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Pre-Exposure Prophylaxis Pilot Implementation in the Dominican Republic- PrEP -DR

This pilot implementation study explores the implementation of pre-exposure prophylaxis (PrEP) in the Dominican Republic, focusing on HIV epidemiology, eligibility criteria, case management, monitoring, and scaling-up strategies.

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Pre-Exposure Prophylaxis Pilot Implementation in the Dominican Republic- PrEP -DR

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  1. Pre-Exposure Prophylaxis Pilot Implementation in the Dominican Republic- PrEP-DR Robert Paulino-Ramirez, MD, DTM&H, HIVS Director Instituto de Medicina Tropical & Salud Global Universidad Iberoamericana-UNIBE Dominican Republic

  2. HIV Epidemiology-Dominican Republic • Concentrated Epidemic • HIV Prevalence in GP: 0.9 [0.7-1.2] -14% decreased new infections since 2010 • PLWHIV: 67,000 [52,000-85,000] • PLWHIV in ART: 35,000 (52%) • PLWHIV virally suppressed: 29,000 (82%) • 7.1 % HIV Prevalence among MSM • 12.9% Syphilis among MSM UNAIDS, 2018

  3. Unainiciativa, Un PaísHow We Started? * Approval from the National Bioethical committee was obtained for this pilot implementation.

  4. Training of Health Care Personnel

  5. Elegibility Criteria • HIV Negative Status • No clinical findings of Acute Retroviral Syndrome • Significative Risk for HIV acquisition* • No contraindicattions to PrEP drugs (TDF/FTC or TDF/3TC) • Creatinine levels GFRe: 60 mL/min • Willing to take PrEP ___________________________________________ * Risk assessment: • Anal or vaginal Sexual Contact without condoms, OR • Recent history (Last 6 months) of any syndromic or diagnosed STI, OR • Recent use of Post-Exposure Prophylaxis-PEP, OR • Serodiscourdant HIV couple.

  6. PrEP Case Management Laboratory HIV VDRL HBsAg HCV Creatinine HIV (-) HBsAG (-) HCV (-) eGFR (> 60 mL/min Medical Department Psychology/Counseling PrEP Unit Risk Behaviour Assessment Pre-Counseling HIV test prescription PrEP Started Follow-up in 15 days, then every 3 months User referred from the community, STIs services, PEP, or Serodiscordant couples

  7. Monitoring of Data

  8. 942 85% Negative results [n=849] Results * PrEP offered [n=849] 100% 32% PrEP Started [n=271] HIV tests done to MSM/TGW 31% MSM Acceptability Rates 50% MSM * Data uptaded as July 15th, 2019

  9. 24% 12% Evidence of HBV vaccination Results (2) eGFR >100 mL/min 79% 1% HPV-related dysplasias Positive Syphilis Test on Baseline 5% Assymptomatic Chlamydia infections* 20% Referred Condom Use on Baseline *C. trachomatis/N.gonorrheae was detected by NAAT in Urine (As July 15th, 2019)

  10. 2% 20% Increase of HBV vaccination Results Follow-up (12 months) eGFR >100 mL/min 81% 72% Persistence rate* New Positive Syphilis Tests 37% Use of Condoms while in PrEP * Persistence Rate was defined as a continuous use of PrEP drugs during the pilot implementation (12 months)

  11. Scaling-Up PrEP in the DR First draft for a National PrEP Implementation Strategy released last year National PrEP guidelines are currently on revision to be published soon

  12. Publishing

  13. New PrEP Units (As July 15th, 2019)

  14. Conclusions Acceptability was good PEP and voluntary partner referral services opportunity to increase the offer. Many opportunities for a comprehensive approach to STIs not limited to HIV Opportunities for HBV vaccination, and Syphilis early detection/treatment Side effects were not significant Importance of mental health interventions and Behavioral modifications It is required more training to health care providers (evidence-based approach of PrEP effectiveness)

  15. Acknowledgements • To the DR MOH Team, specially DIGECITSS- Dr. FelizBáezand Dr. José Ledesma • DR CDC • To PAHO local officer Dr. Rafael Rodríguez • COIN’s Team: Lic. Santo Rosario and Dra. Merelin Muñoz • My PrEP Team: • Mayra Rodriguez, MSc • Leandro Tapia, MD • AneskaMariño, MD • Luis Ortiz, MD • Daniel Reyes, BA • Juana Clase • CBO working with MSM/TGW in the country

  16. Thanks!!

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