developing them currently (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHIVST has been offered to the HIV-negative partners of HIV-discordant couples and women at risk who were on PrEP to use between quarterly clinic visits (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) or biannual clinic visits (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). HIVST has demonstrated high acceptance, high use, and ease of use among PrEP recipients in the settings mentioned above (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Higher preference for HIVST than facility-based HIV testing during PrEP among female sex workers has been documented in one setting (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). However, HIVST uptake among MSM and its correlates are not known.\u003c/p\u003e \u003cp\u003eCOVID-19 is still in a pandemic stage. Social distancing is still a primary to preventing the spread of SARS-COVI-2, causing a severe impact on maintaining the routinely traditional clinical-based HIV testing (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Therefore, the need to develop HIVST in the COVID-19 era has become increasingly prominent. The CDC recommends that HIVST services be provided to PrEP users when other options are not available (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). But so far there is no report of PrEP MSM's willingness to apply HIVST. This study is of great significance for the promotion of the application of HIVST among PrEP users.\u003c/p\u003e \u003cp\u003eWe aimed to assess acceptance of HIVST among PrEP candidates and explore its correlates, including demographics, HIV-testing history, preference for PrEP regimen, HIV-related behaviour. This study will shed light in the utility of HIVST in the era of PrEP, and provide evidence for paired HIV-testing strategy with PrEP implementation.\u003c/p\u003e "},{"header":"Methods","content":" \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign, setting and procedures\u003c/h2\u003e \u003cp\u003eThis cross-sectional study was conducted between December 2018 and September 2019 and leveraged the China Real-world study of Oral Pre-exposure Prophylaxis (CROPrEP) project for participant recruitment (clinical trial reference number here). The study sites were general hospitals equipped with HIV voluntary counselling and testing clinics (VCTs) and HIV treatment clinics with physicians specialising in infectious diseases in four major cities in China: The YouAn Hospital of Capital Medical University in Beijing, The First Affiliated Hospital of China Medical University in Shenyang, The Chongqing Public Health Medical Center of Southwest University in Chongqing, and The Third People\u0026rsquo;s Hospital of Shenzhen.\u003c/p\u003e \u003cp\u003eParticipant recruitment was conducted offline and online using convenient samples and snowballing (i.e., chain referral sampling) by: (i) distribution of posters and brochures in the HIV VCTs at the four study sites for MSM who arrived for counselling and testing; (ii) postings in MSM chat groups and on the study sites\u0026rsquo; official WeChat\u0026trade; and Tencent QQ\u0026trade; accounts (two of the most widely used social media applications in China); (iii) outreach events run by community-based organisations (CBOs) in bars, public baths and parks that provided study information, and MSM peer referral.\u003c/p\u003e \u003cp\u003eAll individuals who were interested in the recruitment advertisement of CROPrEP online and offline, needed to registered for and attend to an on-site screening appointment for eligibility of the CROPrEP trial. This on-site screening provides free testing for HIV infection and syphilis for adult MSM and transgender women. After providing written informed consent, participants willing to enrol underwent consultations with physicians and laboratory testing. The information of demographic, HIV related risk behaviour, HIV testing history and acceptance of HIVST was collected.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eMeasures\u003c/h2\u003e \u003cp\u003eData were collected through self-administrated questionnaires on each participants\u0026rsquo; smartphone. Participants were surveyed for acceptance to use free HIVST kits between each quarterly clinic visit, previous experience of facility-based HIV testing, and HIVST (frequency of using each type of testing service, as well as the reasons for using and not using them), their preference for PrEP regimens (daily or on-demand), demographics (age, education level, marital status, monthly income), HIV-related risk behaviour in the past 3 months (frequency of homosexual anal intercourse, and existence of condom-less anal intercourse). The levels of acceptance of HIVST were defined as \u0026ldquo;very willing to accept\u0026rdquo;, \u0026ldquo;willing to accept\u0026rdquo;, \u0026ldquo;unwilling to accept\u0026rdquo; and \u0026ldquo;very unwilling to accept\u0026rdquo;.