High pre-exposure prophylaxis uptake and early adherence among men who have sex with men and transgender women at risk for HIV Infection: the PrEP Brasil demonstration project

被引:93
作者
Hoagland, Brenda [1 ]
Moreira, Ronaldo I. [1 ]
De Boni, Raquel B. [1 ]
Kallas, Esper G. [2 ]
Madruga, Jose Valdez [3 ]
Vasconcelos, Ricardo [2 ]
Goulart, Silvia [3 ]
Torres, Thiago S. [1 ]
Marins, Luana M. S. [1 ]
Anderson, Peter L. [4 ]
Luz, Paula M. [1 ]
Leite, Iuri da Costa [1 ]
Liu, Albert Y. [5 ]
Veloso, Valdilea G. [1 ]
Grinsztejn, Beatriz [1 ]
机构
[1] Fiocruz MS, Inst Nacl Infectol Evandro Chagas, Rio De Janeiro, Brazil
[2] Univ Sao Paulo, Sch Med, Sao Paulo, Brazil
[3] Univ Sao Paulo, Sch Med, Sao Paulo, Brazil
[4] Univ Colorado Denver, Skaggs Sch Pharm & Pharmaceut Sci, Aurora, CO USA
[5] San Francisco Dept Publ Hlth, Bridge HIV, San Francisco, CA USA
基金
巴西圣保罗研究基金会;
关键词
Pre-exposure prophylaxis; HIV prevention; MSM; transgender women; PrEP uptake; PrEP adherence; DRUG Levels; TENOFOVIR DISOPROXIL FUMARATE; EMTRICITABINE; VALIDITY; BEHAVIOR; MSM;
D O I
10.7448/IAS.20.1.21472
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Introduction: The efficacy of pre-exposure prophylaxis (PrEP) in preventing sexual acquisition of human immunodeficiency virus (HIV) is well established. Little is known about the feasibility of PrEP implementation in middle-income settings with concentrated epidemics among men who have sex with men (MSM) and transgender women (TGW). Methods: PrEP Brasil is a prospective, multicentre, open-label demonstration project assessing PrEP delivery in the context of the Brazilian Public Health System. HIV-uninfected MSM and TGW in 3 referral centres in Rio de Janeiro and Sao Paulo were evaluated for eligibility and offered 48 weeks of daily emtricitabine/tenofovir for PrEP. Concentrations of tenofovir diphosphate in dried blood spot samples (DBS) at week 4 after enrolment (early adherence) were measured. Predictors of drug levels were assessed using ordinal logistic regression models considering the DBS drug level as a 3 level variable (<350 fmol/punch, >= 350-699 fmol/punch and >= 700 fmol/punch). Results: 1,270 individuals were assessed for participation; n = 738 were potentially eligible and n = 450 were offered PrEP (PrEP uptake was 60.9%). Eligible but not enrolled individuals were younger, had lower HIV risk perception and had lower PrEP awareness. At week 4, 424 participants (of the 450 enrolled) had DBS TFV-DP concentrations, 94.1% in the protective range (>= 350 fmol/punch, consistent with >= 2 pills per week), and 78% were in the highly protective range (>= 700 fmol/punch, >= 4 pills per week). Participants with >= 12 years of schooling had 1.9 times the odds (95% CI 1.10-3.29) of a higher versus lower drug level than participants with <12 years of schooling. Condomless receptive anal intercourse in the prior 3 months was also associated with higher drug levels (adjusted OR = 1.78; 95% CI 1.08-2.94). Conclusions: The high uptake and early adherence indicate that PrEP for high-risk MSM and TGW can be successfully delivered in the context of the Brazilian Public Health System. Interventions to address disparities on PrEP awareness and HIV risk perception among the younger and less educated are urgently needed in order to maximize the impact of this prevention strategy on the reduction of HIV infection among MSM and TGW in Brazil.
