Abstract
What is already known about this topic?
Approximately 50% of patients with mpox are human immunodeficiency virus (HIV)-infected globally. Studies have shown that individuals with advanced HIV infection tend to have more severe clinical manifestations and higher mortality rates after mpox infection.
What is added by this report?
The study revealed that individuals living with HIV have a low level of Knowledge, Attitude, and Practice (KAP) towards mpox. Several factors, including age, registered residence, sexual orientation, education level, viral load, and co-occurrence of other sexually transmitted diseases, were found to influence the KAP towards mpox.
What are the implications for public health practice?
This study is the first to investigate the KAP of mpox among individuals living with HIV. The findings suggest that mpox health education should prioritize individuals with co-existing sexually transmitted diseases (STDs) and a high viral load.
Keywords: KAP, Mpox, HIV-Infected individuals
The global mpox outbreak, starting in May 2022, has spread rapidly across non-endemic regions ( 1). In this wave of the epidemic, 38% to 50% of mpox patients are also human immunodeficiency virus (HIV)-infected individuals, which face a higher risk of mpox infection, more severe clinical symptoms, and higher mortality rates due to their compromised immune system ( 2). The spread of mpox is particularly insidious ( 3), and the absence of smallpox vaccination among individuals born after 1980 has resulted in their lack of resistance to mpox ( 4). Furthermore, there is currently a lack of effective treatment measures for mpox, with symptomatic supportive therapy being the primary approach in clinical practice. Consequently, preventing and controlling mpox heavily relies on individuals’ self-regulation and responsible behavior. The Knowledge, Attitude, and Practice (KAP) theory, frequently used in health education for HIV-infected individuals and men who have sex with men (MSMs), addresses this need. Establishing beliefs in individuals requires both knowledge and a strong sense of responsibility. Behavior changes positively only when knowledge transforms into belief. Given these circumstances, the objective of this study is to evaluate the current level of mpox KAP among HIV-infected individuals and identify potential influencing factors.
This cross-sectional study was conducted at the Beijing Ditan Hospital of Capital Medical University from July 18 to August 9, 2023, using convenience sampling through a combination of online and field surveys. The study included participants who were 18 years or older, without any gender restrictions, while those who had previously experienced mpox infection or participated in mpox-related programs were excluded. The field survey involved on-site data verification, while the online survey utilized the Questionnaire Star platform to implement logical jumps and limit responses to one per WeChat account, thus ensuring the questionnaire’s data quality.
The questionnaire surveyed sociodemographic characteristics, HIV infection status, and mpox KAP. The 25-question knowledge section, based on the study by Jairoun AA et al. ( 5), scored 1 point per correct answer, with ≥16 points (≥60% accuracy) indicating mpox awareness. The attitude section included 16 questions and utilized a 5-point Likert scale. Higher scores indicated a more favorable attitude, with 5 points for strongly agree and 1 point for strongly disagree (and vice versa for negative statements). The total attitude score ranged from 16 to 80. Participants scoring ≥48 points (representing more than 60% of the total score) were considered to have a positive attitude towards mpox. To obtain the standardized attitude score, the dimension score was divided by the number of dimension entries. The practice section consisted of 7 questions. The highest score for each question was 3 points, while the lowest score was 1 point. The total practice score ranged from 7 to 21. Participants scoring ≥17 points (representing more than 80% of the total score) were considered to have a positive practice towards mpox. A collinearity test was conducted on the independent variables ( Supplementary Table S1, available at https://weekly.chinacdc.cn/). The mpox knowledge, attitude, practice, and KAP scores were converted into binary variables for binary logistic regression analysis.
Subject duplication was prevented by cross-verifying paper and electronic questionnaires using a unique identification code referred to as the ART (antiretroviral therapy) number. Statistical analysis was performed using SPSS software (web version 26.0; IBM, New York, USA) and RStudio software (version 4.2.1; R Foundation for Statistical Computing, Vienna, Austria). A significance level of P<0.05 (two-tailed) was employed to determine statistical significance. The Ethics Committee of Ditan Hospital granted approval.
