Prep, HIV prevention therapy, has a high dropout rate – 02/22/2023 – Health

In the last five years, the number of users of Prep (pre-exposure prophylaxis) has grown significantly in Brazil. However, almost half of the people (46%) chose not to continue the therapy, according to data from the Ministry of Health.

Prep consists of taking the combination of tenofovir and emtricitabine antiretrovirals daily, thus preventing infection by the virus that causes AIDS. People aged 15 and over have access to the method.

In its panel, the government does not separate the interruptions per year, computing the accumulated from January 2018 to December 2022. Those who started treatment and did not return for a medical appointment in the estimated time to receive a new dose are considered dropouts.

The method began to be distributed by the SUS (Sistema Único de Saúde) in 2018, and soon its followers multiplied. That year, 6,195 people started using it. Today, the number of recipients of at least one dose already exceeds 89 thousand.

Despite the high initial adherence, almost 41,000 decided to discontinue prophylaxis. There are no data on possible causes of withdrawal.

In a note, the Ministry of Health says that Prep is an additional prevention strategy that, unlike HIV drugs, does not need to be done throughout life.

“If the individual’s context changes, he can evaluate with the medical team that accompanies the possibility of interruption. Another preventive method can also be chosen, depending on the individual evaluation”, says the folder.

Ricardo Vasconcelos, an infectologist and researcher at the Hospital das Clínicas of the Faculty of Medicine at USP, says that it is possible to credit the number of dropouts to more than one factor.

The first is changes in the lifestyle of users. “Imagine a single person with several sexual partners who wants to use prophylaxis. In a month, the situation can change. She can find someone, start a monogamous relationship and give up Prep to use condoms, this is common”, says Vasconcelos.

But, adds the doctor, there is a second possibility, this one more dangerous and dependent on careful observation: that of compulsory withdrawal without consideration or alternative.

“The big problem is interrupting in the wrong way, without indication or option in mind. And many people do it just because of the inconvenience of taking pills daily. In this case, there is a trivialization of the dangers of HIV and that is where the worst possibilities reside.”

The difficult journey to access the method and the stigma associated with it can also make it less attractive, says infectologist Alvaro Costa, from the STD/AIDS Reference and Training Center in the state of São Paulo.

“There are many barriers to continuing the treatment. The patient must always go to the referral center for consultation and to pick up medication, often far from home, it’s easy to want to give up. There’s still the stigma. You don’t want to be seen, someone might think that you have Aids or, when men, already deduce that they are gay”, says Costa.

The Ministry of Health claims to be studying ways to facilitate access to Prep, such as establishing the possibility of telecare, thus reducing access barriers and facilitating the maintenance of care.

Pre-exposure prophylaxis should be used when there is any risk of HIV infection. Some more dangerous situations are listed, such as sex work and frequent relationships with more than one partner.

According to studies, therapy reduces the incidence of the virus by up to 95% in participants with detectable blood levels of the drug – that is, with constant adherence to prevention.

There are two ways to use the method. The continuous, with the use of a daily pill without a determined time, and the on-demand, in which the combination must be consumed up to two hours before sexual intercourse and another three doses within two days.

Reaching a larger number of supporters and, at the same time, making them believe that the therapy is viable in the long term, has been the greatest difficulty since the establishment of Prep.

Much of this, says Valdez Madruga, coordinator of the HIV/AIDS committee at the Brazilian Society of Infectology, can be attributed to the little publicity given to the method.

“It is one more prevention method, of course, but we have to reach more people and show the possibility. This has never been done in the country. Information is the main weapon for prevention”.

The deficient universalization of prevention causes, according to Madruga, a bubble phenomenon. Federal data show that gay or bisexual men, white, over 30 years old and with higher education are the majority of those who seek the method. On the other hand, the group is not currently the most affected by HIV.

According to a bulletin released at the end of last year by the Ministry of Health, among men, in the last ten years, there has been an increase in the AIDS detection rate in the 15 to 19 age groups, 20 to 24 years and 25 to 29 years. years.

It is highlighted that the increase among young people in these age groups was, respectively, 45.9%, 26.2% and 16% between 2011 and 2021.

Among women, also in the last ten years, the detection rate showed a decrease in all age groups, with those from 30 to 34 years old and from 35 to 39 years old showing the greatest drops: 57.5% and 53.7%, respectively, when comparing the years 2011 and 2021.

A quarter of the population actively consuming Prep is in the state of São Paulo. Currently, there are almost 20,000 people, the vast majority in the capital.

The proportion of dropouts is slightly higher compared to the national scenario. Since 2018, 50% have chosen not to continue with the method.

Adriano Queiroz, prevention coordinator of the STI/AIDS coordination of the São Paulo Health Department, says that prophylaxis is very efficient, but still seen as something transient. “For now, people seem to understand it as a phase treatment, that is, that it should only be taken in a period of life, that in which one is single and with several partners”.