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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

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Abstract

We aimed to study the uptake of preexposure prophylaxis (PrEP) before and after its implementation in the Portuguese National Health Service (PNHS) among men who have sex with men (MSM). We studied 6164 participants in the Lisbon Cohort of MSM who participated between March 2014 and July 2019. 198 participants (3.2%) reported having recently used PrEP. Approximately one-third started PrEP after its implementation. PrEP uptake increased from 0.15% in 2014 to 5.36% in 2019. In their first use, 86 participants (70.5%) used it daily. How PrEP was obtained varied according to the timing of the first use: prescribed by a physician in Portugal (11.1% before vs 68.8% after implementation) and online (40.7% before vs 14.1% after). We observed an increase in the uptake and in the prescription by a physician, particularly after its implementation in the PNHS representing a change to a more equitable and safer way of using PrEP.

Resumen

Nuestro objetivo fue estudiar el uso de profilaxis pre exposición (PrEP) en hombres que tienen sexo con hombres (HSH), antes y después de su implementación en el Servicio Nacional de Salud de Portugal (PNHS). Estudiamos 6164 participantes de la Cohorte de HSH de Lisboa evaluados entre marzo de 2014 y julio de 2019. De los participantes, 198 (3,2%) indicaron haber utilizado PrEP recientemente. Aproximadamente un tercio comenzó con PrEP después de su implementación en el PNHS. El uso de PrEP aumentó del 0,15% en 2014 al 5,36% en 2019. En su primer uso, 86 participantes (70,5%) la usaron a diario. La forma en que se obtuvo la PrEP varió según el momento del primer uso: prescrito por un médico en Portugal (11,1% antes vs. 68,8% después de la implementación) y online (40,7% antes vs. 14,1% después). Observamos un aumento en el uso y en prescripción médica, particularmente después de su implementación en el PNHS, lo que representa un cambio hacia una forma más equitativa y segura de usar la PrEP.

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Fig. 1
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source of the first reported PrEP. PrEP indicates preexposure prophylaxis

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Acknowledgements

We acknowledge all participants in the Lisbon Cohort of Men Who Have Sex With Men; former and current staff from CheckpointLX and Grupo de Ativistas em Tratamentos, namely, João Brito, Jesus Rojas, Ricardo Fuertes, Nuno Pinto, Fernando Ferreira, Luís Veríssimo, Rui Guerreiro, Alexandre Gomes, Marcos Carvalho, Hugo Correia, Hugo Machado, Julio Esteves, Manuel Mateus, Ricardo Abrantes, Ricardo Jordão, Daniel Simões, Maria José Campos, and Luís Mendão; and Paulo Oliveira and Raquel Lucas from Instituto de Saúde Pública, Universidade do Porto.

Funding

This work was supported by national funds of Fundação para a Ciência e Tecnologia (FCT), under the scope of the project UIDB/04750/2020 - Research Unit of Epidemiology–Institute of Public Health of the University of Porto (EPIUnit). Paula Meireles was the recipient of PhD Grant SFRH/BD/112867/2015 co-funded by the FCT and the Programa Operacional Capital Humano/Fundo Social Europeu (POCH/FSE).

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Contributions

PM participated in the study design, wrote the draft of the manuscript. PM and FF performed the data analysis. MR, MP and HB provided guidance for data analysis and interpretation of results. MR was involved in the recruitment and data collection management. HB conceived the study, participated in the study design and coordination. All authors revised the manuscript for important intellectual content.

Corresponding author

Correspondence to Paula Meireles.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics Approval

This study was approved by the Ethics Committee for Health of São João Hospital Center and Medical School, University of Porto, in 2012 (ID 104/12). Later, two extension requests for data collection were submitted and approved (April 2013 and March 2018). The data treatment authorization from the Portuguese Data Protection Authority was received in 2013 (Authorization Number 3897/2013). The 1964 Helsinki Declaration and its later amendments or comparable ethical standards are being followed. Those accepting to participate are asked to sign the informed consent, at each visit, and given a duplicate of the document.

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Meireles, P., Fernandes, F., Rocha, M. et al. Provision of Preexposure Prophylaxis at the Portuguese National Health Service and Uptake in the Lisbon Cohort of Men Who Have Sex with Men. AIDS Behav 25, 1975–1983 (2021). https://doi.org/10.1007/s10461-020-03127-2

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