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PrEP in Brazil: 18 months of implementation as a public health policy

Learn about the implementation and results of PrEP as a public health policy in Brazil, including eligibility criteria, target populations, monitoring data, challenges, and future steps.

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PrEP in Brazil: 18 months of implementation as a public health policy

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  1. PrEP in Brazil: 18 months of implementation as a public health policy Department of Diseases of Chronic Condition and STI Secretariat for Health Surveillance Ministry of Health of Brazil www.aids.gov.br July, 2019

  2. Background • 200 million population, 27 States • 1988: Unified Health System - SUS • 1996: Free and universal access to ART was guaranteed by law • December 2013: Treatment as Prevention • 2017: DTG incorporated as preferred 1st line regimen • 2018: PrEP implementation in SUS free of charge

  3. PrEP ImplementationTimeline in Brazil

  4. National PrEP Guidelines Elegibilitycriterias: • HIV- and • Unprotected anal or vaginal sex (past 6 months) and/or • Repeated PEP use and/or • Repeated STI • + Other HIV vulnerabilities (drug use, number of partners, etc) Priority targets for PrEP Gay men and other MSM Trans people Sex workers Serodiscordant partnerships PrEP followup - overview Daily dosing of TDF+FTC

  5. ResultsfromJanuary 2018 toJune 2019

  6. PrEPMonitoring: Brazil, Jan/2018 - June/2019 10,350 initiated PrEP* 26 States 192 registered services * Hadatleastonedispensation in theperiod

  7. Discontinuation of PrEP use 87% 69% 58% 42%

  8. % of Commercial Sex WorkReported by Population * 14 transmen PrEP users (total)

  9. People who reported having had unprotected sex with HIV + partners in recent months, by population

  10. % of Users with Symptoms or Diagnosis of STI in the 6 Months Before the 1st Appointment * 14 transmen PrEP users (total)

  11. Syphilis 9% of userswhoinitiated PrEP, tested positive for syphilis in the firstconsultation (n = 674) 5% ofuserstested positive for syphilisduring PrEP use (n = 509) HIVseroconversion 4 userstested positive for HIVduring PrEP use

  12. Adherence to PrEP (pill intake, last month)

  13. Condom Use, in the last 3 months

  14. Number of Sexual Partners, in the last 3 months

  15. Adverse Events Related to PrEP on 30-day Return

  16. Main Challenges • Keeponscalling-up PrEP acrossthe country • Reachingthosewho are undergreatervulnerability • Making PrEP widely known by the ones who can greatly benefit from it

  17. Next Steps • The MoH implemented PrEP as a public policy and will spare no efforts to guarantee its full implementation. Some of these efforts are: • Keep taking advantage of our historical and fruitful partnership with the civil society • Funding PrEP promotion activities driven by the civil society • Fostering partnership between NGOs and local HIV managers and health services • Promote initiatives of peer education • Producing an online PrEP course to easy the opening of new PrEP services • Tailoring communication strategies to reach the most vulnerable populations

  18. Thankyou! gerson.pereira@aids.gov.br

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