Different guidelines for pre-exposure prophylaxis (PrEP) eligibility estimate HIV risk differently: an incidence study in a cohort of HIV-negative men who have sex with men, Portugal, 2014–2018

Abstract

We aimed to measure the association between guideline-specific eligibility and HIV seroconversion. Methods: We studied 1,254 participants from the Lisbon Cohort of men who have sex with men with at least two evaluations between March 2014 and March 2018, corresponding to 1,724.54 person-years (PY) of follow-up. We calculated incidence rates (IR) according to each guideline eligibility definition and incident rate ratios (IRR) to test the association between eligibility at baseline and HIV seroconversion. Results: We found 28 incident cases (IR: 1.62/100 PY; 95% confidence interval (CI) 1.12-2.35). Guidelines' sensitivity varied from 60.7% (EACS) to 85.7% (PNHS) and specificity varied from 31.8% (US CDC) to 51.5% (EACS). IR was highest among those defined as eligible by the PNHS guideline (2.46/100 PY; IRR = 4.61; 95% CI: 1.60-13.27) and lowest for the WHO guideline (1.89/100 PY; IRR = 1.52; 95% CI: 0.69-3.35). Conclusions: Being identified as eligible for PrEP was associated with a higher risk of infection. The magnitude of risk varied according to the guideline used. However, the number of HIV infections identified among ineligible participants highlights the potential for missing people who need PrEP.

Adherence to Pre-Exposure Prophylaxis (PrEP) among Men Who Have Sex with Men (MSM) in Portuguese-Speaking Countries

“…This may mean that the Portuguese health system is more effective than its Brazilian counterpart in identifying immigrants and incorporating them into the PrEP services. In fact, Portugal has exclusive community-based HIV testing and counseling services for MSM and immigrants, which may make a difference in the fight against the virus [ 51 , 53 ].…”

“…Since its implementation, PrEP use in Portugal has been recommended for key populations, although it was only from 2018 onwards that it became available exclusively through a reference hospital for HIV infection. For the users registered in the Portuguese National Health System (Sistema Nacional de Saúde, SNS), screening, monitoring, follow-up and provision of PrEP consultations are free of charge [ 51 , 52 , 53 , 54 , 55 , 56 ].…”