Implementation of pre-exposure prophylaxis programme in Spain. Feasibility of four different delivery models

Abstract

Background Pre-exposure prophylaxis (PrEP) is an effective and cost-effective strategy for HIV prevention. Spain carried out an implementation study in order to assess the feasibility of implementing PrEP programmes within its heterogeneous health system. Methods Observational longitudinal study conducted on four different types of health-care setting: a community centre (CC), a sexually transmitted infections clinic (STIC), a hospital-based HIV unit (HBHIVU) and a hospital-based STI unit (HBSTIU). We recruited gay, bisexual and other men who have sex with men (GBSM) and transgender women at risk of HIV infections, gave them PrEP and monitored clinical, behavioural PrEP-related and satisfaction information for 52 weeks. We collected perceptions on PrEP implementation feasibility from health-care professionals participating in the study. Results A total of 321 participants were recruited, with 99.1% being GBMSM. Overall retention was 87.2% and it was highest at the CC (92.6%). Condom use decreased during the study period, while STIs did not increase consistently. The percentage of people who did not miss any doses of PrEP during the previous week remained at over 93%. No HIV seroconversions occurred. We observed overall decreases in GHB (32.5% to 21.8%), cocaine (27.5% to 21.4%), MDMA (25.7% to 14.3%), speed (11.4% to 5.7%) and mephedrone use (10.7% to 5.0%). The overall participant satisfaction with PrEP was 98.6%. Health-care professionals’ perceptions of PrEP feasibility were positive, except for the lack of personnel. Conclusions PrEP implementation is feasible in four types of health-care settings. Local specificities have to be taken into consideration while implementing PrEP.

Evolution of Risk Behaviors, Sexually Transmitted Infections and PrEP Care Continuum in a Hospital-Based PrEP Program in Barcelona, Spain: A Descriptive Study of the First 2 Years’ Experience

“…The prevalence of potentially traumatic sexual practices (double penetration, fisting, and sex toy use) and group sex were higher than in previous published studies [ 31 ]. After starting PrEP, an increase in condomless anal sex was observed, as described in other studies [ 12 , 14 , 15 , 38 , 40 ]. However, the use of protection during other high-risk sexual practices did not change.…”

“…This was the largest Spanish cohort of users included exclusively in a hospital-based PrEP program [ 38 , 40 ]. Regarding the influence area of the hospital, the percentage of transgender women and sex workers was higher than in other studies, including national series [ 38 , 40 ], increasing users’ vulnerability [ 15 ]. Our cohort was largely composed of individuals derived from NGOs or community centers and STI and PEP consultations.…”

Cost-Effectiveness Analysis of the Daily HIV Pre-Exposure Prophylaxis in Men who Have Sex with Men in Barcelona

“…The model does not include stochastic, individual or behavioral features, losing some nuances in sexual patterns and thus transmission patterns. Besides, it does not account for risk-compensation: the introduction of PrEP may encourage sexual behaviours with higher risk by some individuals (lower condom usage rates, for instance), increasing comorbidity through secondary STIs and thus increasing the overall social and healthcare costs of the intervention, although some studies show no significant increase on STI incidence [13]. Finally, the different endogenous changes in infectivity and force of infection as a result of the evolution of the simulation and the count at different stages of the epidemic are not taken into account.…”

Scaling up preexposure prophylaxis to maximize HIV prevention impact

“…In Thailand, by 2019, it was estimated that 48% of PrEP users had received PrEP services at a community-based organization [8]. In Spain, GBM who received PrEP through a clinic located at a gay community-based organization were less likely to be lost to follow-up [33]. PrEP initiations in community-based clinics are also performed in San Francisco [34].…”