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
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...
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| Veröffentlicht in: | Journal of the International AIDS Society 2017, Vol.20 (1), p.21472-n/a |
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| creator | Hoagland, Brenda Moreira, Ronaldo I. De Boni, Raquel B. Kallas, Esper G. Madruga, José Valdez Vasconcelos, Ricardo Goulart, Silvia Torres, Thiago S. Marins, Luana M. S. Anderson, Peter L. Luz, Paula M Costa Leite, Iuri da Liu, Albert Y. Veloso, Valdilea G. Grinsztejn, Beatriz |
| description | 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 São 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 ( |
| doi_str_mv | 10.7448/IAS.20.1.21472 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5515021</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A518357204</galeid><sourcerecordid>A518357204</sourcerecordid><originalsourceid>FETCH-LOGICAL-c6272-ad81b107852e9b1394e15ae150df25b60d6b85eb9b3ba75c1e6d45e33cb1424c3</originalsourceid><addsrcrecordid>eNqFkt9u0zAUxiMEYmNwyyWyhIS4abGdOHG4mFSmQYsmMYk_t5bjnDTuUjvYydre8Qi8Cq_Ek-C0Y3SoAkWRnePf-c7nnBNFTwkeZ0nCX80mH8cUj8mYkiSj96JjkjE-oimj9_f2R9Ej7xcYp5Qn-cPoKCyE05geRz-mel6j1sHPb99h3VrfOwiftq03jVxrj_q2k1eApCkRSNdskCxrcGBUiC2tmaMlGLSqLarlNSAPa7TSXb2NDjmdk8bPwZTg0Mpuox1y2l-hyjo0nX1BM1OB6rQ1r1FXA7p055fojZNeN6iEUMEHieF4cLUI5OPoQSUbD09u1pPo89vzT2fT0cWHd7OzycVIpTSjI1lyUhCccUYhL0icJ0CYDC8uK8qKFJdpwRkUeREXMmOKQFomDOJYFSShiYpPotOdbtsXSygVmGCkEa3TS-k2wkot7p4YXYu5vRaMhSKUBIGXNwLOfu3Bd2KpvYKmkQZs7wXhPI85YemAPv8LXdjemXA9EeM0SwkjKf8XRWmO4-CbJX-ouWxAaFPZ4E4NpcWEER6zjOKBGh2gQqMgXMUaqHQI3-HHB_jwhB5pdTDhxV5CDbLpam-bfmilP6isnPXeQXX7iwkWw4yLMOOCYkHEdsZDwrP9xtziv4c6AMkOWAVPm__IifezyU73F6YBB3o</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2290314254</pqid></control><display><type>article</type><title>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</title><source>MEDLINE</source><source>DOAJ Directory of Open Access Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Access via Wiley Online Library</source><source>Wiley Online Library Open Access</source><source>PubMed Central</source><creator>Hoagland, Brenda ; Moreira, Ronaldo I. ; De Boni, Raquel B. ; Kallas, Esper G. ; Madruga, José Valdez ; Vasconcelos, Ricardo ; Goulart, Silvia ; Torres, Thiago S. ; Marins, Luana M. S. ; Anderson, Peter L. ; Luz, Paula M ; Costa Leite, Iuri da ; Liu, Albert Y. ; Veloso, Valdilea G. ; Grinsztejn, Beatriz</creator><creatorcontrib>Hoagland, Brenda ; Moreira, Ronaldo I. ; De Boni, Raquel B. ; Kallas, Esper G. ; Madruga, José Valdez ; Vasconcelos, Ricardo ; Goulart, Silvia ; Torres, Thiago S. ; Marins, Luana M. S. ; Anderson, Peter L. ; Luz, Paula M ; Costa Leite, Iuri da ; Liu, Albert Y. ; Veloso, Valdilea G. ; Grinsztejn, Beatriz ; PrEP Brasil Study TeamClinical Trial Number 01989611 ; for the PrEP Brasil Study Team</creatorcontrib><description>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 São 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.