A total of 1,235 individuals with HIV infection were included, with 486 from field surveys and 749 from online surveys. Among the participants, 48.3% (597/1,235) were aged between 35 and 55, 91.5% (1,130/1,235) were male, 61.5% (760/1,235) identified as homosexual, and 61.7% (762/1,235) reported a monthly income over 5,000 Chinese Yuan (CNY). The majority of participants had not received influenza vaccination (72.5%, 895/1,235), had not experienced other sexually transmitted diseases (85.9%, 1,061/1,235), and did not have any chronic diseases (68.9%, 851/1,235). In addition, most respondents reported being infected with HIV for more than 3 years (75.7%, 935/1,235), had a latest CD4 cell count greater than 500/mm 3 (55.3%, 683/1,235), and had a latest viral load test result of less than 20 copies/mL (76.2%, 941/1,235) ( Table 1).
Table 1. Sociodemographic characteristics and infection status of HIV-infected individuals ( N=1,235).
| Variable | n | Constituent ratio (%) |
Awareness
rate (%) |
Knowledge score* | Mann-Whitney U test/Kruskal-Wallis test | Attitude score* | Mann-Whitney U test/Kruskal-Wallis test | Practice score* | Mann-Whitney U test/Kruskal-Wallis test | KAP score* | Mann-Whitney U test/Kruskal-Wallis test | ||||
| U value/H value | P value | U value/H value | P value | U value/H value | P value | U value/H value | P value | ||||||||
| Abbreviation: HIV=human immunodeficiency virus; CNY=Chinese Yuan; KPA=Knowledge, Attitude, and Practice.
* The normality test results for mpox knowledge, attitude, practice, and KAP scores and scores in all dimensions indicated that the data did not follow a normal distribution ( P<0.05) ( Supplementary Table S2, available at https://weekly.chinacdc.cn/). Consequently, the median and interquartile intervals were utilized to describe the scores. † Calculations were conducted using the Mann-Whitney U test. | |||||||||||||||
| Age, years | |||||||||||||||
| <35 | 551 | 44.6 | 52.3 | 15 (10, 19) | 43.8 | <0.001 | 62 (57, 68) | 31.4 | <0.001 | 20 (19, 21) | 1.8 | 0.398 | 97 (88, 105) | 43.6 | <0.001 |
| 35–55 | 597 | 48.3 | 43.0 | 14 (8, 18) | 60 (55, 65) | 20 (19, 21) | 93 (83, 101) | ||||||||
| >55 | 87 | 7.1 | 26.4 | 9 (0, 15) | 59 (52, 64) | 20 (19, 21) | 85 (77, 98) | ||||||||
| Gender | |||||||||||||||
| Male | 1,130 | 91.5 | 48.6 | 14 (9, 18) | 64.0 | <0.001 | 61 (56, 67) | 10.9 | 0.004 | 20 (19, 21) | 9.1 | 0.011 | 95 (85, 103) | 37.1 | <0.001 |
| Female | 103 | 8.3 | 16.5 | 7 (0, 13) | 59 (53, 64) | 21 (19, 21) | 86 (76, 96) | ||||||||
| Transgender | 2 | 0.2 | 100.0 | 22 (22, 22) | 65 (57, 72) | 21 (21, 21) | 108 (100, 115) | ||||||||
| Registered residence | |||||||||||||||
| Urban area | 645 | 52.2 | 55.0 | 15 (11, 19) | 142,773.5 † | <0.001 | 62 (57, 67) | 165,406.5 † | <0.001 | 20 (19, 21) | 142,449.0 † | 0.191 | 97 (88, 104) | 149,673.5 † | <0.001 |
| Rural area | 590 | 47.8 | 36.1 | 12 (6, 17) | 60 (54, 65) | 20 (19, 21) | 92 (80, 100) | ||||||||
| Sexual orientation | |||||||||||||||
| Homosexual | 760 | 61.5 | 54.7 | 15 (10, 19) | 109.6 | <0.001 | 62 (57, 67) | 40.6 | <0.001 | 20 (19, 21) | 11.2 | 0.011 | 97 (88, 104) | 78.1 | <0.001 |
