Temporal dynamics of PrEP adherence, self-efficacy, and risk perception among men who have sex with men in western China: a cross-lagged panel network analysis

Abstract

<title>Abstract</title> Background Pre-exposure prophylaxis (PrEP) effectively reduces HIV infection risk among men who have sex with men (MSM), but its benefit depends on adherence. The longitudinal item-level relationships among PrEP adherence, self-efficacy, and risk perception remain unclear. Methods This repeated-measures longitudinal study included 186 MSM in western China who completed three follow-up assessments from November 2019 to June 2023. PrEP adherence, self-efficacy, and risk perception were assessed at each wave. Cross-sectional network analysis and cross-lagged panel network analysis were used to examine contemporaneous and longitudinal associations. Network accuracy, stability, and robustness were evaluated using bootstrap and sensitivity analyses. Results Across all waves, the item “I can remember to take my medicine on time” was consistently the node most strongly associated with PrEP adherence. The item “When your sexual partner is upset about your use of it” showed high importance in cross-sectional networks. Longitudinal networks indicated strong autoregressive effects of PrEP adherence and stage-specific cross-lagged effects. From T1 to T2, adherence predicted partner-related self-efficacy, side-effect-related self-efficacy, and perceived side effects. From T2 to T3, adherence predicted habit-related experience and concerns about medication effectiveness. Conclusions PrEP adherence among MSM in western China is embedded in a dynamic system involving self-efficacy and risk perception. Stage-specific interventions targeting key psychological and behavioral factors may help improve PrEP adherence.