Nonoccupational post-exposure prophylaxis for HIV after sexual intercourse among women in Brazil: Risk profiles and predictors of loss to follow-up

Abstract

Access to antiretroviral-based HIV prevention has been marked by sex asymmetries, and its effectiveness has been compromised by low clinical follow-up rates. We investigated risk profiles of women who received nonoccupational post-exposure prophylaxis (nPEP), as well as the rates and predictive factors of loss to follow-up after nPEP initiation.Retrospective study evaluating 501 women who received nPEP between 2014 and 2015 at 5 HIV centers (testing centers-VCT, outpatient clinics, and infectious diseases hospital). Risk profiles were drawn based on the characteristics of the women and their sexual partners, and then stratified by sociodemographic indicators and previous use of HIV prevention services. Loss to follow-up (LTFU) was defined as not presenting for follow-up visits or for HIV testing after nPEP initiation. Predictors of LTFU were analyzed by calculating adjusted prevalence ratios (aPRs).Approximately 90% of women had sexual encounters that met the criteria established in the Brazilian guidelines for nPEP. Those who declared to be sex workers (26.5%) or drug users (19.2%) had the highest social vulnerability indicators. In contrast, women who had intercourse with casual partners of unknown HIV risk (42.7%) had higher education and less experience with previous HIV testing (89.3%) or nPEP use (98.6%). Of the women who received nPEP after sexual intercourse with stable partners, 75.8% had HIV-infected partners. LTFU rate was 72.8% and predictors included being Black (aPR = 1.15, 95% confidence interval [CI]: 1.03–1.30), using drugs/alcohol (aPR = 1.15, 95% CI: 1.01–1.32) and having received nPEP at an HIV outpatient clinic (aPR = 1.35, 95% CI: 1.20–1.51) or at an infectious diseases hospital (aPR = 1.37, 95% CI: 1.11–1.69) compared with a VCT. The risk of LTFU declined as age increased (aPR 41–59 years = 0.80, 95% CI: 0.68–0.96).Most women who used nPEP had higher socioeconomic status and were not part of populations most affected by HIV. In contrast, factors that contribute to loss to follow-up were: having increased social vulnerability; increased vulnerability to HIV infection; and seeking nPEP at HIV treatment services as opposed to at a VCT.

Prevalence and reasons of loss to follow-up in HIV clinics: a systematic review of current evidence

“…Since most of these factors should be taken from patients' reports, the lack of cooperation of patients in explaining the reasons for termination of treatment has been one of the most important limitations mentioned in these articles [24]. Also, the lack of complete documentation of information about main indicators of patients' health status was one of the most important limitations mentioned in the references [69]. Although, due to the lack of a national follow-up system in many countries, the possibility that patients continued on treatment in another clinic or under other insurance coverage, has been raised.…”

Adherence to HIV post-exposure prophylaxis in a specialized service in São Paulo, Brazil

“…Worldwide, there are not many studies assessing adherence to medication among users who did not return for follow-up visits. In Brazil, there are few studies on adherence to PEP, in which it was investigated in restricted groups, such as women or men who have sex with other men (MSMs) [13,14], or whose study loci were health services in general, not those specialized in HIV/AIDS care [15]. Thus, the objective of this study was to examine the adherence rate to antiretroviral agents and follow-up visits, as well as to identify the associated characteristics of adherence and the reasons why users do not attend PEP visits in a specialized service in São Paulo, Brazil.…”

Análise da profilaxia pós-exposição em um município do interior de Pernambuco

“…A PEP é dividida em PEP não ocupacional (nPEP) e ocupacional. Na nPEP, a exposição é definida como sexo sem proteção, rompimento do preservativo e contato de mucosas com fluidos potencialmente contaminados (GRANGEIRO et al, 2019).…”