Implementation of pre-exposure prophylaxis programme in Spain. Feasibility of four different delivery models

• Published in: PloS one Vol. 16; no. 2; p. e0246129
• Main Authors: Iniesta, Carlos, Coll, Pep, Barberá, María Jesús, García Deltoro, Miguel, Camino, Xabier, Fagúndez, Gabriela, Díaz, Asunción, Polo, Rosa
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 08.02.2021; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; Anti-HIV Agents - therapeutic use; Antiviral agents; Biology and Life Sciences; Consortia; Editing; Emtricitabine; Epidemiology; Feasibility Studies; Female; Health care; Health Personnel; Health risks; HIV; HIV Infections - prevention & control; Hospitals; Human immunodeficiency virus; Humans; Infectious diseases; Longitudinal Studies; Male; Mathematical models; Medical diagnosis; Medicine and Health Sciences; Perception; Pre-Exposure Prophylaxis - methods; Prophylaxis; Public health; Reviews; Safe Sex; Sexual and Gender Minorities - statistics & numerical data; Sexually transmitted diseases; Sexually Transmitted Diseases - prevention & control; Spain; STD; Syphilis; Tenofovir; Transgender Persons - statistics & numerical data; Treatment Adherence and Compliance - statistics & numerical data; Working groups; Spain
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0246129

Pre-exposure prophylaxis (PrEP) is an effective and cost-effective strategy for HIV prevention. Spain carried out an implementation study in order to assess the feasibility of implementing PrEP programmes within its heterogeneous health system. Observational longitudinal study conducted on four different types of health-care setting: a community centre (CC), a sexually transmitted infections clinic (STIC), a hospital-based HIV unit (HBHIVU) and a hospital-based STI unit (HBSTIU). We recruited gay, bisexual and other men who have sex with men (GBSM) and transgender women at risk of HIV infections, gave them PrEP and monitored clinical, behavioural PrEP-related and satisfaction information for 52 weeks. We collected perceptions on PrEP implementation feasibility from health-care professionals participating in the study. A total of 321 participants were recruited, with 99.1% being GBMSM. Overall retention was 87.2% and it was highest at the CC (92.6%). Condom use decreased during the study period, while STIs did not increase consistently. The percentage of people who did not miss any doses of PrEP during the previous week remained at over 93%. No HIV seroconversions occurred. We observed overall decreases in GHB (32.5% to 21.8%), cocaine (27.5% to 21.4%), MDMA (25.7% to 14.3%), speed (11.4% to 5.7%) and mephedrone use (10.7% to 5.0%). The overall participant satisfaction with PrEP was 98.6%. Health-care professionals' perceptions of PrEP feasibility were positive, except for the lack of personnel. PrEP implementation is feasible in four types of health-care settings. Local specificities have to be taken into consideration while implementing PrEP.