</description><identifier>ISSN: 1758-2652</identifier><identifier>EISSN: 1758-2652</identifier><identifier>DOI: 10.7448/IAS.20.1.21472</identifier><identifier>PMID: 28418232</identifier><language>eng</language><publisher>Switzerland: International AIDS Society</publisher><subject>Acquired immune deficiency syndrome ; Adolescent ; Adult ; AIDS ; Alcohol use ; Analysis ; Anti-HIV Agents - therapeutic use ; Brazil ; Clinical medicine ; Clinical practice guidelines ; Cohort analysis ; Data collection ; Disease prevention ; Drug dosages ; DRUG Levels ; Emtricitabine - therapeutic use ; Female ; Funding ; Health aspects ; Health risks ; Hepatitis ; Heterosexuality ; HIV ; HIV infections ; HIV Infections - drug therapy ; HIV Infections - prevention & control ; HIV prevention ; Homosexuality, Male ; Human immunodeficiency virus ; Humans ; Infections ; Internet ; Laboratories ; Longitudinal Studies ; Male ; Medication Adherence ; MSM ; MSM (Men who have sex with men) ; Patient compliance ; Pediatrics ; Population ; Pre-Exposure Prophylaxis ; PrEP adherence ; PrEP uptake ; Prevention ; Prophylaxis ; Prospective Studies ; Public health ; Regression analysis ; Risk factors ; Sexual Behavior ; Sexually transmitted diseases ; STD ; Studies ; Systematic review ; Tenofovir - therapeutic use ; Transgender people ; Transgender Persons ; transgender women ; Urine ; Womens health ; Young Adult</subject><ispartof>Journal of the International AIDS Society, 2017, Vol.20 (1), p.21472-n/a</ispartof><rights>2017 Hoagland B et al; licensee International AIDS Society</rights><rights>COPYRIGHT 2017 International AIDS Society</rights><rights>2017. This work is published under http://creativecommons.org/licenses/by/3.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2017 Hoagland B et al; licensee International AIDS Society. 2017 The Author(s)</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c6272-ad81b107852e9b1394e15ae150df25b60d6b85eb9b3ba75c1e6d45e33cb1424c3</citedby><cites>FETCH-LOGICAL-c6272-ad81b107852e9b1394e15ae150df25b60d6b85eb9b3ba75c1e6d45e33cb1424c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5515021/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5515021/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,1417,4024,11562,27923,27924,27925,45574,45575,46052,46476,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28418232$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hoagland, Brenda</creatorcontrib><creatorcontrib>Moreira, Ronaldo I.</creatorcontrib><creatorcontrib>De Boni, Raquel B.</creatorcontrib><creatorcontrib>Kallas, Esper G.</creatorcontrib><creatorcontrib>Madruga, José Valdez</creatorcontrib><creatorcontrib>Vasconcelos, Ricardo</creatorcontrib><creatorcontrib>Goulart, Silvia</creatorcontrib><creatorcontrib>Torres, Thiago S.</creatorcontrib><creatorcontrib>Marins, Luana M. S.</creatorcontrib><creatorcontrib>Anderson, Peter L.</creatorcontrib><creatorcontrib>Luz, Paula M</creatorcontrib><creatorcontrib>Costa Leite, Iuri da</creatorcontrib><creatorcontrib>Liu, Albert Y.</creatorcontrib><creatorcontrib>Veloso, Valdilea G.</creatorcontrib><creatorcontrib>Grinsztejn, Beatriz</creatorcontrib><creatorcontrib>PrEP Brasil Study TeamClinical Trial Number 01989611</creatorcontrib><creatorcontrib>for the PrEP Brasil Study Team</creatorcontrib><title>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</title><title>Journal of the International AIDS Society</title><addtitle>J Int AIDS Soc</addtitle><description>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 São 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.