| Heterosexual | 188 | 15.2 | 23.4 | 9 (2, 14) | 58 (53, 64) | 21 (19, 21) | 87 (76, 97) | ||||||||
| Bisexual | 208 | 16.9 | 41.8 | 13 (9, 17) | 60 (55, 66) | 20 (19, 21) | 93 (85, 102) | ||||||||
| Uncertain | 79 | 6.4 | 26.6 | 11 (1, 15) | 57 (52, 64) | 20 (18, 21) | 83 (74, 99) | ||||||||
| Marital status | |||||||||||||||
| Unmarried | 774 | 62.7 | 54.5 | 15 (10, 19) | 97.6 | <0.001 | 62 (57, 68) | 46.4 | <0.001 | 20 (19, 21) | 6.0 | 0.114 | 97 (89, 104) | 83.4 | <0.001 |
| Married | 291 | 23.6 | 28.9 | 11 (3, 15) | 59 (53, 64) | 20 (19, 21) | 89 (79, 98) | ||||||||
| Divorced
/widowed |
144 | 11.6 | 34.0 | 13 (5, 17) | 59 (54, 64) | 20 (19, 21) | 91 (81, 99) | ||||||||
| Cohabitation | 26 | 2.1 | 50.0 | 15 (6, 18) | 60 (57, 65) | 20 (19, 21) | 93 (80, 99) | ||||||||
| Education | |||||||||||||||
| Master’s degree or above | 96 | 7.8 | 78.1 | 18 (15, 20) | 209.9 | <0.001 | 63 (58,69) | 82.6 | <0.001 | 20 (19, 21) | 3.7 | 0.299 | 100 (95, 107) | 179.2 | <0.001 |
| University or technical college | 678 | 54.9 | 55.0 | 15 (11, 19) | 63 (57, 68) | 20 (19, 21) | 97 (90, 104) | ||||||||
| High school or technical secondary | 293 | 23.7 | 30.4 | 11 (6, 15) | 60 (54, 64) | 20 (19, 21) | 90 (80, 98) | ||||||||
| Junior high school or below | 168 | 13.6 | 18.5 | 6 (0, 13) | 56 (52, 62) | 20 (18, 21) | 82 (73, 94) | ||||||||
| Occupation | |||||||||||||||
| Students | 22 | 1.8 | 63.6 | 16 (12, 19) | 52.86 | <0.001 | 65 (60, 69) | 39.4 | <0.001 | 20 (20, 21) | 4.1 | 0.664 | 101 (93, 108) | 58.5 | <0.001 |
| Official staffs/Personnel of enterprises and institutions | 144 | 11.7 | 55.6 | 16 (9, 19) | 62 (58, 67) | 20 (19, 21) | 98 (88, 103) | ||||||||
| Commercial service providers | 321 | 26.0 | 43.9 | 14 (9, 17) | 60 (56, 66) | 20 (18, 21) | 94 (84, 101) | ||||||||
| Workers/Farmers | 207 | 16.8 | 28.5 | 11 (3, 15) | 58 (52, 64) | 20 (19, 21) | 88 (79, 97) | ||||||||
| Retired people | 109 | 8.8 | 45.9 | 13 (9, 18) | 61 (56, 66) | 20 (19, 21) | 93 (85, 103) | ||||||||
| Housekeeping and unemployment | 14 | 1.1 | 57.1 | 18 (12, 21) | 62 (57, 64) | 21 (19, 21) | 98 (91, 105) | ||||||||
| Others | 418 | 33.8 | 51.7 | 15 (9, 19) | 62 (56, 68) | 20 (19, 21) | 96 (87, 104) | ||||||||
| Monthly income | |||||||||||||||
| <2,000 CNY | 199 | 16.1 | 34.2 | 10 (3, 16) | 69.6 | <0.001 | 59 (53, 65) | 35.2 | <0.001 | 20 (19, 21) | 4.0 | 0.259 | 88 (78, 101) | 70.3 | <0.001 |
| 2,000–4,999 CNY | 274 | 22.2 | 34.3 | 12 (6, 17) | 59 (54, 64) | 20 (19, 21) | 91 (80, 98) | ||||||||
| 5,000–9,999 CNY | 449 | 36.4 | 45.4 | 14 (9, 18) | 62 (56, 68) | 20 (19, 21) | 95 (87, 103) | ||||||||
| >10,000 CNY | 313 | 25.3 | 64.5 | 17 (13, 19) | 62 (57, 67) | 20 (19, 21) | 98 (91, 105) | ||||||||
| Have you been vaccinated against flu? | |||||||||||||||
| Yes | 340 | 27.5 | 47.1 | 14 (8, 18) | 154,652.0 † | 0.654 | 60 (54, 65) | 137,693.0 † | 0.010 | 20 (19, 21) | 147,120.0 † | 0.348 | 94 (84, 102) | 143,029 † | 0.103 |
| No | 895 | 72.5 | 45.6 | 14 (9, 18) | 61 (56, 67) | 20 (19, 21) | 95 (85, 103) | ||||||||
| Have any other sexually transmitted diseases? | |||||||||||||||
