Objective To systematically review the willingness to use pre 一 exposure prophylaxis (PrEP) and related factors among men who have sex with men (MSM) in China. Methods CNKI, VIP, Wanfang Data, CBM, EMbase, CINAHL, Pub med, The Cochrane Library and Web of Science were searched from inception to August 16, 2023. Results A total of 31 articles with 31 390 participants were included. The results of meta - analysis showed that the awareness rate of PrEP was 46. 70% (95% Clt 34. 14 - 59. 47), the willingness rate of PrEP use was 61. 49% (95% CI: 51. 58 - 70. 95), and the use rate of PrEP was 3. 41% (95% CI:0. 07 - 10. 62). Age M40 years (OR 二 1. 90, 95% Clz 1. 47 - 2. 57), HIV testing history (OR 二 2. 13, 95% CI: 1. 63 一 2. 80), awareness of PrEP (OR 二 2. 80, 95% CI: 1. 86 - 4. 24), online sexual partner seeking (OR 二 1. 44, 95% CI: 1. 04 一 2. 00), no regular sexual partner (OR = 1. 69, 95% CI: L 32 一 2. 17), oral sex/anal sex behavior (OR 二 1. 86, 95% CI: 1. 32 - 2. 61), number of homosexual anal sex partners in the past 6 months >5(OR 二 1. 86, 95% Cl: 1. 32 - 2. 61), Having oral or anal sex in the past year (OR = 1.40,95% Cl: 1. 19 - 1. 65) was the promoting factor of PrEP use, while uncertain sexual orientation (OR 二 0.60, 95% CI: 0. 41 -0.89) and always using condom in the past 6 months (OR 二 0. 47, 95% C/:0. 29 - 0. 75) were the barriers. Conclusion The rate of MSM PrEP awareness and willingness to use is high in China, but the rate of PrEP use is low; more factors influence the willingness to use PrEP. [ABSTRACT FROM AUTHOR]