Oral Pre-Exposure Prophylaxis of HIV infection – PrEP in Brazil
STI, Aids and Viral Hepatitis Department Secretary for Health Surveillance Ministry of Health Brazil Geneva, May 24 th, 2016 Brazil: Concentrated HIV epidemic in key populations
HIV remains an infectious Prevalence rates diseases of major public health importance in Brazil. There are estimated to be some 781.000 people living with HIV/Aids in Brazil.
Source: special studies conducted between 2009/2010 and 2013. Brazilian Ministry of Health. Biomedical HIV prevention package in Brazil
Oral PrEP containing TDF should be offered as an additional prevention choice for people at substantial risk of HIV infection, as part of combination HIV prevention approaches.
Reliable tool in preventing the transmission of HIV
Implementation of PrEP will contribute to achieving (South America e Caribbean)
Available at www.aids.gov.br; access on April 15, 2016
PrEP studies conducted in Brazil IPrEX Study
Sponsored/funded by DAIDS/NIH, through a grant to the Gladstone Institutes. Location: Brazil, Peru, Ecuador, South Africa, Thailand, US. Population: MSM and transgender women.
PrEP studies conducted in Brazil
The Combine! Study: Protocol for a Pragmatic Clinical Trial on PEP, PrEP and Combination HIV Prevention Methods in Public Clinics in Brazil • Authors: Grangeiro A, et al. (BMJOpen 2015;5:e009021.) • Funding: Brazilian Ministry of Health National Council for Scientific and Technological Development Truvada® donated by Gilead • Start: PrEP Group: Jun/2016
PrEP studies conducted in Brazil
PrEP uptake and associated factors among MSM and TGW in the PrEP Brasil demonstration project
Brenda Hoagland, Valdilea G. Veloso, Raquel B. De Boni, José Valdez Madruga, Esper G. Kallas, Nilo Martinez Fernandes, Ronaldo I. Moreira, Albert Y. Liu and Beatriz Grinsztejn for the PrEP Brasil Study Team Method
Sites . Oswaldo Cruz Foundation - Fiocruz/RJ . University of São Paulo (USP) . Referral Center for HIV Treatment (CRT/SP)
Funding: . Brazilian Ministry of Health . FAPESP/ FAPERJ . FIOCRUZ . Truvada® donated by Gilead
Preliminary Data: 1.187 individuals interviewed (pre-screening visit) . 96.3% (MSM) and 4,7% (TGW) . Median age: 29 years . HIV Positive: 9,8% - High prevalence
PrEP studies conducted in Brazil Evaluation of combined interventions to increase HIV diagnosis among MSM in Curitiba.
Funding: . ICICT, Oswaldo Cruz Foundation - FIOCRUZ, Ministry of Health . CDC GAP/Brazil . DDAHV, SVS, Ministry of Health Goals: . Expand HIV testing options for MSM; . Develop, implement and evaluate the feasibility of an intervention based on the internet for MSM, including: information about HIV and supply HIV self-testing kits (e-testing)
Pre-Exposure Prophylaxis (PrEP) - UNITAID
1. Pre-Exposure Prophylaxis and Linkage to Testing among sexually active older adolescents with substantial HIV Risk in Brazil, Thailand and South Africa
• Goal: Contribute to a decrease in the HIV incidence among adolescents for whom PrEP is recommended in Brazil, Thailand and South Africa. The project is part of efforts to accelerate HIV results in adolescents, MSM and Transgender Women. • Partner's organizations: UNICEF, UNITAID, Brazilian, Thailand, South African Governments and Civil Society.
2. PrEParedness for the Rollout of Effective HIV Prevention among Key Affected Populations in Brazil, Mexico, and Peru
• Goal: to contribute to the global efforts for the rollout and further scale up of PrEP as an innovation to combination HIV prevention approaches within the national HIV and AIDS health policies of Brazil, Mexico and Peru. MSM and Transgender Women. • Implementation institution: FIOTEC/FIOCRUZ • Support institution: UNITAID • Partner's organizations: Brazilian, Mexican and Peruvian Governments, Civil Society and Cayetano Heredia University.
PrEP strategies: Brazil
Perspectives: PrEP strategies
Advisory Board: meeting in October 2015 – Guidelines for public health system; PrEP strategies: 1. Clinical guidelines (ongoing) 2. Operational guidelines (ongoing) 3. Monitoring & Evaluation (ongoing)
Key populations (PWUD, serodiscordant couples, MSM, transgender people and sex workers)
Truvada registration for PrEP in analysis by national regulatory agency
HIV self-testing kits: the pharmaceutical companies interested in commercializing HIV self-testing kits are making the necessary readjustments and submitting them to the analysis of national regulatory agency. PrEP as a public health policy, free-of-charge, by the end of 2016 Acknowlegdments
Fábio Mesquita-DDAHV/MS Brazil Adele Benzaken - DDAHV/MS Brazil Cristina Pimenta - DDAHV/MS Brazil Gerson Pereira - DDAHV/MS Brazil Alessandro Caruso - DDAHV/MS Brazil Flávia Alvarenga - DDAHV/MS Brazil Marcelo Freitas - DDAHV/MS Brazil João Paulo Toledo - DDAHV/MS Brazil João Netto - DDAHV/MS Brazil Ana Flávia Nacif - DDAHV/MS Brazil
Thank you
Flávia Moreno DDAHV/SVS/MS [email protected]