| Yes | 174 | 14.1 | 37.9 | 13 (7, 17) | 85,787.5 † | 0.134 | 60 (53, 65) | 82,192.0 † | 0.020 | 20 (18, 21) | 76,434.5 † | <0.001 | 92 (81, 100) | 860,817.5 † | 0.008 |
| No | 1061 | 85.9 | 47.3 | 14 (9, 18) | 61 (56, 67) | 20 (19, 21) | 95 (85, 103) | ||||||||
| Have any other chronic diseases? | |||||||||||||||
| Yes | 215 | 17.4 | 46.0 | 14 (10, 18) | 29.5 | <0.001 | 61 (55, 66) | 16.0 | <0.001 | 20 (19, 21) | 9.2 | 0.010 | 94 (85, 102) | 27.9 | <0.001 |
| No | 851 | 68.9 | 48.4 | 14 (9, 19) | 61 (56, 67) | 20 (19, 21) | 95 (86, 103) | ||||||||
| Uncertain | 169 | 13.7 | 33.7 | 10 (5, 16) | 58 (53, 64) | 20 (18, 21) | 88 (78, 99) | ||||||||
| Time of confirmed HIV infection | |||||||||||||||
| <1 year | 90 | 7.3 | 38.9 | 13 (5, 17) | 4.0 | 0.137 | 61 (56, 66) | 2.9 | 0.231 | 20 (19, 21) | 4.6 | 0.101 | 94 (83, 101) | 4.2 | 0.120 |
| 1–3 years | 210 | 17.0 | 48.1 | 14 (9, 18) | 62 (56, 67) | 20 (19, 21) | 95 (87, 104) | ||||||||
| >3 years | 935 | 75.7 | 46.2 | 14 (8, 18) | 61 (55, 66) | 20 (19, 21) | 94 (84, 102) | ||||||||
| Latest CD4 test results | |||||||||||||||
| <350/mm 3 | 181 | 14.6 | 45.3 | 14 (9, 17) | 48.9 | <0.001 | 60 (55, 65) | 25.1 | <0.001 | 20 (19, 21) | 5.9 | 0.052 | 95 (84, 102) | 46.2 | <0.001 |
| 350–500/mm 3 | 280 | 22.7 | 39.6 | 13 (7, 17) | 62 (57, 67) | 20 (19, 21) | 94 (83, 102) | ||||||||
| >500/mm 3 | 683 | 55.3 | 52.1 | 15 (10, 19) | 61 (56, 67) | 20 (19, 21) | 96 (87, 104) | ||||||||
| Uncertain | 91 | 7.4 | 20.9 | 8 (1, 13) | 57 (52, 63) | 20 (18, 21) | 83 (74, 97) | ||||||||
| Latest varial copies test results | |||||||||||||||
| <20 cps/mL (undetectable) | 941 | 76.2 | 52.7 | 15 (10, 19) | 127.6 | <0.001 | 62 (57, 67) | 58.0 | <0.001 | 20 (19, 21) | 2.2 | 0.329 | 96 (88, 104) | 119.5 | <0.001 |
| <10 5 cps/mL | 107 | 8.6 | 31.8 | 11 (4, 15) | 58 (53, 64) | 20 (19, 21) | 89 (80, 98) | ||||||||
| >10 5 cps/mL | 17 | 1.4 | 29.4 | 10 (4, 15) | 59 (52, 64) | 21 (17, 21) | 90 (78, 97) | ||||||||
| Uncertain | 170 | 13.8 | 19.4 | 8 (0, 13) | 57 (52, 63) | 20 (18, 21) | 83 (73, 95) | ||||||||
The mean knowledge score for mpox was 14 (interquartile range: 8–18, range: 0–25), with an awareness rate of 46.0%. Out of the 25 questions, two had a correct answer rate of over 80% (Q1 and Q8), while the other three questions had a correct answer rate over 70% but not exceeding 80% (Q7, Q18, and Q19). The lowest correct answer rate was observed for the two questions related to “rash” (Q12 and Q20). The dimension of epidemiologic characteristics had a relatively high correct answer rate (mean: 62.8%), while the treatment dimension had a low correct answer rate (mean: 37.4%). Three questions in the treatment dimension had a correct answer rate of less than 30.0% (Q22, Q23, and Q24) ( Supplementary Table S3, available at https://weekly.chinacdc.cn/). The results of the binary logistic regression analysis indicated that residing in an urban area, homosexual orientation, having a master’s degree or above, and having undetectable viral copies (<20 cps/mL) were all positively associated with knowledge of mpox ( Figure 1).
