IAS 2019 — ImPrEP: What’s going on with PrEP in Latin America?


  • Laura Vargas-Parada, Ph.D.
  • Conference Reports
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Takeaway 

  • 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. 

Study design 

  • 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).

Key results  

  • 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).

    Limitations

    • Conference presentation without peer review. 

    Expert comment 

    • “Despite the successful scale up of antiretroviral treatment in Latin America, our rollout of PrEP and other prevention tools has been slow,” Brenda CrabtreeIAS 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."