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Veloso VG, Cáceres CF, Hoagland B, Moreira RI, Vega-Ramírez H, Konda KA, Leite IC, Bautista-Arredondo S, Vinícius de Lacerda M, Valdez Madruga J, Farias A, Lima JN, Zonta R, Lauria L, Tamayo CVO, Flores HJS, Santa Cruz YMC, Aguayo RMM, Cunha M, Moreira J, Makkeda AR, Díaz S, Guanira JV, Vermandere H, Benedetti M, Ingold HL, Pimenta MC, Torres TS, Grinsztejn B, d'Albuquerque P, Palombo C, Alencastro PR, Ito RKDL, Benedetti JL, Maria FV, Luz PM, Freitas L, Geraldo K, Derrico M, Nazer S, Kristic T, Girade R, Lima R, Carvalho AR, Rocha C, Leite P, Lessa M, Santini-Oliveira M, Bezerra DR, Souza CDO, Corrêa J, Alves M, Souza C, Portugal C, Valões MDS, Mota GL, Gomes JA, Falcão CFL, Riberson FF, Melo L, Oliveira TA, Oliveira Júnior AM, Fonseca B, Lannoy LH, Carlos LAS, Cunha JP, Coracini SMDA, Rodrigues TO, Mettrau ERS, Meira KV, Tavares H, Valeiras APNV, Rocha TMADC, Amorim A, Sabadini P, Córdoba LG, Gusmão C, Faustino E, Hansen JSDS, Cunha AM, Nishimura NU, Santos JEFRP, Cano AB, Dias WMT, Tonhon M, Rezende TR, Gomes A, Rodrigues EDS, Carneiro MDDA, Castilho A, Carvalho M, Diaz-Sosa D, Guillen-Diaz-Barriga C, Hernández L, Robles R, Medina-Mora ME, González M, Icelo IH, Davalos AM, Castro JG, Valdez LOO, Barajas FR, González VR, Guadarrama GV, Macías I, Sánchez JT, Noriega JPO, Moheno M HR, Ramírez JMB, Juarez VDG, Vizcaíno G, Arjona FJ, Calvo G, Vargas S, Elorreaga O, Gutierrez X, Olivos F, Caviedes D, Adriazola D, Juárez E, Mariño G, Qquellon J, Vasquez F, Jiron JP, Flores S, Campos K. Same-day initiation of oral pre-exposure prophylaxis among gay, bisexual, and other cisgender men who have sex with men and transgender women in Brazil, Mexico, and Peru (ImPrEP): a prospective, single-arm, open-label, multicentre implementation study. Lancet HIV 2023; 10:e84-e96. [PMID: 36565708 PMCID: PMC9889521 DOI: 10.1016/s2352-3018(22)00331-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/29/2022] [Accepted: 11/04/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Although gay, bisexual, and other cisgender men who have sex with men (MSM) and transgender women have the highest HIV burden in Latin America, pre-exposure prophylaxis (PrEP) implementation is poor. We aimed to assess the feasibility of same-day oral PrEP delivery in Brazil, Mexico, and Peru. METHODS Implementation PrEP (ImPrEP) was a prospective, single-arm, open-label, multicentre PrEP implementation study conducted in Brazil (14 sites), Mexico (four sites), and Peru (ten sites). MSM and transgender women were eligible to participate if they were aged 18 years or older, HIV-negative, and reported one or more prespecified criteria. Enrolled participants received same-day initiation of daily oral PrEP (tenofovir disoproxil fumarate [300 mg] coformulated with emtricitabine [200 mg]). Follow-up visits were scheduled at week 4 and quarterly thereafter. We used logistic regression models to identify factors associated with early loss to follow-up (not returning after enrolment), PrEP adherence (medication possession ratio ≥0·6), and long-term PrEP engagement (attending three or more visits within 52 weeks). This study is registered at the Brazilian Registry of Clinical Trials, U1111-1217-6021. FINDINGS From Feb 6, 2018, to June 30, 2021, 9979 participants were screened and 9509 were enrolled (Brazil n=3928, Mexico n=3288, and Peru n=2293). 543 (5·7%) participants were transgender women, 8966 (94·3%) were cisgender men, and 2481 (26·1%) were aged 18-24 years. There were 12 185·25 person-years of follow-up. 795 (8·4%) of 9509 participants had early loss to follow-up, 6477 (68·1%) of 9509 were adherent to PrEP, and 5783 (70·3%) of 8225 had long-term PrEP engagement. Transgender women (adjusted odds ratio 1·60, 95% CI 1·20-2·14), participants aged 18-24 years (1·80, 1·49-2·18), and participants with primary education (2·18, 1·29-3·68) had increased odds of early loss to follow-up. Transgender women (0·56, 0·46-0·70), participants aged 18-24 years (0·52, 0·46-0·58), and those with primary education (0·60, 0·40-0·91) had lower odds of PrEP adherence. Transgender women (0·56, 0·45-0·71), participants aged 18-24 years (0·56, 0·49-0·64), and those with secondary education (0·74, 0·68-0·86) had lower odds of long-term PrEP engagement. HIV incidence was 0·85 per 100 person-years (95% CI 0·70-1·03) and was higher for transgender women, participants from Peru, those aged 18-24 years, Black and mixed-race participants, and participants who were non-adherent to PrEP. INTERPRETATION Same-day oral PrEP is feasible for MSM and transgender women in Latin America. Social and structural determinants of HIV vulnerability need to be addressed to fully achieve the benefits of PrEP. FUNDING Unitaid, WHO, and Ministries of Health in Brazil, Mexico, and Peru. TRANSLATIONS For the Portuguese and Spanish translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Valdiléa G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil.
| | - Carlos F Cáceres
- Universidad Peruana Cayetano Heredia, Centro de Investigaciones Interdisciplinarias em Salud, Sexualidad, y SIDA, Lima, Peru
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Ronaldo I Moreira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Hamid Vega-Ramírez
- Instituto Nacional de Psiquiatria Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Kelika A Konda
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Iuri C Leite
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (ENSP-Fiocruz), Rio de Janeiro, Brazil
| | | | | | | | - Alessandro Farias
- CEDAP-Centro Estadual Especializado em Diagnóstico, Assistência e Pesquisa, Salvador, Brazil
| | - Josué N Lima
- Centro de Referência em DST/AIDS-AMDA, Campinas, Brazil
| | | | - Lilian Lauria
- Hospital Municipal Rocha Maia, Rio de Janeiro, Brazil
| | - Cesar Vidal Osco Tamayo
- Centro de Referencia de Infecciones de Transmisión Sexual del Centro Materno Infantil Tahuantinsuyo Bajo, Lima, Peru
| | | | | | | | - Marcelo Cunha
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (ENSP-Fiocruz), Rio de Janeiro, Brazil
| | - Júlio Moreira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Alessandra Ramos Makkeda
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Steven Díaz
- United Nations Population Fund, Mexico City, Mexico
| | - Juan V Guanira
- Universidad Peruana Cayetano Heredia, Centro de Investigaciones Interdisciplinarias em Salud, Sexualidad, y SIDA, Lima, Peru
| | | | - Marcos Benedetti
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | | | | | - Thiago S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
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