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

• Published in: BMC public health Vol. 23; no. 1; p. 1128
• Main Authors: Luz, Paula M, Deshpande, Vijeta, Kazemian, Pooyan, Scott, Justine A, Shebl, Fatma M, Spaeth, Hailey, Pimenta, Cristina, Stern, Madeline, Pereira, Gerson, Struchiner, Claudio J, Grinsztejn, Beatriz, Veloso, Valdilea G, Freedberg, Kenneth A
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 13.06.2023; BioMed Central; BMC
• Subjects: Acquired immune deficiency syndrome; Adults; AIDS; Bisexuality; Brazil; Cities; Condoms; Cost effectiveness; Disease prevention; Emtricitabine; Epidemics; Gays & lesbians; Health aspects; HIV; HIV infection; HIV Infections; HIV prevention; Homosexuality, Male; Human immunodeficiency virus; Humans; Infections; Key and vulnerable populations; Latin America and the Caribbean; Male; Medical tests; Men who have sex with men; Mens health; Modeling; Observational studies; Pre-Exposure Prophylaxis; Pre-exposure prophylaxis (PrEP); Prevention; Prophylaxis; Public health; Risk factors; Sensitivity analysis; Sexual and Gender Minorities; Sexual behavior; Sexual minorities; Sexually transmitted diseases; Simulation; Social aspects; STD; Surveillance; Tenofovir; Urban areas; Urban environments; Brazil; Rio de Janeiro Brazil; Pre-exposure prophylaxis (PrEP); Latin America and the Caribbean; HIV prevention; Key and vulnerable populations; Modeling; Men who have sex with men
• ISSN: 1471-2458; 1471-2458
• DOI: 10.1186/s12889-023-15994-0

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. 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%. Targeting PrEP to young MSM and minimizing discontinuation could substantially increase PrEP's impact.