</description><subject>Acquired immune deficiency syndrome</subject><subject>Adolescent</subject><subject>Adult</subject><subject>AIDS</subject><subject>Alcohol use</subject><subject>Analysis</subject><subject>Anti-HIV Agents - therapeutic use</subject><subject>Brazil</subject><subject>Clinical medicine</subject><subject>Clinical practice guidelines</subject><subject>Cohort analysis</subject><subject>Data collection</subject><subject>Disease prevention</subject><subject>Drug dosages</subject><subject>DRUG Levels</subject><subject>Emtricitabine - therapeutic use</subject><subject>Female</subject><subject>Funding</subject><subject>Health aspects</subject><subject>Health risks</subject><subject>Hepatitis</subject><subject>Heterosexuality</subject><subject>HIV</subject><subject>HIV infections</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Infections - prevention & control</subject><subject>HIV prevention</subject><subject>Homosexuality, Male</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Infections</subject><subject>Internet</subject><subject>Laboratories</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Medication Adherence</subject><subject>MSM</subject><subject>MSM (Men who have sex with men)</subject><subject>Patient compliance</subject><subject>Pediatrics</subject><subject>Population</subject><subject>Pre-Exposure Prophylaxis</subject><subject>PrEP adherence</subject><subject>PrEP uptake</subject><subject>Prevention</subject><subject>Prophylaxis</subject><subject>Prospective Studies</subject><subject>Public health</subject><subject>Regression analysis</subject><subject>Risk factors</subject><subject>Sexual Behavior</subject><subject>Sexually transmitted diseases</subject><subject>STD</subject><subject>Studies</subject><subject>Systematic review</subject><subject>Tenofovir - therapeutic use</subject><subject>Transgender people</subject><subject>Transgender Persons</subject><subject>transgender women</subject><subject>Urine</subject><subject>Womens health</subject><subject>Young Adult</subject><issn>1758-2652</issn><issn>1758-2652</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNqFkt9u0zAUxiMEYmNwyyWyhIS4abGdOHG4mFSmQYsmMYk_t5bjnDTuUjvYydre8Qi8Cq_Ek-C0Y3SoAkWRnePf-c7nnBNFTwkeZ0nCX80mH8cUj8mYkiSj96JjkjE-oimj9_f2R9Ej7xcYp5Qn-cPoKCyE05geRz-mel6j1sHPb99h3VrfOwiftq03jVxrj_q2k1eApCkRSNdskCxrcGBUiC2tmaMlGLSqLarlNSAPa7TSXb2NDjmdk8bPwZTg0Mpuox1y2l-hyjo0nX1BM1OB6rQ1r1FXA7p055fojZNeN6iEUMEHieF4cLUI5OPoQSUbD09u1pPo89vzT2fT0cWHd7OzycVIpTSjI1lyUhCccUYhL0icJ0CYDC8uK8qKFJdpwRkUeREXMmOKQFomDOJYFSShiYpPotOdbtsXSygVmGCkEa3TS-k2wkot7p4YXYu5vRaMhSKUBIGXNwLOfu3Bd2KpvYKmkQZs7wXhPI85YemAPv8LXdjemXA9EeM0SwkjKf8XRWmO4-CbJX-ouWxAaFPZ4E4NpcWEER6zjOKBGh2gQqMgXMUaqHQI3-HHB_jwhB5pdTDhxV5CDbLpam-bfmilP6isnPXeQXX7iwkWw4yLMOOCYkHEdsZDwrP9xtziv4c6AMkOWAVPm__IifezyU73F6YBB3o</recordid><startdate>2017</startdate><enddate>2017</enddate><creator>Hoagland, Brenda</creator><creator>Moreira, Ronaldo I.</creator><creator>De Boni, Raquel B.</creator><creator>Kallas, Esper G.</creator><creator>Madruga, José Valdez</creator><creator>Vasconcelos, Ricardo</creator><creator>Goulart, Silvia</creator><creator>Torres, Thiago S.</creator><creator>Marins, Luana M. S.</creator><creator>Anderson, Peter L.</creator><creator>Luz, Paula M</creator><creator>Costa Leite, Iuri da</creator><creator>Liu, Albert Y.</creator><creator>Veloso, Valdilea G.