Figure 1.
Binary logistic regression analysis of Knowledge, Attitude, and Practice of mpox.
Abbreviation: OR=odds ratio; CI=confidence interval; KAP=Knowledge, Attitude, and Practice.
After accounting for standardization, the total score for mpox attitude was 3.81 (interquartile range: 3.50, 4.12). The barrier dimension had the lowest score, 3.25 (interquartile range: 2.50, 4.00) points ( Supplementary Table S4, available at https://weekly.chinacdc.cn/). The results of the binary logistic regression analysis showed that having a master’s degree or higher education and not having any other sexually transmitted diseases (STDs) were positively associated with a favorable attitude towards mpox ( Figure 1).
The score for mpox practice was 20 (interquartile range: 19, 21). Among the 1,235 individuals infected with HIV, a majority of them (87.3%, 1,078/1,235) sought medical advice upon experiencing unexplained lymphadenopathy and voluntarily disclosed recent exposure to mpox. Furthermore, 78.9% (975/1,235) of individuals expressed willingness to receive the mpox vaccine. With the exception of 27 individuals who had not initiated ART, the majority (87.0% 1,075/1,235) demonstrated good adherence to their daily ART medication. In the past six months, almost 30% (325/1,235) reported having two or more sexual partners, with 107 individuals engaging in male-to-male group sex. When experiencing mpox-related symptoms, the most common actions taken were seeking medical treatment at an infectious disease hospital (96.8%, 1,195/1,235), practicing home quarantine (30.8%, 380/1,235), and notifying the local CDC in their community of residence (29.4%, 363/1,235) ( Table 2). The results of the binary logistic regression analysis indicated that not suffering from other STDs was a positive factor associated with the practice of mpox ( Figure 1).
Table 2. Behavioral characteristics of mpox in HIV-infected individuals.
| Variable | n | Constituent ratio/percent (%) |
| Abbreviation: HIV=human immunodeficiency virus; ART=antiretroviral therapy. | ||
| When you have unexplained lymphadenopathy, will you seek medical advice and inform yourself of mpox-related exposure voluntarily? | ||
| Yes, I will seek medical advice and inform myself of mpox-related exposure voluntarily. | 1,078 | 87.3 |
| No, I will not seek medical advice and inform myself of mpox-related exposure voluntarily. | 96 | 7.8 |
| Yes, I will seek medical advice, but not inform myself of mpox-related exposure voluntarily. | 30 | 2.4 |
| Not seek medical advice | 31 | 2.5 |
| If the mpox vaccine is available, would you like to get it? | ||
| Yes | 975 | 78.9 |
| Normal | 202 | 16.4 |
| No | 58 | 4.7 |
| What would you do if you had mpox-related symptoms? (Multiple choices) | ||
| Go to an infectious disease hospital | 1,195 | 96.8 |
| Informing the CDC in the community of residence | 363 | 29.4 |
| Seek help from social organizations | 238 | 19.3 |
| Ask friends for help | 76 | 6.2 |
| Buy medicine by yourself | 57 | 4.6 |
| Home quarantine | 380 | 30.8 |
| Nothing was done | 4 | 0.3 |
| Whether you can take ART drugs regularly every day? | ||
| Yes | 1,075 | 87.0 |
| Forget to take it occasionally every month (1 or 2 times) | 126 | 10.2 |
| No, I often forget. | 7 | 0.6 |
| ART is not initiated. | 27 | 2.2 |
| Number of sexual partners engaged in anal sex between men in the past six months. | ||
| One | 325 | 26.3 |
| Two | 173 | 14.0 |
| Three and above | 179 | 14.5 |
| No same-sex sexual activity has occurred | 558 | 45.2 |
| Has there been any male-to-male group sexual activity in the past six months? | ||
| Yes | 107 | 8.7 |
| No | 1,128 | 91.3 |
The total KAP score is calculated by summing the scores of mpox KAP. The score range is from 23 to 126, with the highest score being 124 points and the lowest score being 30 points. The majority of research subjects fall within the range of 90 to 106 points. Binary logistic regression analysis revealed that individuals below the age of 35, with homosexual orientation, holding a master’s degree or higher, and having undetectable viral copies (<20 cps/mL) were all positive factors associated with higher mpox KAP scores. The relationship between suffering from chronic diseases and mpox KAP remains uncertain ( Figure 1).
