Back HIV Prevention Pre-exposure (PrEP) IAS 2015: First Brazilian Data Reinforce Evidence that PrEP is Mostly Used by Those at Greatest Risk

IAS 2015: First Brazilian Data Reinforce Evidence that PrEP is Mostly Used by Those at Greatest Risk

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The first data from a Brazilian open-label demonstration project of HIV pre-exposure prophylaxis (PrEP) show, in common with several other studies presented at the 8th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention last month in Vancouver, that the higher a person’s risk of HIV infection, the more likely they are to seek and use PrEP.

[Produced in collaboration with Aidsmap.com]

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

People at higher risk were more likely to be interested in and enroll in the PrEP Brasil study, and people who self-referred to the study were more likely to join it than ones referred by doctors.

For the first time in a PrEP study, PrEP Brasil was able to demonstrate high uptake and interest among a relatively small but significant group of transgender women, showing that "efforts to educate transgender community paid off," Grinsztejn said at a media briefing.

The demonstration project enrolled men who have sex with men (MSM) and transgender women between April 2014 and April 2015 at FIOCRUZ and at 2 sites in São Paulo at the city’s university clinic (USP) and its Referral Centre for HIV Treatment (CRT). 

Grinszstejn noted that HIV prevalence among MSM and transgender women in Brazil is very high in some locations. In the capital city, Brasilia, nearly 1 in 4 MSM has HIV; in Rio de Janeiro and São Paulo HIV prevalence in MSM is 18% and 15%, respectively. Other regional cities such as Salvador (at 6.5%) and Recife (at 4%) have lower prevalence, but even Manaus in the heart of Amazonia has 8% prevalence.

The study was open to MSM and transgender women aged 18 or over who, in the previous year, had had 2 or more condomless anal sex partners, or 2 or more HIV-positive anal sex partners (regardless of condom use), or a diagnosis of a bacterial sexually transmitted infection (STI).

At the USP site, the study was advertised but clinic attendees were responsible for self-referral; at the other 2 sites, referral could be by attendees directly or by their physician. A total of 986 people were either approached or referred themselves. Of these 82 (8%) turned out to have HIV while 106 did not fit the risk criteria. The remaining 798 were invited to an initial screening visit and of these, 490 (61%) attended. At this point, 3 more people tested HIV-positive and some others were disqualified from the study for clinical reasons such as chronic kidney disease; 427 attended their first enrollment visit.

A total of 409 people eventually started PrEP -- just over the 400 initially planned for. This represents a 51% uptake of PrEP among all those who were potentially eligible. 6% (24 individuals) were transgender women; although this is still a relatively small number, it represents the largest proportion of trans people so far recruited in a PrEP study, and it is encouraging that 67% of potentially eligible transgender women started PrEP.

A higher proportion of potentially eligible people (78%) at the entirely self-referred USP site started PrEP than at either of the other 2 sites (62.5% at CRT and 38.5% at FIOCRUZ); qualitative research will try to elucidate the differences in recruitment rates.

Other predictors of enrolment among those eligible included having a steady partner -- 58% of these joined -- and how likely people thought it was that they might become HIV-positive in the next year. Among those who thought the chance of their acquiring HIV in the forthcoming year was from zero to 1 in 4, 43% started PrEP; among those who thought the chance was between 1 in 2 and certain, 61% started. Two-thirds of those potentially eligible had an HIV test in the preceding year; of those, 58% enrolled versus 34% who had not tested. 6 in 10 had heard of PrEP before, and of those, 59% enrolled versus 38% who had not heard of it.

Among participants who self-referred, 62% who met the criterion of having had more than 2 condomless sex partners in the last year attended the screening visit, as did 64% of those who had had 2 or more HIV-positive partners (versus 47% who had not had an HIV-positive partner, and 42% who did not know).

In a multiple regression analysis, the strongest predictors of attendance at the screening visit were having 2 or more condomless sex partners (80% more likely to attend), and the strongest predictor of enrollment was being a transgender woman (64% more likely to enroll).

PrEP Brasil is still running and its final results will be presented next year. See http://prepbrasil.com.br for the study’s website (in Portuguese).

8/18/15

Reference

B Hoagland, VG Veloso, RB De Boni, B Grinsztejn, et al (PrEP Brasil Study Team). Pre-exposure prophylaxis (PrEP) uptake and associated factors among MSM and TGW in the PrEP Brasil demonstration project. 8th International AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention. Vancouver, July 19-22, 2015. Abstract TUAC0205LB.