Ícaro Ramos, Ascom – Project PrEPara Salvador
HIV Pre-Exposure Prophylaxis (PrEP) is a biomedical method of prevention, in the form of a medication, which protects the individual from infection. The Ministry of Health has already offered PrEP free of charge in SUS (PrEP-SUS), since 2018, for people aged 18 or over. According to official data, there are already 211 health services that dispense the drug and that have accumulated about 14 thousand users of PrEP in the country.
In Brazil, PrEP is not yet offered to adolescents under 18 years of age in SUS health services. This offer is made only in the PrEP1519 Project, a study demonstrating the use of PrEP, which aims to investigate the effectiveness of PrEP for HIV protection among men who have sex with other men, transvestites and transsexual women, aged 15 to 19 years old , in the cities of Salvador, Belo Horizonte and São Paulo. The project has been conceived and executed since 2018 by professors and researchers from UFBA, UNEB, USP and UFMG.
On October 29 and 30, 2020, partial results of the research were presented at the II Annual Meeting of PrEP Adolescent Projects funded by Unitaid ( https://unitaid.org ) in Brazil and South Africa, which took place virtually.
The meeting was attended by representatives of Unitaid, World Health Organization (WHO), Pan American Health Organization (PAHO), Ministry of Health of Brazil, London School of Hygiene and Tropical Medicine of England, and Brazilian researchers linked to the PrEP1519 from the sites in Salvador, São Paulo and Belo Horizonte, as well as researchers from WITS University in South Africa, who carry out a similar project with adolescent women and young people aged 15-24 (Project PrEP).
Service provision during the pandemic and telehealth
During the COVID-19 pandemic, there was a significant reduction in the supply and demand for health services, including those related to HIV, due to quarantine measures and the need for social isolation. In order to continue operating, these services have adapted, adopting new practices of service and monitoring of activities.
In general, initiatives in Brazil and South Africa had to adapt the services offered by PrEP, in addition to other methods of preventing HIV and other sexually transmitted infections through telemedicine, mobile clinics, staff training, protective equipment. individual, among other actions.
“The establishment of new service practices quickly and appropriately was very good for us. We have intensified the use of online platforms to connect Project PrEP users / participants to health services. We produce information for field personnel and users. We train our people and deliver PrEP medication at home, ”explains Dr. Saiqa Mulick, professor at WITS University and coordinator of Project PrEP.
In Brazil, the PrEP1519 Project implemented preventive measures to COVID-19 that included consultations by call center, transportation via app for displacing participants who needed face-to-face assistance and sending a prevention kit (condoms, lubricants, pouch)with HIV self tests and prevention information) to the participant’s home. “In March of this year, we decided to keep the PrEP1519 clinics in operation, recognizing it as an essential service in the pandemic, as it was predicted that teenagers would not stop sexual activity. In this way, teleconsultations were implemented and are here to stay ”, says professor Dr. Inês Dourado, from the Collective Health Institute at UFBA, and coordinator of the study in Salvador. Data from the survey on the impacts of COVID-19 showed that 60% of participants in PrEP15 19 had sexual encounters during the pandemic.
This contingency plan for COVID-19 revealed the importance of continuing HIV prevention services carried out virtually. The experience was evaluated by the participants in a positive way. “Many teenagers have a routine that makes it difficult to stay or go to health services”, reinforces Prof. Alexandre Grangeiro, coordinator of the study in São Paulo. Therefore, he believes that it is necessary to test techniques to simplify the use of PrEP, such as drug delivery in a decentralized manner.
The PrEP debate in SUS
One of the objectives of research on the use of PrEP among adolescents is to base public policy makers with scientific evidence on the effectiveness of the strategy. In this sense, the Brazilian and South African experiences are accompanied by specialists in economic analysis for PrEP cost-effectiveness studies.
Economist Andreia Costa Santos, from the London School of Hygiene and Tropical Medicine in England, has conducted research on the cost-effectiveness of PrEP among adolescents in the PrEP1519 Project: “We will assess how much PrEP can become an economy for SUS in comparison with the treatment of HIV / AIDS ”, explains the researcher. This analysis will take into account the average cost of treatment, the diagnosis of HIV / AIDS and the cost-effectiveness ratio for prevention in each age group.
Young people interested in participating in the PrEP1519 Project can get in touch through the project’s WhatsApp (71) 9 99640-9030 or through Instagram (@preparasalvador). Virtual assistant Amanda Selfie can help too! Just call her to chat on the website (Prep1519.org) or on Facebook (@ amandaselfie.bot).