DISCUSSION
The survey revealed that the level of knowledge regarding mpox among 1,235 investigated HIV-infected individuals was low (46.0%). This aligns with the awareness rate (47.2%, 1,781/3,563) of mpox among MSM reported by Zheng Min et al. in July 2022 ( 6) and is significantly lower than the knowledge of other infectious diseases such as acquired immunodeficiency syndrome (AIDS, 91.0%) ( 7) and syphilis (70.9%) ( 8). A low level of awareness regarding typical features of mpox, like rash, among HIV-infected individuals was found. It suggests that individuals with HIV do not associate rash with prevention measures or seek medical advice, which hinders self-monitoring of symptoms in key populations. The attitude score towards mpox among HIV-infected individuals was moderate, similar to the findings of an analysis of AIDS health beliefs in newly infected individuals conducted by Yang Rongrong et al. (7.27/10) ( 9). A lower score in the dimension of the barrier indicates that HIV-infected individuals perceive more obstacles in preventing mpox.The practice scores for mpox were high, as most HIV-infected individuals proactively sought medical advice when experiencing mpox-related symptoms. However, more than 20% of respondents displayed hesitancy towards receiving the mpox vaccine, which was lower than in other studies (78.9% vs. 90.2%) ( 10).
Approximately 10% of participants engaged in male-to-male group sex in the past six months, increasing mpox infection risks. Despite higher mpox awareness in the homosexual population, behavior changes remain limited, indicating that high awareness rates do not necessarily translate into positives attitudes or behavioral changes. Studies have shown significant knowledge-behavior separation in MSM groups ( 11). Factors such as social discrimination and traditional culture contribute to the challenge of changing behaviors, with having multiple sexual partners being a common and difficult-to-change behavior in the community.
The absence of other STDs in the past six months positively influenced attitudes and practices related to mpox prevention measures among HIV-infected individuals. HIV-infected individuals with STDs were more likely to engage in sexual activity with multiple partners compared to those without STDs (39.5% vs. 26.6%). This indicates that individuals who are HIV-infected but do not have other STDs are more knowledgeable about safe sexual behavior and are more concerned about their own health in relation to diseases, prompting them to actively seek information about mpox prevention measures. Therefore, implementing interventions targeting HIV-infected individuals with STDs is essential for enhancing their KAP towards mpox.
Viral load significantly influences mpox KAP among individuals living with HIV. Those with undetectable viral load exhibited better medication adherence (89.4% vs. 79.2%). Improving ART effectiveness can enhance mpox KAP, subsequently reducing mpox infection risk. Therefore, targeted interventions and improved adherence to medication should be implemented for HIV-infected individuals with high viral load in order to enhance mpox prevention and control efforts.
This study has certain limitations. First, a convenience sampling method was used, which may affect the representativeness of the results. However, the large size of the cohort helps to mitigate this potential selection bias. Future research should aim to include studies from different regions to obtain a more comprehensive understanding. Second, the inclusion of sensitive questions, such as the number of sexual partners, might introduce information bias. To minimize this issue, questions were placed at the end of the questionnaire, and participants were provided with a private and quiet environment during the survey to encourage honest responses.
This study is the first to investigate mpox KAP among individuals living with HIV. The findings serve as a reference for preventing and managing mpox in this population. The survey results indicate that the level of mpox KAP among HIV-infected individuals is suboptimal. Age, registered residence, sexual orientation, education level, viral load, and co-infection with other STDs are factors that influence mpox KAP. Therefore, targeted mpox health education programs should be prioritized for HIV-infected individuals who have STDs and high viral load.