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analyses\u003c/h2\u003e \u003cp\u003eWe conducted statistical analysis by SPSS v20.0 (IBM. Armonk, NY, USA). Demographics, preference for PrEP regimen, history of HIV testing, and level of acceptance of HIVST among all participants were described using numbers and percentages. Univariable and multivariable ordinal logistic regression analyses was used to assess the predictors of an increased level of acceptance to use HIVST between each quarterly clinic visit. Variables with \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.2 in the univariable analysis were included in the multivariable model. Variables in the final model were selected with an entry procedure. Model fitness was assessed by the goodness-of-fit statistics. Odds ratio and adjusted odds ratios were calculated by a general linear model. \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 in the multivariate analysis was the cut-off for a significant difference.\u003c/p\u003e \u003c/div\u003e "},{"header":"Results","content":" \u003cp\u003eA total of 1222 men participated in on-site screening and completed the relevant screening programs. Among these men, the median age was 30-year-old (Interquartile rang, IQR 25\u0026ndash;36) and 79.4% (970/1222) had education level as undergraduate and above. There was 68.3% (835/1222) of them had unprotected anal intercourse during the previous 3\u0026nbsp;months. Among all participants, 48.5% (592/1222) preferred daily medication and 51.5% (630/1222) preferred event-driven medication (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of PrEP candidates in four major cities of China, 2018\u0026ndash;2019 (N\u0026thinsp;=\u0026thinsp;1222)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreference of PrEP regimen\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDaily\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e592 (48.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOn-demand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e630 (51.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years) [Median, IQR]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (25\u0026ndash;36)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19\u0026ndash;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e319 (26.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e26 and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e903 (73.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSenior high and below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e252 (20.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUndergraduate and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e970 (79.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMonthly income (US dollars)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;857\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e649 (53.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;858\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e573 (46.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e662 (54.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried with a female, in a stable relationship with a male, Divorced or widowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e560 (45.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFrequency of homosexual intercourse in the previous 3 months\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEvery day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (1.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEvery week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e434(35.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEvery month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e591(48.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than once a month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e182 (14.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHad condom-less anal intercourse in the previous 3 months\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e835 (68.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e387 (31.