Eligibility for Pre-exposure Prophylaxis According to Different Guidelines in a Cohort of HIV-Negative Men Who Have Sex with Men in Lisbon, Portugal

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.

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“…as we have previously shown [14]. Further, we hypothesise that this may also result in different ability to predict HIV seroconversion.…”

Section: Guideline and Criteria For Eligibilitymentioning

confidence: 53%

“…A more detailed description is available elsewhere [14]. Information regarding the 12 months before the baseline was used, except for the EACS criterion regarding the use of PEP, for which lifetime information was used.…”

Section: Study Instruments and Variablesmentioning

confidence: 99%

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

Meireles

Plankey

Rocha³

et al. 2020

Eurosurveillance

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“…Each criterion of the guideline was matched with the behavioral information collected at the baseline and follow-up evaluations and was operationally defined as described in Table 1. A more detailed description is available elsewhere (15). Exposure ascertainment was based on the information regarding the previous 12 months provided at the baseline visit and, thereafter, based on the period between visits.…”

Section: Study Instruments and Variablesmentioning

confidence: 99%

Transitions Between Preexposure Prophylaxis Eligibility States and HIV Infection in the Lisbon Cohort of HIV-Negative Men Who Have Sex With Men: A Multistate Model Analysis

Meireles¹,

Moreira²,

Rocha³

et al. 2021

American Journal of Epidemiology

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We aimed to describe transitions between preexposure prophylaxis (PrEP) eligibility and HIV infection among HIV-negative men who have sex with men (MSM). We used data from 1885 MSM, who had not used PrEP, enrolled in the Lisbon Cohort of MSM with at least 2 consecutive measurements of PrEP eligibility from 2014 to 2020. A time-homogeneous Markov multistate model was applied to describe the transitions between states of PrEP eligibility—eligible (E) and ineligible (I)—and from these to HIV infection (HIV). The intensities of the transitions were closer for I–E and E-I (intensities’ ratio, 1.107 [95%CI, 1.008-1.176]), while the intensity of the E–HIV transition was higher than that for ineligible–HIV infection (I–HIV) (intensities’ ratio, 9.558 [95%CI, 0.738-65.048]). The probabilities of transitions increased with time; for 90 days, the probabilities were similar for the transitions I-E and E-I (0.285 [95%CI, 0.252-0.319] vs 0.258 [95% CI, 0.228-0.287]), while the transition E-HIV was more likely than I-HIV (0.004 [95%CI, 0.003-0.007] vs 0.001 [95%CI, 0.001-0.008]) but tended to become closer with time. Being classified as ineligible was a short-time indicator of a lower probability of acquiring HIV. Once an individual moved to eligible, he was at a higher risk of seroconversion demanding a timely delivery of PrEP.

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“…Nevertheless, studies conducted with MSM have revealed difficulties in accessing PrEP in Portugal, particularly regarding the ideal way to enter the system, the waiting time for the first consultation, or even approval for treatment. This has led, for example, to the purchase of these drugs online at high prices and their use without proper monitoring, something that may not be possible for immigrants (10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Pre-exposure prophylaxis among Brazilian men who have sex with men: a comparative study between migrants and non-migrants

Sousa,

Lima,

Ribeiro

et al. 2023

Front. Public Health

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IntroductionInvestigating the use and adherence to pre-exposure prophylaxis (PrEP) in MSM is a global health priority in the fight against HIV. Strategies must be capable of increasing usage and reaching not only the population living in the country but also those who immigrate, who face additional vulnerabilities. Based on this, in this observational, cross-sectional, and analytical study, our aim is to analyze the use of PrEP among Brazilian men who have sex with men, whether they are migrants or not. We aim to highlight preventive opportunities and strategies for the global health scenario.MethodsWe utilized a sample of Brazilians living in the country and Brazilian immigrants residing in Portugal, one of the main destinations for Brazilians in recent years. To estimate the prevalence ratio (PR) of PrEP use, we employed the Poisson regression model with robust variance estimation using a covariance matrix.ResultsA total of 1,117 Brazilian MSM PrEP users participated in this study, with 788 residing in Brazil and 328 in Portugal. Multivariate analysis was conducted in three stages: overall, and for subgroups of residents in Brazil and immigrants in Portugal. We identified four convergent factors that increased the prevalence of PrEP use in Brazilians regardless of migration status: having two or more casual sexual partners per month, engaging in challenging sexual practices as the receptive partner, disclosing serological status on apps, and being single. Among native Brazilians, four unique factors stood out: being in a polyamorous relationship, having sexual relations with unknown casual partners, and having higher levels of education.DiscussionThis study highlights the need to implement strategies to strengthen PrEP adherence in Brazil and create international programs that facilitate its usage among populations migrating between these two countries.

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Eligibility for Pre-exposure Prophylaxis According to Different Guidelines in a Cohort of HIV-Negative Men Who Have Sex with Men in Lisbon, Portugal

Cited by 4 publications

References 26 publications

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

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

Transitions Between Preexposure Prophylaxis Eligibility States and HIV Infection in the Lisbon Cohort of HIV-Negative Men Who Have Sex With Men: A Multistate Model Analysis

Pre-exposure prophylaxis among Brazilian men who have sex with men: a comparative study between migrants and non-migrants

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