</creator><creator>Grinsztejn, Beatriz</creator><general>International AIDS Society</general><general>John Wiley & Sons, Inc</general><general>Taylor & Francis</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>2017</creationdate><title>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</title><author>Hoagland, Brenda ; Moreira, Ronaldo I. ; De Boni, Raquel B. ; Kallas, Esper G. ; Madruga, José Valdez ; Vasconcelos, Ricardo ; Goulart, Silvia ; Torres, Thiago S. ; Marins, Luana M. S. ; Anderson, Peter L. ; Luz, Paula M ; Costa Leite, Iuri da ; Liu, Albert Y. ; Veloso, Valdilea G. ; Grinsztejn, Beatriz</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c6272-ad81b107852e9b1394e15ae150df25b60d6b85eb9b3ba75c1e6d45e33cb1424c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Acquired immune deficiency syndrome</topic><topic>Adolescent</topic><topic>Adult</topic><topic>AIDS</topic><topic>Alcohol use</topic><topic>Analysis</topic><topic>Anti-HIV Agents - therapeutic use</topic><topic>Brazil</topic><topic>Clinical medicine</topic><topic>Clinical practice guidelines</topic><topic>Cohort analysis</topic><topic>Data collection</topic><topic>Disease prevention</topic><topic>Drug dosages</topic><topic>DRUG Levels</topic><topic>Emtricitabine - therapeutic use</topic><topic>Female</topic><topic>Funding</topic><topic>Health aspects</topic><topic>Health risks</topic><topic>Hepatitis</topic><topic>Heterosexuality</topic><topic>HIV</topic><topic>HIV infections</topic><topic>HIV Infections - drug therapy</topic><topic>HIV Infections - prevention & control</topic><topic>HIV prevention</topic><topic>Homosexuality, Male</topic><topic>Human immunodeficiency virus</topic><topic>Humans</topic><topic>Infections</topic><topic>Internet</topic><topic>Laboratories</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Medication Adherence</topic><topic>MSM</topic><topic>MSM (Men who have sex with men)</topic><topic>Patient compliance</topic><topic>Pediatrics</topic><topic>Population</topic><topic>Pre-Exposure Prophylaxis</topic><topic>PrEP adherence</topic><topic>PrEP uptake</topic><topic>Prevention</topic><topic>Prophylaxis</topic><topic>Prospective Studies</topic><topic>Public health</topic><topic>Regression analysis</topic><topic>Risk factors</topic><topic>Sexual Behavior</topic><topic>Sexually transmitted diseases</topic><topic>STD</topic><topic>Studies</topic><topic>Systematic review</topic><topic>Tenofovir - therapeutic use</topic><topic>Transgender people</topic><topic>Transgender Persons</topic><topic>transgender women</topic><topic>Urine</topic><topic>Womens health</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hoagland, Brenda</creatorcontrib><creatorcontrib>Moreira, Ronaldo I.</creatorcontrib><creatorcontrib>De Boni, Raquel B.</creatorcontrib><creatorcontrib>Kallas, Esper G.</creatorcontrib><creatorcontrib>Madruga, José Valdez</creatorcontrib><creatorcontrib>Vasconcelos, Ricardo</creatorcontrib><creatorcontrib>Goulart, Silvia</creatorcontrib><creatorcontrib>Torres, Thiago S.</creatorcontrib><creatorcontrib>Marins, Luana M. S.</creatorcontrib><creatorcontrib>Anderson, Peter L.</creatorcontrib><creatorcontrib>Luz, Paula M</creatorcontrib><creatorcontrib>Costa Leite, Iuri da</creatorcontrib><creatorcontrib>Liu, Albert Y.</creatorcontrib><creatorcontrib>Veloso, Valdilea G.</creatorcontrib><creatorcontrib>Grinsztejn, Beatriz</creatorcontrib><creatorcontrib>PrEP Brasil Study TeamClinical Trial Number 01989611</creatorcontrib><creatorcontrib>for the PrEP Brasil Study Team</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>Wiley Online Library (Open Access Collection)</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of the International AIDS Society</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hoagland, Brenda</au><au>Moreira, Ronaldo I.