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHave heard of/known about HIVST\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1145 (93.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77 (6.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHave used HIVST before\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e910 (74.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e312 (25.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHave used a facility-based HIV testing before\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e901 (73.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e321 (26.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTimes of using HIVST in the past year [Median, IQR]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (2\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTimes of using facility-based HIV testing in the past year [Median, IQR]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003ePrevious experience of HIV facility-based testing and HIVST\u003c/h2\u003e \u003cp\u003eA total of 1145 participants (93.6%) reported that they had heard of HIVST, and 910 participants (74.5%) had used HIVST previously. The median number of times HIVST was used in the previous year was three (IQR 2\u0026ndash;5). There were 321 participants (26.3%) had never used facility-based HIV testing before. The main reason given for the 321 participants who had never used facility-based HIV testing was that they undertook HIVST (49.2%, 158/321). The median number of times participants who undertook facility-based HIV testing in the past year was two (IQR 1\u0026ndash;4). (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eAcceptance of HIVST during PrEP and motives\u003c/h2\u003e \u003cp\u003eOf 1222 participants, 1184 (96.9%) accept HIVST during PrEP. Of these, 77.5% (947/1222) were very willing to accept, 19.4% (237/1222) were willing to accept, 2.4% (29/1222) were unwilling to accept, and 0.7% (9/1222) were very unwilling to accept HIVST to use between quarterly clinic visits during PrEP. The main motives for acceptance of HIVST were \u0026ldquo;good privacy for HIV testing\u0026rdquo; (69.1%, 818/1184) and \u0026ldquo;ease of use\u0026rdquo; (68.9%, 816/1184). The main reasons for non-acceptance of HIVST were \u0026ldquo;fear of inaccuracy of the results of HIVST\u0026rdquo; (41.1%, 16/38) and \u0026ldquo;fear of needles/blood\u0026rdquo; (34.2%, 13/38) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAcceptance of HIVST and reasons among PrEP candidates in China, 2018\u0026ndash;2019\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAcceptance to use HIVST between each quarterly clinic visit of PrEP (N\u0026thinsp;=\u0026thinsp;1222)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery willing to\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e947 (77.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWilling to\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e237 (19.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnwilling to\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29 (2.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery unwilling to\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (0.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReasons for acceptance (N\u0026thinsp;=\u0026thinsp;1184)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood privacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e818 (69.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEasy to use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e816 (68.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevents drug resistance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e150 (12.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGetting testing results is quick\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e611 (51.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e151 (12.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (0.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReasons for non-acceptance (N\u0026thinsp;=\u0026thinsp;38)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfraid of needle/blood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13 (34.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorry about the accuracy of HIVST\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16 (41.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHIVST is not easy to use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (15.