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The ImPrEP Experience: Uptake and Feasibility of Same-Day PrEP for MSM and TGW in Latin America

This presentation shares the findings and results of the ImPrEP project, which aimed to assess the uptake, acceptability, and feasibility of same-day PrEP for MSM and TGW in Brazil, Peru, and Mexico. The project also evaluated the effectiveness of using HIV self-testing to increase demand for HIV combination prevention among high-risk populations.

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The ImPrEP Experience: Uptake and Feasibility of Same-Day PrEP for MSM and TGW in Latin America

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  1. The ImPrEP Experience Valdilea G. Veloso @Valdilea Share your thoughts on this presentation with #IAS2019

  2. HIV epidemic in Latin America In 2016, 860,000 people livingwith HIV. 48,000 new infectionsper year. 6.1M+ 2.1M – 6.1M 1.6M – 2.1M < 1.6M No data UNAIDS Estimates 2017

  3. WHO on HIV Pre-exposure prophylaxis (PrEP) 2018 WHO PrEP implementation tool. Update on adolescents and M&E. 2017 • PrEP drugs oEML • (TDF/FTC; TDF/3TC; TDF); • WHO PrEP Implementation tool • Global PrEP Coalition 2015 PrEP for people at substantial HIV risk (≈3 per 100 person years) (strong recommendation) 2014 PrEP for MSM (strong recommendation) Other KP (conditional) WHO PrEP implementation tool – an enabling document 2012 PrEP for SDC, MSM and TG in the context of demo projects (conditional recommendation) http://www.who.int/hiv/pub/prep/en/

  4. PrEParedness for the Rollout of Effective HIVPrevention among Key Affected Populations inBrazil, Peru and Mexico • Objective: assess uptake, acceptability and feasibility of same day PrEP (TDF/FTC orally once a day) for MSM and TGW in the context of HIV combination prevention. • Design: multi-site prospective, open-label demonstration/implementation study, daily oral PrEP. • Countries: Brazil (Fiocruz - Coordination), Peru and Mexico. • Population: 7500 MSM/TGW (Brazil: 3,000; Mexico: 3,000; Peru: 1,500). • Sites: Public Health services and NGOs. • Regional Exchange Platform on PrEP • Working Group on Drug Licensing and Costing • Substudies (seroincidence, economic and mathematical modelling studies, etc). Brazil: 14 sites in 12 cities Mexico: 6 sites in 3 cities Peru: 10 sites in 7 cities

  5. CommunityEngagementandParticipation

  6. B. Online Survey - Among MSM and TGW Completed • Total of 43,687 MSM startedand19,457 completedthequestionnaire(11,043 in Brazil; 2,037 in Peru; 6,779 in Mexico) • 03 posterspresentedat CROI 2019 (awarenessofPrEP, barriers for PrEP use; willingnessto use HIV self-testing) • 01 articlesubmittedtopublication • Online surveyamong TGW deployedby May 2018 in Brazil, Peru, andMexico. 319 valid responses. Data hasnotbeenanalyzedyet • New online surveyonlongacting, implantables, STI and HIV Self-Test

  7. SurveyFlow Chart

  8. Resultados: Disposición a PrEP, barreras y facilitadores

  9. Resultados: factores asociados a disposición de uso de PrEP

  10. C. HIV self-testing to increase combination prevention demand in the ImPrEP project • MAIN OBJECTIVE: To evaluate the feasibility and effectivenessof HIVST secondary distribution by individuals using PrEP in increasing demand for HIV combination preventionamong high risk MSM and TGW • DESIGN:Adaptative randomized trial in Lima and Rio de Janeiro • INTERVENTION: MSM/TGW enrolled to ImPrEP will be 1:1 randomized to receive 5 HIVST+voucher or 5 vouchers alone to distribute into their MSM/TGW network + ControlArm InterventionArm

  11. Demonstration/implementation Study, Brasil, Mexico, Peru • Objective: assess uptake, acceptability and feasibility of same day PrEP (TDF/FTC orally once a day) for MSM and TGW in the context of HIV combination prevention. • Design: multi-site prospective, open-label demonstration/implementation study, daily oral PrEP. • Countries: Brazil (Fiocruz - Coordination), Peru and Mexico. • Population: 7500 MSM/TGW (Brazil: 3,000; Mexico: 3,000; Peru: 1,500). • Sites: Public Health services and NGOs. Brazil: 14 sites in 12 cities Mexico: 6 sites in 3 cities Peru: 10 sites in 7 cities

  12. Demonstration/ImprementationStudy • Main outcomes were: • PrEP early continuation defined as attendance to the first 2 follow-up visits within 120 days of PrEP initiation • PrEP adherence, measured using pharmacy refill data defined as having at least 16 days of PrEP medication filled per 30-day period (medication possession ratio ≥0.53).

  13. Study procedures by visitas • 30 DAYS • QUARTELY • ENROLLMENT • Behaviour assessment • Signsandsymptoms for HIV acute viral infection assessment • HIV Rapid Test • HIV Viral Load • Renal Function • Shyphilis ; hepatitis B and C tests; anal swabs for chlamydiaandghonorhea • 30 tablets of TDF / FTC • Adverse eventsevaluation • Signsandsymptoms for HIV acute viral infection • Sexual behavior assessment • Adherence Self report for thelast 30 days • HIV rapidtestandsyphilisserology • Renal function • DBS collection (twice per year) • 90 tablets of TDF / FTC • Adverse events evaluation • Signs and symptoms for HIV acute viral infection • Sexual behavior assessment • Adherence self report for the last 30 days • Review of the exams collected at enrollment • HIV Rapid Test • DBS collection • 90 tablets of TDF / FTC

  14. PrEPMonitoring System in SICLOM (ARV logistic system)

  15. Brazil – 14 sites in 12 cities

  16. Mexico – 6 sites in 3 cities

  17. Peru – 10 sites in 7 cities

  18. Brazil – 14 sites in 12 cities EnrolledbyJune 2019 3.466

  19. Mexico – 6 sites in 3 cities EnrolledbyJune 2019 736

  20. Peru – 10 sites in 7 cities EnrolledbyJune 2019 736

  21. Acknowledgments ImPrEPteams Studyparticipants Thankstooursponsors

  22. ThankYou !

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