Provision of Preexposure Prophylaxis at the Portuguese National Health Service and Uptake in the Lisbon Cohort of Men Who Have Sex with Men

Meireles, Paula; Fernandes, Francisco; Rocha, Miguel; Plankey, Michael; Barros, Henrique

doi:10.1007/s10461-020-03127-2

Cited by 3 publications

(4 citation statements)

References 21 publications

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“…EMIS data were collected in 2017, when PrEP availability in Europe was much lower than it currently is (25,26), which may explain the higher percentage of reported users in Portugal, compared with those with a reactive test in the EMIS sample. This study also finds a lower percentage of PrEP use among MSM than that found in a cohort of MSM in Lisbon, where 3.2% of the participants reported PrEP use (27), indicating that our sample will likely represent another subset of MSM, with less access or willingness to take PrEP. The low knowledge of SW regarding PrEP ( 28) is similar to what was found in other research conducted in the US with street-based SW and in China (29).…”

Section: Discussioncontrasting

confidence: 43%

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

Simões

Meireles

Rocha³

et al. 2021

Front. Public Health

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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.

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Section: Discussioncontrasting

confidence: 43%

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

Simões

Meireles

Rocha³

et al. 2021

Front. Public Health

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“…Our findings indicate that, although PrEP has been made available free of charge by the health systems of both countries since 2017 and the fact that MSM are a priority group in HIV prevention in both countries, fewer than one-quarter of the participants stated that they used this prophylactic measure, which is very close to the prevalence of use found in other recent surveys carried out in these countries [ 6 , 46 ].…”

Section: Discussionsupporting

confidence: 77%

“…The availability of PrEP in Europe, of which Portugal is a part, is fragmented, complex and in flux [ 39 , 47 ]. Among its member countries in 2016, only France reported that PrEP was nationally available and reimbursed, while data for the year 2019 [ 46 ] showed that 22 of the 55 countries indicated that reimbursed PrEP was available from their national health service, either through insurance or paid for by the public sector. In 2019, Portugal reported 718 PrEP users through its health system, while France reported 25,229 users and Cyprus only 10 [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

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

Sousa

Lima

Ribeiro

et al. 2023

IJERPH

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Strengthening strategies to improve adherence to the use of pre-exposure prophylaxis (PrEP) in key populations constitutes a global health priority to be achieved across countries, especially in countries that share a high flow of people such as Brazil and Portugal. This study aimed to analyze the factors associated with adherence to PrEP among MSM from two Portuguese-speaking countries, highlighting the opportunities and preventive strategies for the global health scenario. This was a cross-sectional analytical online survey conducted from January 2020 to May 2021 with MSM in Brazil and Portugal. For analysis of the data, the Poisson regression model was used to estimate the prevalence ratio (PR) for developing a model to evaluate the associated factors in both countries in a comparative and isolated way. Adherence to PrEP use corresponded to 19.5% (n = 1682) of the overall sample: 18.3% (n = 970) for Brazil and 21.5% (n = 712) for Portugal. Having more than two sex partners in the last 30 days (aPR: 30.87) and routinely undergoing HIV tests (aPR: 26.21) increased the use of this medication. Being an immigrant (PR: 1.36) and knowing the partner’s serological status (PR: 1.28) increased adherence to PrEP in Portugal, whereas, in Brazil, it was being an immigrant (PR: 0.83) and not knowing the serological status (PR: 2.24) that promoted the use of this medication. Our findings reinforce the need to invest in programs and strategies to improve access and adherence to PrEP, especially in key populations.

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“…Nevertheless, studies conducted with MSM have revealed difficulties in accessing PrEP in Portugal, particularly regarding the ideal way to enter the system, the waiting time for the first consultation, or even approval for treatment. This has led, for example, to the purchase of these drugs online at high prices and their use without proper monitoring, something that may not be possible for immigrants (10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Pre-exposure prophylaxis among Brazilian men who have sex with men: a comparative study between migrants and non-migrants

Sousa,

Lima,

Ribeiro

et al. 2023

Front. Public Health

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IntroductionInvestigating the use and adherence to pre-exposure prophylaxis (PrEP) in MSM is a global health priority in the fight against HIV. Strategies must be capable of increasing usage and reaching not only the population living in the country but also those who immigrate, who face additional vulnerabilities. Based on this, in this observational, cross-sectional, and analytical study, our aim is to analyze the use of PrEP among Brazilian men who have sex with men, whether they are migrants or not. We aim to highlight preventive opportunities and strategies for the global health scenario.MethodsWe utilized a sample of Brazilians living in the country and Brazilian immigrants residing in Portugal, one of the main destinations for Brazilians in recent years. To estimate the prevalence ratio (PR) of PrEP use, we employed the Poisson regression model with robust variance estimation using a covariance matrix.ResultsA total of 1,117 Brazilian MSM PrEP users participated in this study, with 788 residing in Brazil and 328 in Portugal. Multivariate analysis was conducted in three stages: overall, and for subgroups of residents in Brazil and immigrants in Portugal. We identified four convergent factors that increased the prevalence of PrEP use in Brazilians regardless of migration status: having two or more casual sexual partners per month, engaging in challenging sexual practices as the receptive partner, disclosing serological status on apps, and being single. Among native Brazilians, four unique factors stood out: being in a polyamorous relationship, having sexual relations with unknown casual partners, and having higher levels of education.DiscussionThis study highlights the need to implement strategies to strengthen PrEP adherence in Brazil and create international programs that facilitate its usage among populations migrating between these two countries.

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Provision of Preexposure Prophylaxis at the Portuguese National Health Service and Uptake in the Lisbon Cohort of Men Who Have Sex with Men

Cited by 3 publications

References 21 publications

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

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

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

Pre-exposure prophylaxis among Brazilian men who have sex with men: a comparative study between migrants and non-migrants

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