HIV感染风险在线预测预警对MSM人群HIV新发感染及相关高危行为的影响研究

Men who have Sex with Men (MSM) are the focus population of the worldwide HIV prevention campaign, Internet or mobile social networking applications (Apps) have turned to be the predominant sexual partners finding method among MSM population. According to previous reports, the seeking sexual partners through Internet or mobile social networking applications (Apps) was significantly correlated with multiple sexual partners, unprotected anal intercourse and higher HIV infection risk. Lacking understanding of self HIV-acquiring risk results in the difficulty of changing HIV-related high-risk behaviors, which hinders the HIV prevention to MSM population. Theoretically, online HIV acquiring risk prediction model can help MSM well understand self-HIV infection risk level and then take protected sexual behaviors. While, previous established HIV acquiring risk prediction models to MSM failed to incorporate the parameters of social networks and HIV transmission works of MSM subjects' sexual partners. Our study plans to incorporate the parameters of social networks and HIV transmission works of MSM subjects' sexual partners to optimize we previously established online HIV acquiring risk prediction model, and increase its predict precision. Then high-risk MSM will be enrolled and prospectively followed-up to evaluate the effect of optimized online HIV acquiring risk prediction model to the incidence of HIV and high-risk behaviors of men who have sex with men, compared with traditional HIV prevention strategy, to eventually provide innovative strategy for prediction and prevention of the HIV epidemic toward MSM population.

男男性行为者(MSM)是HIV防控的重点人群，而互联网和手机社交网络成为MSM寻伴主要方式，增加了其多性伴、无保护肛交及HIV感风险。由于不清楚自身HIV感染风险导致MSM难以改变高危行为，成为HIV疫情防控的重要阻碍因素。HIV感染风险预测模型可提高MSM对自身HIV感染风险客观认知，进而促进安全性行为的发生。但传统HIV感染风险预测模型缺乏MSM人群的社会网络特征及其性伴HIV传播网络参数。我们拟优化前期建立的在线HIV感染风险预测模型，在模型中整合社会网络特征和MSM性伴HIV传播网络参数，以增加模型的预测准确度。随后通过互联网招募MSM研究对象并开展前瞻性随访，评估优化的HIV风险评估模型及其有针对性HIV防控信息推送相对传统防控方式对MSM的高危性行为特征及HIV新发感染率的影响效能，旨在对我国MSM人群的HIV疫情预测预警及防控策略制定提供参考依据。

我国男男性行为(MSM)人群HIV感染率高，但高比例的高危MSM无法客观知晓自己的HIV感染风险且HIV检测比例低，亟待为该人群提供方便、准确、易用的HIV在线诊断工具。另外，既往尚无基于HIV在线诊断工具对MSM人群的HIV检测、高危性行为及HIV新发感染风险影响效果的前瞻性研究。我们基于建立的沈阳前瞻性研究队列（N=999）建立了MSM人群HIV新发感染预测的Cox比例风险模型，该风险诊断模型具有较好的校准度和区分度；在此基础上，基于微信小程序我们进一步开发了个体MSM人群新发感染预测HIV在线风险评估预测工具，并首次对沈阳198名MSM开展了随机对照临床试验研究。其中实验组（N=100）推送HIV在线风险评估预测工具，而对照组（N=98）仅推送传统HIV健康教育和检测促进的文字信息。干预实施第12周后，研究对象总保留率接近90%（87.5%），干预组过去3个月MSM男性性伴侣的数量和与临时性伴侣使用安全套的比率均显著低于对照组。该研究同时发现，上述电子健康干预的增量成本效益比为131.60美元，即平均减少1个性伴侣，需要增加19.70美元，增加1%的性伴侣使用安全套。研究结果显示，基于在线HIV风险预测工具的综合干预可以显著减少MSM中男性性伴侣的数量，并提高与临时伴侣使用安全套的比率，表明这种在线新型干预工具是一种非常有前景的MSM人群HIV检测促进和行为干预工具，且具有卫生经济学优势，值得在更大范围推广应用。