Valdilea G Veloso Valdilea Share your thoughts on this presentation with IAS2019 Conflict of Interest Disclosure I have no conflit of interest to report National ID: 1043118
Download Presentation The PPT/PDF document "PrEP scale up and STI management in Bra..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
1.
2. PrEP scale up and STI management in Brazil Valdilea G. Veloso@ValdileaShare your thoughts on this presentation with #IAS2019
3. Conflict of Interest DisclosureI have no conflit of interest to report.
4. National PrEP Guideline (PCDT PrEP)Developed by a special committee of scientific experts and civil society. National Commission for Technology Incorporation (CONITEC) has recommended the inclusion of PrEP + ANVISA regulatory approval of TDF+FTC (Gilead) in May 2017.The priority target for PrEP are key populations, which concentrate the highest prevalence of HIV in the country:Gays and other MSM;Trans people;Sex workers,Serodiscordant coupleswww.aids.gov.br/pcdtThe Brazilian guideline offers daily dosing of TDF+FTC.
5. PrEP Guideline App
6. Distribution of PrEP Services in Brasil(*) tiveram pelo menos uma dispensação no período analisadoDados de jan a dez de 2018- By June 2019: 196 PrEP services
7. Updated Guidelines for STI
8. WHO on HIV Pre-exposure prophylaxis (PrEP)2012 PrEP for SDC, MSM and TG in the context of demo projects (conditional recommendation) WHO PrEP implementation tool – an enabling documenthttp://www.who.int/hiv/pub/prep/en/ 2014PrEP for MSM (strong recommendation) Other KP (conditional)2015PrEP for people at substantial HIV risk (≈3 per 100 person years) (strong recommendation)2017 PrEP drugs oEML (TDF/FTC; TDF/3TC; TDF); WHO PrEP Implementation tool Global PrEP Coalition2018WHO PrEP implementation tool. Update on adolescents and M&E.
9. Implementação da Profilaxia Pré-Exposição ao HIV Um projeto de demonstração- PrEP Brasil
10. 8.16.216.7OverallYoung (18-24 years)Transgender women0102030Incidence(per 100 person years)6.210.53.411.28.035.0Lower limitUpper limitIncidence of Syphilis over 96 weeks of follow-up
11. Prevalence of Chlamydia and Gonorrhea over 96 weeks of follow-up6.797.7387.53.734.899.387.6112.3912.54.3510.66.6714.294204.760OverallYoung (18-24 years)Transgender womenChlamydiaGonorrheaChlamydiaGonorrheaChlamydiaGonorrhea0102030Prevalence(per 100 participants)3.85.05.54.41.82.99.710.410.510.65.76.92.22.26.34.40.24.916.513.018.520.68.516.30.00.00.00.00.00.019.329.211.740.213.90.0Lower limitUpper limitWeekBaseline (n = 450)48 (n = 375)96 (n = 280)p = 0.58p = 0.22p = 0.40p = 0.93p = 0.58p = 0.22
12. 8.36.622.1ChlamidyaGonorrheaSyphilis0102030Prevalence(per 100 participants)3.413.22.211.014.829.2Lower limitUpper limitPrevalence of Chlamydia, Gonorrhea and Syphilis at baseline
13. PrEParedness for the Rollout of Effective HIVPrevention among Key Affected Populations in Brazil, Peru and MexicoObjective: 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 study.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 PrEPWorking Group on Drug Licensing and CostingSubstudies (seroincidence, economic and mathematical modelling studies, etc).Brazil: 14 sites in 12 citiesMexico: 6 sites in 3 citiesPeru: 10 sites in 7 cities
14. Brazil – 14 sites in 12 cities
15. 11.57.41011.17.09.317.012.220.7OverallMSMTransgender womenChlamydiaGhonorrheaSyphilis0102030Prevalence(per 100 participants)10.66.69.212.48.110.810.26.38.412.17.810.112.78.416.121.316.025.3Lower limitUpper limitChlamydiaGhonorrheaSyphilisChlamydiaGhonorrheaSyphilisSexually Transmitted Infections at enrollment
16. Tests Methodologies for STI Screening and diagnosis- Molecular tests for Chlamydia & Gonococcus are not yet avaliable for routine care - HIV Rapid test (3rd Generation)- Syphilis Rapid Test
17. Sampling Sites for Scale Up of MolecularSTI ScreeningCommercial kits are validated for urine samples, not for rectal or orofaringeWould we have regulatory implications if rectal or oral sampling be recommended as standard of care in Brazil ?
18. Rapid tests challenges in the Context of PrEPSyphilisHIV Rapid Test
19. Sampling Sites for Scale Up of Molecular STI ScreeningWHO will recommend multiple sites sampling ?
20. What is the best frequency of screening for Chlamydia & gonococcus ?
21. Frequency of STI Screening
22. Sampling Sites Missing diagnosis with urine sampling onlyGonococcus Infectionn% Urine -437 Rectal Swab +317,10%Orofaringeal +133,00%Oro or Rectal Swabs +4410,10%Chlamydia InfectionUrine -432 Rectal Swab +5212,00%Orofaringeal +51,20%Oro or Rectal Swabs +5713,20%
23. Central laoratories for STI Molecular diagnosisA central laboratory (LACEN) is vailable in each one of the 27Brazilian States. The laboratory will be the referal laboratories for STI screening
24. PrEP expansion in BrazilThe Ministry of Health has already secured funds to expand PrEP services building on VCTs Units, that will provide the full services involved in HIV Combination PreventionThe definiton of Sampling and Frequency will be essential to plan for adequate estructure and procedures definitions
25. AcknowledgmentsPrEP Brasil, PreParadas and ImPrEP teamsStudy participantsThanks to our sponsors
26. Thank You !