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Towards a fair consideration of PrEP as part of combination HIV prevention in Latin America.
J Int AIDS Soc. 2016; 19(7(Suppl 6)):21113.JI

Abstract

INTRODUCTION

Despite progress in scaling up antiretroviral treatment, HIV prevention strategies have not been successful in significantly curbing HIV incidence in Latin America. HIV prevention interventions need to be expanded to target the most affected key populations with a combination approach, including new high impact technologies. Oral pre-exposure prophylaxis (PrEP) is recommended as additional prevention choice for individuals at higher risk of infection and could become a cost-effective prevention tool. We discuss the barriers and solutions for a fair consideration of PrEP as part of combination HIV prevention strategies in Latin America.

DISCUSSION

Although demonstration projects are ongoing or being planned in a number of countries, to date no Latin American country has implemented a public PrEP programme. The knowledge of policymakers about PrEP implementation needs to be strengthened, and programmatic guidance and cost estimate tools need to be developed to support adequate planning. Despite high levels of awareness among health providers, especially if engaged in HIV or key population care, willingness to prescribe PrEP is still low due to the lack of national policies and guidelines. Key populations, especially men who have sex with men, transgender women and sex workers, have been engaged in demonstration projects, and qualitative research shows high awareness and willingness to use PrEP, especially if accessible in the public sector for free or at affordable price. Concerns of safety, adherence, effectiveness and risk compensation need to be addressed through targeted social communication strategies to improve PrEP knowledge and stimulate demand. Alliance among policymakers, civil society and representatives from key populations, healthcare providers and researchers will be critical for the design and successful implementation of PrEP demonstration projects of locally adapted delivery models. The use of mechanisms of joint negotiation and procurement of antiretrovirals could reduce costs and significantly increase the cost-effectiveness of PrEP.

CONCLUSIONS

PrEP is an additional prevention tool and should be implemented in combination and synergy with other prevention interventions. PrEP programmes should target high-risk individuals from key populations for higher cost-effectiveness. Demonstration projects may generate strategic information for and lead to the implementation of full-scale PrEP programmes.

Authors+Show Affiliations

Pan American Health Organization (PAHO), Washington, DC, USA; ravasigi@paho.org.Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.Instituto Nacional de Salud Pública, Cuernavaca, México.Investigaciones Medicas en Salud, Lima, Peru.Ministerio de Salud y Protección Social, Bogotá, Colombia.Centro de Investigación Interdisciplinaria en Sexualidad, SIDA y Sociedad, Universidad Peruana Cayetano Heredia, Lima, Peru.Pan American Health Organization (PAHO), Washington, DC, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27760687

Citation

Ravasi, Giovanni, et al. "Towards a Fair Consideration of PrEP as Part of Combination HIV Prevention in Latin America." Journal of the International AIDS Society, vol. 19, no. 7(Suppl 6), 2016, p. 21113.
Ravasi G, Grinsztejn B, Baruch R, et al. Towards a fair consideration of PrEP as part of combination HIV prevention in Latin America. J Int AIDS Soc. 2016;19(7(Suppl 6)):21113.
Ravasi, G., Grinsztejn, B., Baruch, R., Guanira, J. V., Luque, R., Cáceres, C. F., & Ghidinelli, M. (2016). Towards a fair consideration of PrEP as part of combination HIV prevention in Latin America. Journal of the International AIDS Society, 19(7(Suppl 6)), 21113. https://doi.org/10.7448/IAS.19.7.21113
Ravasi G, et al. Towards a Fair Consideration of PrEP as Part of Combination HIV Prevention in Latin America. J Int AIDS Soc. 2016;19(7(Suppl 6)):21113. PubMed PMID: 27760687.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Towards a fair consideration of PrEP as part of combination HIV prevention in Latin America. AU - Ravasi,Giovanni, AU - Grinsztejn,Beatriz, AU - Baruch,Ricardo, AU - Guanira,Juan Vicente, AU - Luque,Ricardo, AU - Cáceres,Carlos F, AU - Ghidinelli,Massimo, Y1 - 2016/10/18/ PY - 2016/03/25/received PY - 2016/07/12/accepted PY - 2016/10/21/pubmed PY - 2017/9/21/medline PY - 2016/10/21/entrez KW - HIV KW - Latin America KW - antiretrovirals KW - pre-exposure prophylaxis KW - prevention SP - 21113 EP - 21113 JF - Journal of the International AIDS Society JO - J Int AIDS Soc VL - 19 IS - 7(Suppl 6) N2 - INTRODUCTION: Despite progress in scaling up antiretroviral treatment, HIV prevention strategies have not been successful in significantly curbing HIV incidence in Latin America. HIV prevention interventions need to be expanded to target the most affected key populations with a combination approach, including new high impact technologies. Oral pre-exposure prophylaxis (PrEP) is recommended as additional prevention choice for individuals at higher risk of infection and could become a cost-effective prevention tool. We discuss the barriers and solutions for a fair consideration of PrEP as part of combination HIV prevention strategies in Latin America. DISCUSSION: Although demonstration projects are ongoing or being planned in a number of countries, to date no Latin American country has implemented a public PrEP programme. The knowledge of policymakers about PrEP implementation needs to be strengthened, and programmatic guidance and cost estimate tools need to be developed to support adequate planning. Despite high levels of awareness among health providers, especially if engaged in HIV or key population care, willingness to prescribe PrEP is still low due to the lack of national policies and guidelines. Key populations, especially men who have sex with men, transgender women and sex workers, have been engaged in demonstration projects, and qualitative research shows high awareness and willingness to use PrEP, especially if accessible in the public sector for free or at affordable price. Concerns of safety, adherence, effectiveness and risk compensation need to be addressed through targeted social communication strategies to improve PrEP knowledge and stimulate demand. Alliance among policymakers, civil society and representatives from key populations, healthcare providers and researchers will be critical for the design and successful implementation of PrEP demonstration projects of locally adapted delivery models. The use of mechanisms of joint negotiation and procurement of antiretrovirals could reduce costs and significantly increase the cost-effectiveness of PrEP. CONCLUSIONS: PrEP is an additional prevention tool and should be implemented in combination and synergy with other prevention interventions. PrEP programmes should target high-risk individuals from key populations for higher cost-effectiveness. Demonstration projects may generate strategic information for and lead to the implementation of full-scale PrEP programmes. SN - 1758-2652 UR - https://www.unboundmedicine.com/medline/citation/27760687/Towards_a_fair_consideration_of_PrEP_as_part_of_combination_HIV_prevention_in_Latin_America_ L2 - https://doi.org/10.7448/IAS.19.7.21113 DB - PRIME DP - Unbound Medicine ER -