</au><au>De Boni, Raquel B.</au><au>Kallas, Esper G.</au><au>Madruga, José Valdez</au><au>Vasconcelos, Ricardo</au><au>Goulart, Silvia</au><au>Torres, Thiago S.</au><au>Marins, Luana M. S.</au><au>Anderson, Peter L.</au><au>Luz, Paula M</au><au>Costa Leite, Iuri da</au><au>Liu, Albert Y.</au><au>Veloso, Valdilea G.</au><au>Grinsztejn, Beatriz</au><aucorp>PrEP Brasil Study TeamClinical Trial Number 01989611</aucorp><aucorp>for the PrEP Brasil Study Team</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>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</atitle><jtitle>Journal of the International AIDS Society</jtitle><addtitle>J Int AIDS Soc</addtitle><date>2017</date><risdate>2017</risdate><volume>20</volume><issue>1</issue><spage>21472</spage><epage>n/a</epage><pages>21472-n/a</pages><issn>1758-2652</issn><eissn>1758-2652</eissn><abstract>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 São 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.</abstract><cop>Switzerland</cop><pub>International AIDS Society</pub><pmid>28418232</pmid><doi>10.7448/IAS.20.1.21472</doi><tpages>14</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of the International AIDS Society, 2017, Vol.20 (1), p.21472-n/a |
| issn | 1758-2652 1758-2652 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5515021 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Access via Wiley Online Library; Wiley Online Library Open Access; PubMed Central |
| subjects | Acquired immune deficiency syndrome Adolescent Adult AIDS Alcohol use Analysis Anti-HIV Agents - therapeutic use Brazil Clinical medicine Clinical practice guidelines Cohort analysis Data collection Disease prevention Drug dosages DRUG Levels Emtricitabine - therapeutic use Female Funding Health aspects Health risks Hepatitis Heterosexuality HIV HIV infections HIV Infections - drug therapy HIV Infections - prevention & control HIV prevention Homosexuality, Male Human immunodeficiency virus Humans Infections Internet Laboratories Longitudinal Studies Male Medication Adherence MSM MSM (Men who have sex with men) Patient compliance Pediatrics Population Pre-Exposure Prophylaxis PrEP adherence PrEP uptake Prevention Prophylaxis Prospective Studies Public health Regression analysis Risk factors Sexual Behavior Sexually transmitted diseases STD Studies Systematic review Tenofovir - therapeutic use Transgender people Transgender Persons transgender women Urine Womens health Young Adult |
| title | 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 |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-19T12%3A09%3A28IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=High%20pre%E2%80%90exposure%20prophylaxis%20uptake%20and%20early%20adherence%20among%20men%20who%20have%20sex%20with%20men%20and%20transgender%20women%20at%20risk%20for%20HIV%20Infection:%20the%20PrEP%20Brasil%20demonstration%20project&rft.jtitle=Journal%20of%20the%20International%20AIDS%20Society&rft.au=Hoagland,%20Brenda&rft.aucorp=PrEP%20Brasil%20Study%20TeamClinical%20Trial%20Number%2001989611&rft.date=2017&rft.volume=20&rft.issue=1&rft.spage=21472&rft.epage=n/a&rft.pages=21472-n/a&rft.issn=1758-2652&rft.eissn=1758-2652&rft_id=info:doi/10.7448/IAS.20.1.21472&rft_dat=%3Cgale_pubme%3EA518357204%3C/gale_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2290314254&rft_id=info:pmid/28418232&rft_galeid=A518357204&rfr_iscdi=true |