PrEP in Brazil: 18 months of implementation as a public health policy Department of Diseases of Chronic Condition and STI Secretariat for Health Surveillance Ministry of Health of Brazil www.aids.gov.br July, 2019

Background 200 million population, 27 States 1988: Unified Health System - SUS 1996: Free and universal access to ART was guaranteed by law December 2013: Treatment as Prevention 2017: DTG incorporated as preferred 1st line regimen 2018: PrEP implementation in SUS free of charge

PrEP Implementation Timeline in Brazil

National PrEP Guidelines Elegibility criterias: HIV- and Unprotected anal or vaginal sex (past 6 months) and/or Repeated PEP use and/or Repeated STI + Other HIV vulnerabilities (drug use, number of partners, etc) Priority targets for PrEP Gay men and other MSM Trans people Sex workers Serodiscordant partnerships PrEP follow up - overview PrEP eligibility screening and prescription for 30 days First follow up visit within 30 days TDF/FTC refil for 90 days Every 90 days for new TDF+FTC prescription and clinical follow up Daily dosing of TDF+FTC

Results from January 2018 to June 2019

PrEP Monitoring: Brazil, Jan/2018 - June/2019 10,350 initiated PrEP* 26 States 192 registered services * Had at least one dispensation in the period

Discontinuation of PrEP use 87% 69% 58% 42%

% of Commercial Sex Work Reported by Population * 14 transmen PrEP users (total)

People who reported having had unprotected sex with HIV + partners in recent months, by population

% of Users with Symptoms or Diagnosis of STI in the 6 Months Before the 1st Appointment * 14 transmen PrEP users (total)

9% 5% 4 Syphilis HIV seroconversion of users who initiated PrEP, tested positive for syphilis in the first consultation (n = 674) 5% of users tested positive for syphilis during PrEP use (n = 509) HIV seroconversion 4 users tested positive for HIV during PrEP use

Adherence to PrEP (pill intake, last month)

Condom Use, in the last 3 months

Number of Sexual Partners, in the last 3 months

Adverse Events Related to PrEP on 30-day Return

Main Challenges Keep on scalling-up PrEP across the country Reaching those who are under greater vulnerability Making PrEP widely known by the ones who can greatly benefit from it

Next Steps The MoH implemented PrEP as a public policy and will spare no efforts to guarantee its full implementation. Some of these efforts are: Keep taking advantage of our historical and fruitful partnership with the civil society Funding PrEP promotion activities driven by the civil society Fostering partnership between NGOs and local HIV managers and health services Promote initiatives of peer education Producing an online PrEP course to easy the opening of new PrEP services Tailoring communication strategies to reach the most vulnerable populations

Thank you! gerson.pereira@aids.gov.br