Conflicts of interest
No conflicts of interest.
SUPPLEMENTARY MATERIAL
Table S1. Collinearity test of independent variables.
| Variables |
Non standardized
coefficients |
Standardized
coefficients |
t | P | Tolerance | VIF | ||
| β | SE | β | ||||||
| Abbreviation: SE=standard error; VIF=variance inflation factor. | ||||||||
| Age | −0.020 | 0.026 | −0.024 | −0.757 | 0.449 | 0.679 | 1.472 | |
| Gender | −0.129 | 0.048 | −0.074 | −2.684 | 0.007 | 0.888 | 1.126 | |
| Registered residence | −0.073 | 0.029 | −0.073 | −2.540 | 0.011 | 0.821 | 1.218 | |
| Sexual orientation | −0.037 | 0.014 | −0.072 | −2.561 | 0.011 | 0.868 | 1.152 | |
| Marital status | −0.028 | 0.019 | −0.045 | −1.496 | 0.135 | 0.769 | 1.300 | |
| Education | −0.125 | 0.020 | −0.206 | −6.377 | <0.001 | 0.655 | 1.526 | |
| Occupation | <0.001 | 0.007 | <0.001 | −0.015 | 0.988 | 0.967 | 1.034 | |
| Monthly income | 0.019 | 0.015 | 0.038 | 1.248 | 0.212 | 0.735 | 1.360 | |
| Have you been vaccinated against flu? | 0.001 | 0.030 | 0.001 | 0.021 | 0.983 | 0.974 | 1.026 | |
| Have any other sexually transmitted diseases? | −0.063 | 0.038 | −0.044 | −1.671 | 0.095 | 0.972 | 1.029 | |
| Have any other chronic diseases? | −0.048 | 0.024 | −0.053 | −1.973 | 0.049 | 0.937 | 1.067 | |
| Time of confirmed HIV infection | −0.019 | 0.023 | −0.023 | −0.818 | 0.414 | 0.858 | 1.165 | |
| Latest CD4 test results | 0.011 | 0.016 | 0.018 | 0.688 | 0.492 | 0.963 | 1.038 | |
| Latest varial copies test results | −0.071 | 0.014 | −0.149 | −5.069 | <0.001 | 0.793 | 1.261 | |
Table S2. Normality test of total score and scores in various dimensions of mpox.
| Variables and dimensions | Shapiro-Wilk test | |
| Z value | P value | |
| Abbreviation: KAP=Knowledge, Attitude, and Practice. | ||
| Mpox knowledge score | 0.937 | <0.001 |
| Basic cognition | 0.874 | <0.001 |
| Epidemiological characteristics | 0.876 | <0.001 |
| Clinical manifestation | 0.890 | <0.001 |
| Prevention | 0.866 | <0.001 |
| Treatment | 0.912 | <0.001 |
| Mpox attitude score | 0.986 | <0.001 |
| Susceptibility | 0.949 | <0.001 |
| Seriousness | 0.897 | <0.001 |
| Benefits | 0.908 | <0.001 |
| Barrier | 0.967 | <0.001 |
| Self-efficacy | 0.807 | <0.001 |
| Mpox practice score | 0.803 | <0.001 |
| Mpox KAP score | 0.980 | <0.001 |
Table S3. List of mpox knowledge among subjects.
