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

Paula M Luz; Vijeta Deshpande; Pooyan Kazemian; Justine A Scott; Fatma M Shebl; Hailey Spaeth; Cristina Pimenta; Madeline Stern; Gerson Pereira; Claudio J Struchiner; Beatriz Grinsztejn; Valdilea G Veloso; Kenneth A Freedberg

doi:10.1186/s12889-023-15994-0

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. 2023 Jun 13;23(1):1128. doi: 10.1186/s12889-023-15994-0.

Authors

Paula M Luz¹, Vijeta Deshpande², Pooyan Kazemian³, Justine A Scott², Fatma M Shebl², Hailey Spaeth², Cristina Pimenta⁴, Madeline Stern², Gerson Pereira⁴, Claudio J Struchiner⁵, Beatriz Grinsztejn⁶, Valdilea G Veloso⁶, Kenneth A Freedberg^{2

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Affiliations

¹ Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil 4365, Rio de Janeiro, 21040-360, Brazil. luzpaulamendes@gmail.com.
² Medical Practice Evaluation Center, Massachusetts General Hospital, 100 Cambridge Street, Suite 1684, Boston, MA, 02114, USA.
³ Department of Operations, Weatherhead School of Management, Case Western Reserve University, 11119 Bellflower Road, Cleveland, OH, 44106, USA.
⁴ Ministry of Health of Brazil, SRTVN Quadra 701, Lote D, Edifício PO700, 5º Andar, Brasília/DFBrasilia, 70719-040, Brazil.
⁵ Escola de Matemática Aplicada, Fundação Getúlio Vargas, Rio de Janeiro, Brazil.
⁶ Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil 4365, Rio de Janeiro, 21040-360, Brazil.
⁷ Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
⁸ Harvard University Center for AIDS Research, Harvard Medical School, 42 Church Street, Cambridge, MA, 02138, USA.
⁹ Division of General Internal Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
¹⁰ Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
¹¹ Department of Health Policy and Management, Harvard School of Public Health, 677 Huntington Ave, Boston, MA, 02115, 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: HIV prevention; Key and vulnerable populations; Latin America and the Caribbean; Men who have sex with men; Modeling; Pre-exposure prophylaxis (PrEP).

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Brazil
Emtricitabine
HIV Infections*
Homosexuality, Male
Humans
Male
Pre-Exposure Prophylaxis*
Sexual and Gender Minorities*

Substances

Emtricitabine

Abstract

Publication types

MeSH terms

Substances

Grants and funding