High acceptability of PrEP teleconsultation and HIV self-testing among PrEP users during the COVID-19 pandemic in Brazil

ABSTRACT In March 2020, telemedicine and HIV self-testing were adopted by Brazilian Public Health services to minimize disruptions in pre-exposure prophylaxis (PrEP) access and delivery during the COVID-19 pandemic. To understand the acceptability of PrEP teleconsultation and HIV self-testing, we conducted a web-based study during social distancing period (April-May, 2020) among men who have sex with men and transgender/non-binary individuals using social media. Out of the 2375 HIV negative respondents, 680 reported PrEP use and were included in this analysis. Median age was 33 years (IQR: 28-40), 98% cisgender men, 56% white, 74% high education, and 68% middle/high income. Willingness to use HIVST was 79% and 32% received an HIV self-testing during social distancing period. The majority reported preference for PrEP/HIV self-testing home delivery instead of collecting at the service. PrEP teleconsultation was experienced by 21% and most reported feeling satisfied with the procedures. High acceptability of PrEP teleconsultation was reported by 70%. In ordinal logistic model, having higher education was associated with high aceptability of PrEP teleconsultation (aOR:1.62; 95%CI: 1.07-2.45). Our results point out that PrEP teleconsultation and PrEP/HIV self-testing home delivery could be implemented by PrEP services in Brazil to avoid PrEP shortage during the COVID-19 pandemic and thereafter as an option to increase retention and adherence.

Telemedicine as a tool for PrEP delivery during the COVID-19 pandemic in a large HIV prevention service in Rio de Janeiro-Brazil

Abstract COVID-19 public health responses such as social distancing and community containment measures protocols are critical to preventing and containing the spread of coronavirus. Brazil accounts for almost half of Latin American HIV cases and Rio de Janeiro is the city with the second largest number of AIDS. Clinical appointments and pharmacy antiretroviral refills may be impaired due to restricted traffic and possible lockdowns, preventing people living with HIV and those using PrEP from accessing needed antiretrovirals. We hereby describe the telemedicine procedures implemented in a large PrEP delivery service in Rio de janeiro in the context of the COVID-19 pandemic. At the initial teleconsultation, individuals undergoe HIV rapid testing and are assessed by phone for PrEP related procedures. Individuals receive a digital prescription to retrieve a 120-day PrEP supply plus two HIV self-test kits. Subsequent follow-up teleconsultations will be performed remotely by phone call, including instructions for the HIV self-test performance, which results are to be sent using a digital picture. Participants will attend the service only for PrEP refill. The use of telemedicine procedures is being effective to avoid PrEP shortage and reduce the time PrEP users spend at the service during the COVID-19 pandemic and social distancing recommendations.

The 12 city HIV Surveillance Survey among MSM in Brazil 2016 using respondent-driven sampling: a description of methods and RDS diagnostics / Inquérito sobre o HIV entre HSH no Brasil em 2016 usando respondent-driven sampling (RDS): descrição dos métodos e dos diagnósticos do RDS

ABSTRACT: Introduction: This paper details the methods used in the second national Biological and Behavioral Surveillance Survey (BBSS) of HIV, syphilis, and hepatitis B and C among men who have sex with men in Brazil. Methods: Respondent-driven sampling (RDS) was used in 12 cities in 2016. The targeted sample size was initiated with five to six seeds in each city. HIV, syphilis, and Hepatitis B and C rapid tests were offered to participants. RDS Analyst with Gile's successive sampling (SS) estimator was used to adjust results as recommended and a weight for each individual was generated for further analysis. Data for the 12 cities were merged and analyzed using Stata 14.0 complex survey data tools with each city treated as its own stratum. Results: Duration of data collection varied from 5.9 to 17.6 weeks. 4,176 men were recruited in the 12 cities. Two sites failed to achieve targeted sample size due to a six-month delay in local IRB approval. No city failed to reach convergence in our major outcome variable (HIV). Conclusion: The comprehensive BBSS was completed as planned and on budget. The description of methods here is more detailed than usual, due to new diagnostic tools and requirements of the new STROBE-RDS guidelines.

RESUMO: Introdução: Este artigo detalha os métodos utilizados na segunda Pesquisa Nacional de Vigilância Biológica e Comportamental (BBSS) do HIV, sífilis e hepatite B e C entre os homens que fazem sexo com homens no Brasil. Métodos: O método Respondent-driven Sampling (RDS) foi utilizado em 12 cidades em 2016. A amostra foi iniciada com cinco a seis sementes em cada cidade. Testes rápidos para o HIV, sífilis e Hepatite B e C foram oferecidos aos participantes. O software RDS Analyst com o estimador de amostragem sucessiva (SS) de Gile foi utilizado para ajustar os resultados como recomendado, gerando um peso para cada indivíduo para análises. Osdados das 12cidades foram unidos em um único banco e analisados usando as ferramentas de dados complexos do Stata 14.0, com cada cidade sendo tratada como seu próprio estrato. Resultados: A duração da coleta de dados variou de 5,9 a 17,6 semanas e 4.176 homens foram recrutados nas 12 cidades. Dois sites não alcançaram o tamanho da amostra alvo devido a uma demora de seis meses na aprovação local do Comitê de Ética. Todas as cidades atingiram a convergência na principal variável estudada (HIV). Conclusão: O BBSS foi representativo e concluído conforme planejado e dentro do orçamento. A descrição dos métodos aqui é mais detalhada do que o habitual, devido às novas ferramentas e requisitos de diagnóstico das novas diretrizes do STROBE-RDS.

Descentralização das políticas e ações em saúde: impactos e desafios para o enfrentamento da epidemia de HIV/AIDS: relatoria / Decentralization policies and actions in health: impacts and challenges to confront the epidemic of HIV / AIDS, rapporteur

Título uniforme - Aprimorando o Debate (II): Respostas Frente à AIDS no Brasil. Projeto: Aprimorando o Debate (II): Respostas Frente à AIDS no Brasil. Seminário com vários títulos.