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIt is unnecessary for HIVST as long as there is facility-based testing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (26.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI am not high-risk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (7.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfraid of a positive result of HIVST\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (15.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfraid other people would see me using HIVST and think I am HIV-positive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (15.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (5.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eCorrelation of increased acceptance of HIVST during PrEP\u003c/h2\u003e \u003cp\u003eUnivariable ordinal logistic regression analysis revealed several factors to be correlated with an increased level of acceptance of HIVST (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05): daily PrEP regimen; education level; monthly income; number of using facility-based HIV testing in the previous year; number of the times HIVST had been used in the previous year.\u003c/p\u003e \u003cp\u003eThe multivariable ordinal logistic regression analysis revealed the significant and independent predictors of higher acceptance of HIVST use during PrEP. Participants who preferred daily PrEP were 1.8-times (95% CI: 1.3\u0026ndash;2.4) more likely to have higher acceptance of HIVST than those who preferred on-demand PrEP (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Compared with those with an education level of senior high school or below, men having an education level of undergraduate and above were 2.6-times (95% CI: 1.1\u0026ndash;2.1) more likely to have higher acceptance of HIVST (P\u0026thinsp;=\u0026thinsp;0.023). Compared with people who had monthly income lower than 858 USD, men with monthly income above 858 were 0.7-times (95% CI: 0.5\u0026ndash;0.9) more likely to have higher acceptance of HIVST (P\u0026thinsp;=\u0026thinsp;0.017). Compared with people who had\u0026thinsp;\u0026ge;\u0026thinsp;2 facility-based HIV tests in the previous year, those who did not were 1.4-times (95% CI: 1.1\u0026ndash;1.9) more likely to have higher acceptance of HIVST (P\u0026thinsp;=\u0026thinsp;0.014). Compared with people who had\u0026thinsp;\u0026ge;\u0026thinsp;3 HIVSTs in the previous year, those who did not were 0.3-times (95% CI: 0.2\u0026ndash;0.4) more likely to have higher acceptance of HIVST (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e Table 3 Univariable and multivariable ordinal logistic regression models for predicting increased level of acceptance to use HIVST during PrEP among PrEP candidates in China, 2018\u0026ndash;2019 (N\u0026thinsp;=\u0026thinsp;1222)\u003c/p\u003e \n\u003cp\u003e\u003cimg src=\"data:image/png;base64,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\"\u003e\u003c/p\u003e"},{"header":"Discussion","content":" \u003cp\u003eWe exam the acceptance of HIVST among PrEP candidates and its correlates in a multicentre oral PrEP demonstration project in China. The median times of HIVST and facility-based HIV testing in the past year of these candidates were 3 and 2 respectively. Nearly all (96.9%) of the PrEP candidates accepted HIVST. Men with a preference for daily PrEP and had used facility-based HIV testing less than twice in the previous year were more likely to have higher level of acceptance of HIVST. This result showed the necessity and feasibility of offering HIVST service during PrEP.\u003c/p\u003e \u003cp\u003eThe rate of acceptance of HIVST is high among PrEP candidates of MSM, which is in accordance with previous studies of sero-discordant couples and females using PrEP in Africa (\u003cspan additionalcitationids=\"CR29 CR30\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). This high rate can be explained by the fact that HIVST had already became a main way of HIV testing among these MSM. Among these PrEP candidates, the median number of HIVST use in the previous year had already outnumbered that of facility-based HIV testing. There were three-quarters of the PrEP candidates had used HIVST previously and nearly all of them have heard about HIVST before. The self-reported major reasons of this acceptance were good privacy, easy to use and getting testing results quickly. Also, this study was conducted before the COVID-19 pandemic, which indicates possibility of a higher acceptance of HIVST during the pandemic. This high acceptance of HIVST also suggests a method to maintain this ongoing PrEP trial, since the quarantine against COVID-19 is still required. Above results suggest feasibility to provide HIVST to MSM PrEP users.