- Same-day preexposure prophylaxis (PrEP) initiation in Latin America is feasible and safe, with good levels of early continuation and adherence.
- Young men who have sex with men (MSM) and transgender women (TGW) may require differentiated care to improve PrEP continuation.
Why this matters
- MSM represent the principal population at risk for new HIV infections in Latin America.
- Use of PrEP is rare.
- Large-scale demonstration study in Brazil, Perú, and México.
- MSM and TGW eligible for recruitment (i.e., HIV-uninfected, ≥18 years old, reporting 1+ risk criteria) were screened and enrolled, receiving a 30-day supply of oral tenofovir+emtricitabine.
- Creatinine, HBV, HCV, and sexually transmitted infection testing performed.
- Main outcomes:
- PrEP early continuation: attendance to first 2 follow-up visits within 120 days of PrEP initiation.
- PrEP adherence: having at least 16 days of PrEP medication filled per 30-day period (medication possession ratio ≥0.53).
- February 2018 to April 2019.
- 4954 individuals:
- Brazil (3205), Perú (1010), and México (739).
- 1329.6 person-years of PrEP use.
- Median age: 29 years (interquartile range, 24-36)
- 94% MSM; 6% TGW.
- STI testing baseline:
- Active syphilis 9.9% (95% CI, 9.0-10.8).
- Rectal chlamydia 11.7% (95% CI, 10.7-12.7).
- Rectal gonorrhea 7.4% (95% CI, 6.6-8.2).
- Early continuation 79.8% of participants; PrEP adherence 96.9%.
- Early continuation significantly lower among TGW, 56% (OR, 0.29; 95% CI, 0.21-0.40), and young MSM, 71% (OR, 0.52; 95% CI, 0.40-0.67).
- HIV incidence: 0.8/100 person/years (95% CI, 0.4-1.4).
- Conference presentation without peer review.
- “Despite the successful scale up of antiretroviral treatment in Latin America, our rollout of PrEP and other prevention tools has been slow,” Brenda Crabtree, IAS 2019 Local Scientific Chair, said in a statement. “The evidence is clear: we need better and more tailored interventions to meet the needs of key and vulnerable communities."