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IMPACT OF PRE-EXPOSURE PROPHYLAXIS UPTAKE AMONG GAY, BISEXUAL, AND OTHER MEN WHO HAVE SEX WITH MEN IN URBAN CENTERS IN BRAZIL: A MODELING STUDY
Luz, Paula M. et al. | Date Issued: 2023
Author
Luz, Paula M.
Deshpande, Vijeta
Kazemian, Pooyan
Scott, Justine A.
Shebl, Fatma M.
Spaeth, Hailey
Pimenta, Cristina
Stern, Madeline
Pereira, Gerson
Struchiner, Claudio J.
Grinsztejn, Beatriz
Veloso, Valdiléa G.
Freedberg, Kenneth A.
Affilliation
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brazil.
Medical Practice Evaluation Center. Massachusetts General Hospital. Boston, MA, USA.
Department of Operations. Weatherhead School of Management. Case Western Reserve University. Cleveland, OH, USA.
Medical Practice Evaluation Center. Massachusetts General Hospital. Boston, MA, USA.
Medical Practice Evaluation Center. Massachusetts General Hospital. Boston, MA, USA.
Medical Practice Evaluation Center. Massachusetts General Hospital. Boston, MA, USA.
Ministry of Health of Brazil. Brasília, DF, Brazil.
Medical Practice Evaluation Center. Massachusetts General Hospital. Boston, MA, USA.
Ministry of Health of Brazil. Brasília, DF, Brazil.
Fundação Getúlio Vargas. Escola de Matemática Aplicada. Rio de Janeiro, RJ, Brazil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brazil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brazil.
Medical Practice Evaluation Center. Massachusetts General Hospital. Boston, MA, USA / Harvard University Center for AIDS Research. Harvard Medical School. Cambridge, MA, USA / Division of General Internal Medicine. Massachusetts General Hospital. Boston, MA, USA / Division of Infectious Diseases. Massachusetts General Hospital. Boston, MA, USA / Department of Health Policy and Management. Harvard School of Public Health. Boston, MA, USA.
Abstract
Background: Men who have sex with men (MSM) in Brazil remain disproportionately affected by HIV. We estimated the potential incidence reduction by five years with increased uptake of publicly-funded, daily, oral tenofovir/emtricitabine (TDF/FTC) for HIV pre-exposure prophylaxis (PrEP) among MSM using the Cost Effectiveness of Preventing AIDS Complications microsimulation model. We used national data, local studies, and literature to inform model parameters for three cities: Rio de Janeiro, Salvador, and Manaus. Results: In Rio de Janero, a PrEP intervention achieving 10% uptake within 60 months would decrease incidence by 2.3% whereas achieving 60% uptake within 24 months would decrease incidence by 29.7%; results were similar for Salvador and Manaus. In sensitivity analyses, decreasing mean age at PrEP initiation from 33 to 21 years increased incidence reduction by 34%; a discontinuation rate of 25% per year decreased it by 12%. Conclusion: Targeting PrEP to young MSM and minimizing discontinuation could substantially increase PrEP's impact.
Keywords
Pre-exposure prophylaxis (PrEP)
HIV prevention
Men who have sex with men
Modeling
Latin America and the Caribbean
Key and vulnerable populations
 
Publisher
BioMed Central
Citation
LUZ, Paula M. et al. Impact of pre-exposure prophylaxis uptake among gay, bisexual, and other men who have sex with men in urban centers in Brazil: a modeling study. BMC Public Health, v. 23, n. 1, p. 1-12, June 2023.
DOI
10.1186/s12889-023-15994-0
ISSN
1471-2458