\u003c/p\u003e \u003cp\u003eThis study also indicates necessity to provide HIVST to MSM PrEP users. The WHO recommends general MSM test for HIV every half year (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e) and PrEP users test HIV at a facility-based testing service at least every quarter (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). However, there were more than a quarter of the PrEP candidates had never used any facility-based HIV testing before, which indicates potential hardship in maintaining their attendance to facility-based HIV testing during PrEP. Missed attending facility-based testing and difficulty in attending clinical visits leads to interruption and discontinuation of PrEP (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Fortunately, PrEP candidates with less than two facility-based HIV testing in the past year were more likely to accept HIVST. Providing PrEP users with HIVST can serve as additional options for HIV testing.\u003c/p\u003e \u003cp\u003ePreference for daily regimen of PrEP is also correlated with higher acceptance of HIVST during PrEP. This study allowed PrEP candidates to choose their regimen between daily and on-demand (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Real-world studies have shown that, compared to those who chose on-demand PrEP, MSM chose daily PrEP were having more HIV-related risk behaviour (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Resistance to ART is more likely to occur with a higher selection pressure of the drug (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Considering the higher exposure to HIV infection and generally low adherence to PrEP among MSM, with daily administration of PrEP to a HIV-infected person, mutations that affect the efficacy of first-line ART can develop in 2 weeks (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Providing HIVST for daily users of PrEP could meet their needs. Nevertheless, challenges in supervision for on-demand PrEP must be addressed because non-daily use of PrEP becomes more common outside of controlled research settings (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis study has both strengths and limitations. This study explored acceptance of HIVST among MSM PrEP users for the first time, revealing the high necessity and feasibility to paired PrEP with HIVST. However, since fourth generation of HIVST, which could can detect both HIV antibodies and p24 antigens, we provided the third generation HIVST to PrEP candidates. The high acceptance of HIVST reported in this study indicates better acceptance of fourth generation of HIVST among PrEP users in the future. Also, this study is a cross-sectional design, which cannot provide actual use in the follow-up and impact of HIVST usage on behaviour of PrEP users. The data of actual usage of HIVST and its impact on behaviour among PrEP users will be reported soon.\u003c/p\u003e "},{"header":"Conclusions","content":" \u003cp\u003eThe MSM who participated in the first real-world PrEP trial in China had high acceptance to HIVST during PrEP. Inadequate facility-based HIV testing in the previous year and preference for daily PrEP was correlated with higher acceptance of HIVST. Providing HIVST to MSM PrEP users is feasible and necessary, especially during the time of social distancing and quarantine.\u003c/p\u003e "},{"header":"List Of Abbreviations","content":"\u003cp\u003eHIV, human immunodeficiency virus; HIVST, HIV self-testing; PrEP, pre-exposure prophylaxis; COVID-19, coronavirus disease 2019; MSM, men who have sex with men; CBO, community-based organization;\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthical approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eThe study protocol was approved by the ethics review board of the First Affiliated Hospital of China Medical University (IRB[2018]273) in Shenyang, China. Written informed consent was obtained from each participant before collecting study information or blood samples. Participants took part in the study voluntarily and had the right to refuse to answer any question. Participants had the right to withdraw from the study without penalty. The protocol for the CROPrEP trial has been published (37). This HIVST study among PrEP recipients was registered on Chinese Clinical Trial Registry (trial ID ChiCTR1800020374).