The cost‐effectiveness of HIV pre‐exposure prophylaxis in men who have sex with men and transgender women at high risk of HIV infection in Brazil

Luz, Paula M.; Osher, Benjamin; Grinsztejn, Beatriz; MacLean, R; Losina, Elena; Stern, Madeline E; Struchiner, Cláudio J.; Freedberg, Kenneth A.; Mesquita, Fábio; Walensky, Rochelle P.; Veloso, Valdiléa G.; Paltiel, A. David

doi:10.1002/jia2.25096

Cited by 30 publications

(26 citation statements)

References 35 publications

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“…As a result, transmission networks of resistance variants may have been selected among these MSM, thus reflecting this prevalence. Due to the higher prevalence of HIV infection in MSM (Kerr et al, 2018) and transgender women in Brazil (Grinsztejn et al, 2017), pre-exposure prophylaxis is recommended by the Brazilian Ministry of Health, who have made efforts to implement it and suggest it may be cost-effective (Luz et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

HIV-1 Molecular Epidemiology, Transmission Clusters and Transmitted Drug Resistance Mutations in Central Brazil

et al. 2019

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We aimed to characterize HIV-1 molecular epidemiology and transmission clusters among heterosexual (HET) and men who have sex with men (MSM) individuals, as well as transmitted drug resistance mutations (TDRM) in Central-Western Brazil. This cross-sectional survey was conducted among 190 antiretroviral naïve HIV-1 infected individuals. Proviral DNA was extracted, and nested PCR amplified partial polymerase gene (PR/RT). After sequencing, subtypes were assigned, and the sequences were analyzed for the occurrence of possible transmission networks. Calibrated Population Resistance (CPR) tool from Stanford HIV Database was used to investigate the presence of TDRM. Among 150 individuals whose samples were successfully sequenced, the most prevalent HIV-1 subtype was B, followed by recombinant forms. The occurrence of twenty transmission clusters composed by at least two sequences was verified, suggesting the existence of transmission clusters among individuals from the same or distinct sexual orientations. Intermediate level of TDRM (12%) was found in the study population, and almost half of the subjects with TDRM had more than one resistance mutation. No correlations between sexual orientation and the presence of TDRM, HIV-1 subtypes/recombinants forms were verified. Taken together, the necessity of the continuous monitoring of the TDRM to verify the importance of pre-genotyping and to delineate future strategies in primary antiretroviral therapy. Likewise, the knowledge of the HIV-1 transmission networks in Brazil would allow the implementation of effective HIV-1 prevention strategies in local settings.

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Section: Discussionmentioning

confidence: 99%

HIV-1 Molecular Epidemiology, Transmission Clusters and Transmitted Drug Resistance Mutations in Central Brazil

et al. 2019

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“…Similarly, an analysis from Brazil found that PrEP provision to MSM/TGW at substantial risk (defined as any of the following behaviors in the prior 12 months: condomless anal sex with ≥2 partners, ≥2 episodes of anal sex with an HIV-infected partner, or history of STD diagnosis) would substantially reduce 5-year and lifetime risk of HIV infection [39]. In this analysis, PrEP adherence and uptake was assumed as per demonstration studies [40] and it was found that PrEP led to a cost per life-year saved that was well below Brazil's GDP per capita.…”

Section: Preventionmentioning

confidence: 99%

The HIV epidemic in Latin America

Luz

Veloso

Grinsztejn

2019

Current Opinion in HIV and AIDS

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Purpose of review To describe how countries in Latin America and the Caribbean are (or are not) meeting 2016 WHO guidelines on the use of antiretroviral drugs for treating and preventing HIV infection, that is, their progress on the adoption of ‘Treat All’ and of preexposure prophylaxis (PrEP) as an additional prevention tool for people at substantial risk of HIV infection. Recent findings The HIV epidemic in the region continues largely concentrated in vulnerable populations with MSM and transgender women (TGW) suffering the highest burden. On treatment, the challenges of late initiation as well as suboptimal adherence persist. On prevention, recent studies on PrEP willingness in key populations show promising results, meanwhile PrEP implementation projects as well as actual PrEP adoption by national health systems is expanding. A glimpse of real-world PrEP uptake is shown through Brazil's first-year experience of offering PrEP in multiple cities in all regions of the country. Summary In conclusion, accomplishments have been made though challenges for fully addressing the HIV epidemic persist. The impact of both treatment and PrEP will be limited by the availability and prompt use of all services, including HIV testing.

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“…This initiative lead to a remarkable increase in PLWHA starting HAART in Brazil, from 48,696 to 81,177 in 2012 and 2015, respectively. Since 2015, 90% of patients receiving HAART in the country had been virally suppressed 6 . The efficacy of pre-exposure prophylaxis (PrEP) and its feasibility implementation in Brazil was recently demonstrated 6,7 and the strategy has been scheduled to be offered by the SUS from 2017 onwards, with some uneven outcomes due to ongoing budget restraints.…”

Section: Introductionmentioning

confidence: 99%

Inequalities in HAART uptake and differential survival according to exposure category in Rio de Janeiro, Brazil

et al. 2018

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Despite substantial improvement in prognosis and quality of life among people living with HIV/AIDS (PLWHA) in Brazil, inequalities in access to treatment remain. We assessed the impact of these inequalities on survival in Rio de Janeiro over a 12-year period (2000/11). Data were merged from four databases that comprise the national AIDS monitoring system: SINAN-AIDS (Brazilian Information System for Notificable Diseases; AIDS cases), SISCEL (laboratory tests), SICLOM (electronic dispensing system), and SIM (Brazilian Mortality Information System), using probabilistic linkage. Cox regressions were fitted to assess the impact of HAART (highly active antiretroviral therapy) on AIDS-related mortality among men who have sex with men (MSM), people who inject drugs (PWID), and heterosexuals diagnosed with AIDS, between 2000 and 2011, in the city of Rio de Janeiro, RJ, Brazil. Among 15,420 cases, 60.7% were heterosexuals, 36.1% MSM and 3.2% PWID. There were 2,807 (18.2%) deaths and the median survival time was 6.29. HAART and CD4+ > 200 at baseline were associated with important protective effects. Non-whites had a 33% higher risk of dying in consequence of AIDS than whites. PWID had a 56% higher risk and MSM a 11% lower risk of dying of AIDS than heterosexuals. Non-white individuals, those with less than eight years of formal education, and PWID, were more likely to die of AIDS and less likely to receive HAART. Important inequalities persist in access to treatment, resulting in disparate impacts on mortality among exposure categories. Despite these persistent disparities, mortality decreased significantly during the period for all categories under analysis, and the overall positive impact of HAART on survival has been dramatic.

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The cost‐effectiveness of HIV pre‐exposure prophylaxis in men who have sex with men and transgender women at high risk of HIV infection in Brazil

Cited by 30 publications

References 35 publications

HIV-1 Molecular Epidemiology, Transmission Clusters and Transmitted Drug Resistance Mutations in Central Brazil

HIV-1 Molecular Epidemiology, Transmission Clusters and Transmitted Drug Resistance Mutations in Central Brazil

The HIV epidemic in Latin America

Inequalities in HAART uptake and differential survival according to exposure category in Rio de Janeiro, Brazil

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