Brazilian Beatriz Grinsztejn study strengthens evidence that PrEP is mostly used by the most vulnerable

Beatriz Grinsztejn (photo: Liz Highleyman)
Beatriz Grinsztejn (photo: Liz Highleyman)

The first data from a Brazilian project of an open-label study on HIV pre-exposure prophylaxis (PrEP), in common with several other studies presented at the 8A last month in Vancouver International AIDS Conference, are exactly the most vulnerable people effectively look for PrEP

These initial results were presented by Beatriz Grinsztejn of Brazil, Oswaldo Cruz Foundation (FIOCRUZ), public health research institute of Brazil in Rio de Janeiro, which, among many other functions, has an HIV clinic.

People most at risk were more likely to be interested and sign up for PrEP study in Brazil, and people seeking the studies are just the most likely to get involved with these treatments and studies than anticipated by doctors.

For the first time in a Brazilian PrEP study was able to demonstrate high absorption and interest in a relatively small group, but significant of transgender women, showing that efforts to educate the community transgender worth it Grinsztejn said in a press conference .

The demonstration project enrolled men who have sex with men (MSM) and transgender women between April 2014 and April 2015 FIOCRUZ and 2 locations in São Paulo in the clinic of University City (USP) and its reference center for HIV treatment (CRT).

Grinszstejn noted that HIV prevalence among men who have sex with men, MSM, is very high; in Rio de Janeiro and São Paulo HIV prevalence among MSM is 18 15% and% respectively. Other regional cities such as Salvador (about 6.5%) and Recife (with 4%) have a lower prevalence but to Manaus, in the heart of the Amazon has 8% prevalence.

The study was open to MSM and transgender aged 18 years or more than the year before, had had 2 or more partners for unprotected anal sex, or 2 or more partners of HIV-positive anal sex (regardless of condom use) or a diagnosis of a sexually transmitted bacterial infection (STI).

On the USP website, the study was announced, but clinic participants were responsible for self-referral; in other 2 sites, the reference (adherence to the protocol) could be on the part of the participants in the right way or be referred by their doctor. A total of 986 people were addressed or referred to. These 82 (8%) ended up having an HIV + diagnosis already on enrollment, while 106 did not meet the risk criteria. The remaining 798 were invited for an initial screening visit and of these, 490 (61%) participated. At this point, more 3 people tested HIV-positive and some others were declassified from the study for clinical reasons, such as chronic kidney disease; 427 participated in their first sign-up visit.

A total of 409 people started PrEP. -pouco More of 400 initially planned. This represents a 51% of PrEP funding among all those who were potentially eligible. 6% (24 individuals) were transgender women; although this is still a relatively small number represents the highest proportion of trans people so far enrolled in a study of PrEP and it is encouraging that 67% of potentially eligible transgender women have started PrEP.

A higher proportion of potentially eligible persons (78%) in said fully self USP site started PrEP than any of the other sites 2 (62,5 on the CRT) and 38,5 Fiocruz; Qualitative research attempts to elucidate the differences in recruitment rates.

Other registration predictors among those eligible included, such as those who have a steady partner ... 58% of them joined the study.

Among those who thought the possibility of their acquiring HIV that next year was zero to 1 / 4, 43% started with PrEP; between those who thought the chance was between 1 2 in and certainty of contracting HIV, 615 started PrEP. Two-thirds of those potentially eligible had taken an HIV test in the previous year; of these, 58% of registered against 34% who had not done any testing. 6 10 on each individuals had heard of PrEP before and 59 38%% versus subscribers who had not heard of PrEP before.

Among the participants who reported voluntarily to PrEP 62% of those who attended the criteria of having had more than 2 partners with unprotected sex in the past year participated in the screening visit, as did 64% of those who had 2 or more HIV-positive partners versus ( 47% who did not have an HIV-positive partner) and 42% did not know.

In a multiple regression analysis, the strongest predictors of attendance when the screening visit were having 2 or more sexual partners without a condom (80% more likely to participate), and the strongest registration predictor was being a transgender woman (64 % more likely to sign up).

The PrEP study is still underway in Brazil and the results will be presented next year

Produced By HIV and Hepatitis in collaboration with Aidsmap Translated by Claudio Souza Original in IAS 2015: First Brazilian Data Reinforce Evidence que PrEP is Mostly Used by Those at Greatest Risk reviewed by Mara Macedo

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