\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\n\u003cp\u003eThe datasets used and analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis work was supported by the Mega-Projects of national science research (13rd Five-Year Plan [2017ZX10201101-002-007]), the Mega-Projects of national science research (12\u003csup\u003eth\u003c/sup\u003e Five-Year Plan [2012ZX10001006-001-010]), National Natural Science Foundation of China (81872674), the Mega-Projects of national science research (2018ZX10101001-001-003). The funders had no role in the study design, data collection and analysis, interpretation of data, writing the manuscript, decision to publish, or preparation of the paper.\u003c/p\u003e\n\u003ch2\u003eAuthors\u0026rsquo; contributions\u003c/h2\u003e\n\u003cp\u003eConceived and designed the experiment: JZ, JJX, HS; performed the study and experiments: JZ, JX, HYW, ZXC, QHH, XJH, YKC, HW, XQH, YL, LKZ, ZLH, RTB, SCL, HL, HBD, YJJ, WQG; drafted the study report: JZ, JJX, WMT. All authors reviewed and approved the final report.\u003c/p\u003e\n\u003ch2\u003eAcknowledgements\u003c/h2\u003e\n\u003cp\u003eThe authors would like to thank the community-based organizations of \u003cem\u003eSunshine\u003c/em\u003e at Shenyang, \u003cem\u003eYouAn-Tian Yuan Studio\u003c/em\u003e at Beijing, \u003cem\u003eChongqing Red Ribbon AIDS Care Center\u003c/em\u003e at Chongqing and \u003cem\u003e258 Rainbow Workshop\u003c/em\u003e at Shenzhen for their help with recruiting and maintaining the participants. We would also like to thank all of the participants for being in our study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eUS Public Health Service. PREEXPOSURE PROPHYLAXIS FOR THE PREVENTION OF HIV INFECTION IN THE UNITED STATES-2017 UPDATE: A CLINICAL PRACTICE GUIDELINE. 2017.\u003c/li\u003e\n\u003cli\u003eCDC recommends pill to protect against HIV - CBS News. Available at \u003ca href=\"https://www.cbsnews.com/news/cdc-recommends-pill-to-protect-against-hiv/\"\u003ehttps://www.cbsnews.com/news/cdc-recommends-pill-to-protect-against-hiv/\u003c/a\u003e. Accessed on 3rd Sep, 2019.\u003c/li\u003e\n\u003cli\u003eYun K, Xu JJ, Zhang J, Li JM, Hu QH, Chu ZX, et al. Female and younger subjects have lower adherence in PrEP trials: a meta-analysis with implications for the uptake of PrEP service to prevent HIV. Sex Transm Infect. 2018;94(3):163-8.\u003c/li\u003e\n\u003cli\u003eHurt CB, Eron JJ, Jr., Cohen MS. Pre-exposure prophylaxis and antiretroviral resistance: HIV prevention at a cost? Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2011;53(12):1265-70.\u003c/li\u003e\n\u003cli\u003eDelaugerre C, Rodriguez C, Capitant C, Nere ML, Mercier-Darty M, Carette D, et al. Drug resistance among patients who acquired HIV infection in a preexposure prophylaxis trial. Aids. 2018;32(16):2353-61.\u003c/li\u003e\n\u003cli\u003eLehman DA, Baeten JM, McCoy CO, Weis JF, Peterson D, Mbara G, et al. Risk of drug resistance among persons acquiring HIV within a randomized clinical trial of single- or dual-agent preexposure prophylaxis. J Infect Dis. 2015;211(8):1211-8.\u003c/li\u003e\n\u003cli\u003eLiegler T, Abdel-Mohsen M, Bentley LG, Atchison R, Schmidt T, Javier J, et al. HIV-1 drug resistance in the iPrEx preexposure prophylaxis trial. J Infect Dis. 2014;210(8):1217-27.\u003c/li\u003e\n\u003cli\u003eVolk JE, Nguyen DP, Hare CB, Marcus JL. HIV Infection and Drug Resistance with Unsupervised Use of HIV Pre-Exposure Prophylaxis. AIDS Res Hum Retroviruses. 2018;34(4):329-30.\u003c/li\u003e\n\u003cli\u003eGolub SA, Gamarel KE, Rendina HJ, Surace A, Lelutiu-Weinberger CL. From Efficacy to Effectiveness: Facilitators and Barriers to PrEP Acceptability and Motivations for Adherence Among MSM and Transgender Women in New York City. AIDS patient care and STDs. 2013;27(4):248-54.\u003c/li\u003e\n\u003cli\u003eIdoko J, Folayan MO, Dadem NY, Kolawole GO, Anenih J, Alhassan E. \"Why should I take drugs for your infection?\": outcomes of formative research on the use of HIV pre-exposure prophylaxis in Nigeria. BMC public health. 2015;15:12.\u003c/li\u003e\n\u003cli\u003eZucker J, Carnevale C, Richards P, Slowikowski J, Borsa A, Gottlieb F, et al. Predictors of Disengagement in Care for Individuals Receiving Pre-exposure Prophylaxis (PrEP). J Acquir Immune Defic Syndr. 2019;81(4):e104-e8.\u003c/li\u003e\n\u003cli\u003eScott HM, Spinelli M, Vittinghoff E, Morehead-Gee A, Hirozawa A, James C, et al. Racial/ethnic and HIV risk category disparities in preexposure prophylaxis discontinuation among patients in publicly funded primary care clinics. Aids. 2019;33(14):2189-95.