Knowledge and Use of PEP and PrEP Among Key Populations Tested in Community Centers in Portugal

Abstract

Background: Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) have been increasingly available in Europe. Due to the high burden of HIV in key populations, these could benefit from their use. In 2016, in Portugal, an open, non-interval, prospective cohort study was established in a network of 26 community-based voluntary HIV/STI counseling and testing centers. Data collected included questions on PEP and PrEP knowledge and use. We aimed to estimate the proportion of PEP and PrEP knowledge and its use among key populations, visiting the centers between 2016 and 2019.Method and results: Individuals who self-identify as being among at least one key population for HIV, men who have sex with men (MSM), people who inject drugs (PWID), sex workers (SW), migrants, and male-to-female transgender individuals (MTF), responded to questions on PEP and PrEP knowledge and use while waiting for their test results between 2016 and 2019 (n = 12,893 for PEP; n = 10,973 for PrEP). Reported knowledge was low in all key populations for both tools: 15.7% of respondents reported knowing about PEP and 10.9% about PrEP over the course of 4 years. PEP was used by 1.8% and PrEP by 0.4% of the respondents, MSM being 88.9% of PrEP users, and 52.8% of PEP users. Multivariate logistic regression showed multiple factors associated with knowing the tools, including age, education, country of birth, gender, year of test, having a reactive HIV test in the same visit, reporting an STI or condomless sex in the last 12 months, and identifying with being MSM or SW.Conclusions: Knowledge and use of PEP and PrEP remain low among key populations in Portugal. The need remains to increase knowledge and use among those at risk for HIV infection.

HIV/AIDS post‐exposure prophylaxis knowledge and uptake among health professionals in Africa: Systematic review and meta‐analysis

“…According to this systematic review and meta‐analysis, the estimated pooled uptake of HIV/AIDS PEP among healthcare providers in Africa with a random‐effects model was 40.09% (95% CI: 30.14–50.04). This study is similar with study conducted in Pakistan (35.3%) [62,64], but higher than studies conducted in Bhutan (2.1%) [63] and Portugal (1.8%) [64]. This might be due to variations in sociodemographic characteristics, knowledge level and accessibility of the drug.…”

“…Funnel plot with pseudo 95% confidence limits F I G U R E 8 Sensitivity analysis of pooled prevalence of knowledge for each study being removed one at a time similar with study in Pakistan (35.3%) [62,64], but higher than studies conducted in Bhutan (2.1%) [63] and Portugal (1.8%) [64]. This might be due to variations in sociodemographic characteristics, knowledge level and accessibility of the drug.…”

Awareness and Use of Post-exposure Prophylaxis for HIV Prevention Among Men Who Have Sex With Men: A Systematic Review and Meta-Analysis

“…Seven studies reported higher awareness than 70% among gay men in Israel ( 15 ), young MSM of color in the United States ( 34 ), MSM users of geosocial networking applications in England ( 11 ), non-HIV-positive MSM in Italy ( 32 ), sexually active MSM living with HIV in France ( 35 ), MSM in 22 Sub-Saharan African countries ( 36 ), and among MSM college students in three cities of China ( 37 ). Four studies reported much lower levels of awareness (<40%) among MSM in China ( 33 ); MSM tested in community centers in Portugal ( 38 ) MSM receiving rapid HIV testing in Spain ( 39 ), and among black MSM in the United States ( 13 ). Nine studies reported modest PEP awareness: 41.23% among men engaging in condomless anal sex with men in the United States ( 8 ), 42.5% among MSM in Beijing, China ( 16 ), 46.67% among gay and bisexual men in California ( 40 ), 50% among MSM in Brazil ( 41 ), 56.70% among sexually active MSM in Vancouver, Canada ( 31 ), 57.06% among MSM in Vancouver, Canada ( 42 ), 60.22% among Thai MSM ( 30 ), 60.6% among MSM in four cities of China ( 43 ), and 65.77% among HIV-positive MSM in England ( 44 ).…”

“…These factors, which could potentially impede or facilitate participant's awareness of PEP, were conceptually divided into different categories within the individual, social (including partners, families, and communities), and structural domains (health systems and legal factors). In the individual domain, low educational attainment, unemployment, having casual partners, and closeted bisexual were negative factors; high-level education, white race/ethnicity, gay sexual identity, knowing the HIV status of one's self, higher personal sexual altruism, metropolitan resident, higher annual Higher number of partners (11) Higher number of partners (39,42) Having casual partners (35) Higher personal sexual altruism (42) Metropolitan resident (8,42) Greater perceived agency to ask sexual partners' HIV status (42) Older age (31,35,37,40) Higher annual income (16,40,43) Having unprotected anal sex (40) Having sex under the influence of a drug (37,40,41) Younger age (16,32) Using Internet as the main way of meeting partners (39) Social factors Interaction with gay culture (39) Internet and community of MSM (33) Lower levels of HIV stigma (16,32) HIV leadership programming (31) Structural factors Disclosure of one's sexual orientation to general practitioner (11) Greater access to condoms (42) Previous HIV testing (11,15,32,38,43) Previous sexually transmitted infection (STI) diagnosis (38,42) Contact with HIV/AIDS organization…”

Adherence to Pre-Exposure Prophylaxis (PrEP) among Men Who Have Sex with Men (MSM) in Portuguese-Speaking Countries

“…Implementation of PrEP free of charge through the national health systems of these two countries began in 2017, with extensive expansion in later years [ 18 ], although few studies have evaluated the success of its implementation [ 27 , 32 , 33 , 34 ] and no survey has focused on studying the population of both countries together, much less comparing them [ 32 , 33 , 34 , 35 ]. Questions still remain whether PrEP can be translated to a successful public health intervention, leading to a decrease in the population-level incidence of HIV, if it is treated only as a local policy, without countries considering the dynamics of the flows of migration and information between countries, for example [ 36 ].…”