Banca de DEFESA: Patrícia Matias Pinheiro

Uma banca de DEFESA de DOUTORADO foi cadastrada pelo programa.
STUDENT : Patrícia Matias Pinheiro
DATE: 20/07/2023
TIME: 08:30
LOCAL: Virtual (teams)
TITLE:

PRE-EXPOSURE PROPHYLAXIS (PREP): FROM THE TURNING POINT IN HIV PREVENTION TO THE CHALLENGE OF ADHERENCE

KEY WORDS:

Post Exposure Prophylaxis; Medication Adherence; HIV

PAGES: 223
BIG AREA: Ciências da Saúde
AREA: Medicina
SUBÁREA: Clínica Médica
SPECIALTY: Doenças Infecciosas e Parasitárias
SUMMARY:

Introduction: PrEP (Post Exposure Prophylaxis) consists of the use of antiretrovirals used by patients who are at increased risk of HIV infection. It is an effective epidemic control strategy, however if fully adopted.  Objective: To describe the profile of patients using PrEP and the factors associated with dropout and discontinuation rates in Brazil from 2018 to 2020. Materials and Methods: Four studies were developed.  The first, cross-sectional, evaluated the difference in profile between users of a PrEP, service and another for STI screening.  The second, case-control that investigated the factors associated with dropout rates in the first 30 days of therapy.  The third, case-control, showed the factors associated with discontinuing PrEP for reasons such as: poor adherence to the medication, adverse events, acute HIV infection.  The last, a cohort that evaluated the risk behavior of patients before and after starting PrEP.  Data came from primary databases, collected from 2020 to 2021 at a PrEP service at a tertiary hospital and at a public Testing and Counseling Center in the Federal District, Brazil. Secondary data were extracted from SICLOM, totaling 34,000 people and containing data from users of the national database from 2018 to 2020. Results: The study showed that PrEP users are homosexual or MSM (89%), with a mean age age of 33 ± 9 years;  68% with more than 12 years of study.  Before starting PrEP, 10.4% did not use condoms and after that it increased to 24.7%, showing some risk compensation.  Dropout rates in the first 30 days were 22.25% and the main factors were: sexual orientation (ORa: 0.81; 95%CI:0.71-0.91; p<0.01), race (ORa: 1.15; 95%CI: 1.08-1.22 p<0.001), education (ORa:1.54; 95%CI: 1.35-1.76 p<0.001), reason for seeking PrEP (ORa:1.21; 95%CI:1.14-1.30, p<0.001) , PEP use (ORa:0.94, 95%CI: 0.91-0.98, p<0.001), frequency of condom use more than half of the time (ORa: 0.8595%CI: 0.78-0.93, p<0.001), sex in exchange of money(ORa: 0.82CI95%: 0.73-0.91, p<0.001), use of substances, such as: poppers (ORa: 0.65, CI95%: 0.54-0.78, p<0.001), cocaine (ORa: 1.22, CI95%: 1.08-1.37p=0.002), clubs drugs (ORa: 0.79, CI95%:0.70-0.89, p<0.001) and erection stimulants (ORa: 0.64, CI95%: 0.56-0.72, p<0.001) and symptoms of acute viral infection (ORa: 0.80, 95%CI: 0.71-0.89, p<0.001) .  The interruption had the following profile: 83% were men, aged between 30-39 years (34%), motivated by: 23.3% due to changes in tests, 9.0% adverse events, 4.3% due to a positive HIV test, 3.4% due to low medication adherence and 59.8% due to their own decision.  Conclusion: The data points to inequality in the access of the most vulnerable populations regarding the risk of HIV infection, requiring policies that make this strategy more inclusive.  Even after starting PrEP, patients are still exposed to risks, neglecting effective non-pharmacological preventive measures, especially for other types of STIs.  In addition, it was found that the abandonment and interruption of patients have generated challenges in adherence, which can directly affect the good efficacy of the therapy.

COMMITTEE MEMBERS:
Presidente - 1961891 - WILDO NAVEGANTES DE ARAUJO
Interna - 2487183 - ELZA FERREIRA NORONHA
Interno - 2838102 - RODOLFO REGO DEUSDARA RODRIGUES
Externo à Instituição - HERMANO ALEXADNRE LIMA ROCHA - UFC
Externo à Instituição - Jadher Pércio - MS