\u003c/li\u003e\n\u003cli\u003eRolle CP, Onwubiko U, Jo J, Sheth AN, Kelley CF, Holland DP. PrEP Implementation and Persistence in a County Health Department Setting in Atlanta, GA. AIDS and behavior. 2019;23(Suppl 3):296-303.\u003c/li\u003e\n\u003cli\u003eZou H, Hu N, Xin Q, Beck J. HIV testing among men who have sex with men in China: a systematic review and meta-analysis. AIDS and behavior. 2012;16(7):1717-28.\u003c/li\u003e\n\u003cli\u003eYi S, Tuot S, Chhoun P, Brody C, Pal K, Oum S. Factors associated with recent HIV testing among high-risk men who have sex with men: a cross-sectional study in Cambodia. BMC public health. 2015;15:743.\u003c/li\u003e\n\u003cli\u003eKhawcharoenporn T, Mongkolkaewsub S, Naijitra C, Khonphiern W, Apisarnthanarak A, Phanuphak N. HIV risk, risk perception and uptake of HIV testing and counseling among youth men who have sex with men attending a gay sauna. AIDS research and therapy. 2019;16(1):13.\u003c/li\u003e\n\u003cli\u003eStromdahl S, Hoijer J, Eriksen J. Uptake of peer-led venue-based HIV testing sites in Sweden aimed at men who have sex with men (MSM) and trans persons: a cross-sectional survey. Sex Transm Infect. 2019;95(8):575-9.\u003c/li\u003e\n\u003cli\u003eTun W, Vu L, Dirisu O, Sekoni A, Shoyemi E, Njab J, et al. Uptake of HIV self-testing and linkage to treatment among men who have sex with men (MSM) in Nigeria: A pilot programme using key opinion leaders to reach MSM. J Int AIDS Soc. 2018;21 Suppl 5:e25124.\u003c/li\u003e\n\u003cli\u003eDiez M, Bleda MJ, Varela JR, Ordonana J, Azpiri MA, Vall M, et al. Trends in HIV testing, prevalence among first-time testers, and incidence in most-at-risk populations in Spain: the EPI-VIH Study, 2000 to 2009. Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin. 2014;19(47):20971.\u003c/li\u003e\n\u003cli\u003eZhang C, Li XH, Brecht ML, Koniak-Griffin D. Can self-testing increase HIV testing among men who have sex with men: A systematic review and meta-analysis. Plos One. 2017;12(11):19.\u003c/li\u003e\n\u003cli\u003eJamil MS, Prestage G, Fairley CK, Grulich AE, Smith KS, Chen M, et al. Effect of availability of HIV self-testing on HIV testing frequency in gay and bisexual men at high risk of infection (FORTH): a waiting-list randomised controlled trial. The lancet HIV. 2017;4(6):E241-E50.\u003c/li\u003e\n\u003cli\u003eJohnson CC, Kennedy C, Fonner V, Siegfried N, Figueroa C, Dalal S, et al. Examining the effects of HIV self-testing compared to standard HIV testing services: a systematic review and meta-analysis. Journal of the International Aids Society. 2017;20:10.\u003c/li\u003e\n\u003cli\u003eMaheswaran H, Clarke A, MacPherson P, Kumwenda F, Lalloo DG, Corbett EL, et al. Cost-Effectiveness of Community-based Human Immunodeficiency Virus Self-Testing in Blantyre, Malawi. Clin Infect Dis. 2018;66(8):1211-21.\u003c/li\u003e\n\u003cli\u003eCambiano V, Ford D, Mabugu T, Mavedzenge SN, Miners A, Mugurungi O, et al. Assessment of the Potential Impact and Cost-effectiveness of Self-Testing for HIV in Low-Income Countries. J Infect Dis. 2015;212(4):570-7.\u003c/li\u003e\n\u003cli\u003eCDC. Centers for Disease Control and Prevention. Self-Testing. Available at \u003ca href=\"https://www.cdc.gov/hiv/testing/self-testing.html\"\u003ehttps://www.cdc.gov/hiv/testing/self-testing.html\u003c/a\u003e. Accesed at 13th Jan, 2020.\u003c/li\u003e\n\u003cli\u003eWHO. Guidelines on HIV self-testing and partner notification Supplement to consolidated guidelines on HIV testing services. Availabe at \u003ca href=\"https://www.who.int/hiv/pub/vct/hiv-self-testing-guidelines/en/\"\u003ehttps://www.who.int/hiv/pub/vct/hiv-self-testing-guidelines/en/\u003c/a\u003e. Accessed on 13th Jan, 2020. 2016.\u003c/li\u003e\n\u003cli\u003eWHO. HIV self-testing. Available at \u003ca href=\"https://www.who.int/hiv/topics/self-testing/en/\"\u003ehttps://www.who.int/hiv/topics/self-testing/en/\u003c/a\u003e. Accessed on 13th Jan, 2020. 2019.\u003c/li\u003e\n\u003cli\u003eNgure K, Heffron R, Mugo N, Irungu E, Njuguna N, Mwaniki L, et al. Uptake of HIV Self-testing among People Receiving PrEP in Kenya. Aids Research and Human Retroviruses. 2014;30:A70-A.\u003c/li\u003e\n\u003cli\u003eOrtblad KF, Kearney JE, Mugwanya K, Irungu EM, Haberer JE, Barnabas RV, et al. HIV-1 self-testing to improve the efficiency of pre-exposure prophylaxis delivery: a randomized trial in Kenya. Trials. 2019;20:10.