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页数:14
相关论文
共 46 条
[1]  
Allison P.D., 2012, Logistic regression using SAS: Theory and application
[2]   Emtricitabine-Tenofovir Concentrations and Pre-Exposure Prophylaxis Efficacy in Men Who Have Sex with Men [J].
Anderson, Peter L. ;
Glidden, David V. ;
Liu, Albert ;
Buchbinder, Susan ;
Lama, Javier R. ;
Vicente Guanira, Juan ;
McMahan, Vanessa ;
Bushman, Lane R. ;
Casapia, Martin ;
Montoya-Herrera, Orlando ;
Veloso, Valdilea G. ;
Mayer, Kenneth H. ;
Chariyalertsak, Suwat ;
Schechter, Mauro ;
Bekker, Linda-Gail ;
Kallas, Esper Georges ;
Grant, Robert M. .
SCIENCE TRANSLATIONAL MEDICINE, 2012, 4 (151)
[3]  
[Anonymous], 2004, NIAAA Council Approves Definition of Binge Drinking
[4]  
[Anonymous], 2015, PROT CLIN DIR TER MA
[5]  
[Anonymous], LEVANTAMENTO DOMICIL
[6]   Surveillance of HIV Transmitted Drug Resistance in Latin America and the Caribbean: A Systematic Review and Meta-Analysis [J].
Avila-Rios, Santiago ;
Sued, Omar ;
Rhee, Soo-Yon ;
Shafer, Robert W. ;
Reyes-Teran, Gustavo ;
Ravasi, Giovanni .
PLOS ONE, 2016, 11 (06)
[7]   Antiretroviral Prophylaxis for HIV Prevention in Heterosexual Men and Women [J].
Baeten, J. M. ;
Donnell, D. ;
Ndase, P. ;
Mugo, N. R. ;
Campbell, J. D. ;
Wangisi, J. ;
Tappero, J. W. ;
Bukusi, E. A. ;
Cohen, C. R. ;
Katabira, E. ;
Ronald, A. ;
Tumwesigye, E. ;
Were, E. ;
Fife, K. H. ;
Kiarie, J. ;
Farquhar, C. ;
John-Stewart, G. ;
Kakia, A. ;
Odoyo, J. ;
Mucunguzi, A. ;
Nakku-Joloba, E. ;
Twesigye, R. ;
Ngure, K. ;
Apaka, C. ;
Tamooh, H. ;
Gabona, F. ;
Mujugira, A. ;
Panteleeff, D. ;
Thomas, K. K. ;
Kidoguchi, L. ;
Krows, M. ;
Revall, J. ;
Morrison, S. ;
Haugen, H. ;
Emmanuel-Ogier, M. ;
Ondrejcek, L. ;
Coombs, R. W. ;
Frenkel, L. ;
Hendrix, C. ;
Bumpus, N. N. ;
Bangsberg, D. ;
Haberer, J. E. ;
Stevens, W. S. ;
Lingappa, J. R. ;
Celum, C. .
NEW ENGLAND JOURNAL OF MEDICINE, 2012, 367 (05) :399-410
[8]   Worldwide burden of HIV in transgender women: a systematic review and meta-analysis [J].
Baral, Stefan D. ;
Poteat, Tonia ;
Stromdahl, Susanne ;
Wirtz, Andrea L. ;
Guadamuz, Thomas E. ;
Beyrer, Chris .
LANCET INFECTIOUS DISEASES, 2013, 13 (03) :214-222
[9]   Adherence to Medications: Insights Arising from Studies on the Unreliable Link Between Prescribed and Actual Drug Dosing Histories [J].
Blaschke, Terrence F. ;
Osterberg, Lars ;
Vrijens, Bernard ;
Urquhart, John .
ANNUAL REVIEW OF PHARMACOLOGY AND TOXICOLOGY, VOL 52, 2012, 52 :275-+
[10]  
Castillo-Mancilla JR, 2013, AIDS RES HUM RETROV, V29, P384, DOI [10.1089/aid.2012.0089, 10.1089/AID.2012.0089]