| Knowledge dimension | Serial number | Items | Correct No. | Rate of correct answer (%) |
| Abbreviation: AIDS=acquired immunodeficiency syndrome; ART=antiretroviral therapy. | ||||
| Basic cognition | Q1 | Mpox is a viral infectious disease. | 994 | 80.5 |
| Q2 | Mpox is a bacterial infectious disease. | 519 | 42.0 | |
| Q3 | The current worldwide epidemic of mpox occurs mainly in tropical rainforest areas and occasionally in other areas. | 488 | 39.5 | |
| Epidemiological characteristics | Q4 | Do you know what are the sources of infection for mpox? | 862 | 69.8 |
| Q5 | Do you know the time interval between mpox infection and the onset of symptoms? | 625 | 50.6 | |
| Q6 | Mpox can be transmitted from animals to humans through direct contact with the blood, body fluids, and consumption of undercooked meat of infected animals. | 724 | 58.6 | |
| Q7 | Mpox can be transmitted from person to person through contact with respiratory secretions, blood, and body fluids of infected person. | 953 | 77.2 | |
| Q8 | Mpox can be transmitted sexually. | 1,007 | 81.5 | |
| Q9 | People are generally susceptible to mpox. | 480 | 38.9 | |
| Clinical manifestation | Q10 | Mpox and smallpox have similar signs and symptoms. | 661 | 53.5 |
| Q11 | Will people experience fever, runny nose, sore throat, and other cold symptoms in the early stages after being infected with mpox? | 805 | 65.2 | |
| Q12 | How long does mpox rash usually appear after onset? | 134 | 10.9 | |
| Q13 | After infection with mpox, will there be lymphadenopathy? | 659 | 53.4 | |
| Q14 | After infection with mpox, will muscle pain and severe headache occur? | 647 | 52.4 | |
| Q15 | Mpox is a self-limited disease with symptoms usually lasting 2-4 weeks. | 581 | 47.0 | |
| Prevention | Q16 | Can 20 seconds of regular hand washing with soap or alcohol-based hand sanitizer prevent mpox transmission? | 550 | 44.5 |
| Q17 | Can mpox transmission be prevented by avoiding contact with wild animals (live or dead) or by adequately cooking wild animal products? | 661 | 53.5 | |
| Q18 | Can mpox transmission be prevented by avoiding any object that has been in contact with a mpox patient/sick animal? | 866 | 70.1 | |
| Q19 | Can reducing the number of sexual partners reduce the risk of mpox transmission? | 930 | 75.3 | |
| Q20 | Can transmission of mpox be prevented by avoiding contact with anyone with rash? | 196 | 15.9 | |
| Treatment | Q21 | The treatment of mpox should be based on symptomatic and supportive treatment. | 824 | 66.7 |
| Q22 | Can Paracetamol be used to treat patients with mpox fever? | 313 | 25.3 | |
| Q23 | Are antibiotics effective in the treatment of mpox? | 212 | 17.2 | |
| Q24 | For AIDS patients co-infected with mpox, can effective ART improve the treatment effect of mpox? | 308 | 24.9 | |
| Q25 | So far, there is no effective cure for mpox. Is that correct? | 653 | 52.9 | |
Table S4. Mpox attitude total and dimensional scores.
| Variables | Range of scores |
Score
M (Q25, Q75)* |
Standardized score
M (Q25, Q75)* |
Explanation |
| * The normality test results of mpox attitude scores and scores in all dimensions showed that the data did not follow normal distribution ( P<0.05) ( Supplementary Table S2). Therefore, median and interquartile intervals were used to describe attitude scores. | ||||
| Mpox attitude score | 16.00–80.00 | 61.00 (56.00, 66.00) | 3.81 (3.50, 4.12) | |
| Susceptibility | 3.00–15.00 | 12.00 (10.00, 13.00) | 4.00 (3.33, 4.33) | Individual’s subjective feelings about the possibility of suffering from mpox. |
| Seriousness | 3.00–15.00 | 12.00 (10.00, 14.00) | 4.00 (3.33, 4.67) | Individual’s subjective perceptions and feelings about the severity of mpox. |
| Benefits | 4.00–20.00 | 16.00 (14.00, 20.00) | 4.00 (3.50, 5.00) | Individual’s subjective perceptions and feelings about the benefits obtained by taking healthy behaviors. |
| Barrier | 4.00–20.00 | 13.00 (10.00, 16.00) | 3.25 (2.50, 4.00) | Individual’s subjective perceptions and feelings of difficulties or obstacles that may be encountered in mpox prevention. |
| Self-efficacy | 2.00–10.00 | 8.00 (8.00, 10.00) | 4.00 (4.00, 5.00) | Individuals confidence in developing good sexual behaviors. |
Funding Statement
Provided by the National Natural Science Foundation of the People’s Republic of China (Grant No. 71934002) and the Beijing Hospitals Authority (Grant No. XMLX202149)
Contributor Information
Rui Song, Email: 13126595640@163.com.
Lei Zhou, Email: zhoulei@chinacdc.cn.
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