\u003c/li\u003e\n\u003cli\u003eNgure K, Heffron R, Mugo N, Thomson KA, Irungu E, Njuguna N, et al. Feasibility and acceptability of HIV self-testing among pre-exposure prophylaxis users in Kenya. Journal of the International Aids Society. 2017;20:8.\u003c/li\u003e\n\u003cli\u003eOrtblad KF, Chanda MM, Musoke DK, Ngabirano T, Mwale M, Nakitende A, et al. Acceptability of HIV self-testing to support pre-exposure prophylaxis among female sex workers in Uganda and Zambia: results from two randomized controlled trials. BMC infectious diseases. 2018;18:8.\u003c/li\u003e\n\u003cli\u003eJiang H, Zhou Y, Tang W. Maintaining HIV care during the COVID-19 pandemic. The lancet HIV. 2020;7(5):e308-e9.\u003c/li\u003e\n\u003cli\u003eCDC. Self-test. Available at \u003ca href=\"https://www.cdc.gov/hiv/testing/self-testing.html\"\u003ehttps://www.cdc.gov/hiv/testing/self-testing.html\u003c/a\u003e. Accessed on 15th May, 2020. . 2020.\u003c/li\u003e\n\u003cli\u003eMakyao N, Ramadhan DA, Urasa P, Subi DL, Chaula DZ, Kisendi R, et al. Lesson learnt from a combined HIV prevention using HIV self-testing and oral pre-exposure prophylaxis (PrEP) demonstration project in the United Republic of Tanzania. HIV medicine. 2019;20:245-.\u003c/li\u003e\n\u003cli\u003eWHO. WHO. Consolidated guidelines on HIV testing services. Available at \u003ca href=\"https://www.who.int/hiv/pub/guidelines/hiv-testing-services/en/\"\u003ehttps://www.who.int/hiv/pub/guidelines/hiv-testing-services/en/\u003c/a\u003e. Accessed on 13th Jan, 2020. . 2015.\u003c/li\u003e\n\u003cli\u003ePREEXPOSURE PROPHYLAXIS FOR THE PREVENTION OF HIV INFECTION IN THE UNITED STATES \u0026ndash; 2017 UPDATE 2017.\u003c/li\u003e\n\u003cli\u003eWang H, Zhang Y, Mei Z, Jia Y, Leuba SI, Zhang J, et al. Protocol for a multicenter, real-world study of HIV pre-exposure prophylaxis among men who have sex with men in China (CROPrEP). BMC infectious diseases. 2019;19(1):721.\u003c/li\u003e\n\u003cli\u003eMolina J-M GJ, Beniguel L, Rojas-Castro D, Algarte-Genin M, Pialoux G et al. Incidence of HIV-infection in the ANRS Pr\u0026eacute;venir study in Paris region with daily or on-demand PrEP with TDF/FTC. 22nd International AIDS Conference (AIDS 2018); Amsterdam, 23\u0026ndash;27 July 2018: International AIDS Society. Late breaker oral abstract WEAE0406LB (\u003ca href=\"http://programme.aids2018.org/Abstract/Abstract/13278\"\u003ehttp://programme.aids2018.org/Abstract/Abstract/13278\u003c/a\u003e, accessed 19 December 2019). 2018.\u003c/li\u003e\n\u003cli\u003eZimmermann HM, Eekman SW, Achterbergh RC, Schim van der Loeff MF, Prins M, de Vries HJ, et al. Motives for choosing, switching and stopping daily or event‐driven pre‐exposure prophylaxis \u0026ndash; a qualitative analysis. J Int AIDS Soc. 2019;22(10).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"HIV self-testing, Pre-exposure prophylaxis, men who have sex with men","lastPublishedDoi":"10.21203/rs.3.rs-36752/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-36752/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e 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. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eMSM 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. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eWe 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.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e 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.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTrial registration: \u003c/strong\u003eChiCTR1800020374 on 27\u003csup\u003eth\u003c/sup\u003e Dec 2018. \u003ca href=\"http://www.chictr.org.cn/searchproj.aspx\" rel=\"noopener noreferrer\" target=\"_blank\"\u003ehttp://www.chictr.org.cn/searchproj.aspx\u003c/a\u003e\u003c/p\u003e","manuscriptTitle":"High Acceptance of HIV Self-testing Among PrEP Recipients before COVID-19 Era: A Cross-sectional Analysis from PrEP Demonstration Project of MSM in China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2020-06-25 16:29:52","doi":"10.21203/rs.3.rs-36752/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e01de4f0-4e85-4c9f-a45c-7bde4ae2bec3","owner":[],"postedDate":"June 25th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":129700,"name":"Infectious Diseases"}],"tags":[],"updatedAt":"2020-06-25T20:38:09+00:00","versionOfRecord":[],"versionCreatedAt":"2020-06-25 16:29:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-36752","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-36752","identity":"rs-36752","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}