1. The Brazilian Experience
Implementation of DTG in the light of WHO’s new directions and signal of risk of NTD:
how to scale up treatment, respect client choices and monitor risk
Adele Schwartz Benzaken
Ministry of Health of Brazil
Departament of Surveillance, Prevention and Control of STIs, HIV / AIDS and Viral Hepatitis

2. No conflict of interests

3. Lessons from early adoption of DTG
2016: INSTI= U$ 8.8/day. Following negotiation (2017): U$ 1.50/day – DTG purchase.
Exclusions: FSV, DDI, d4T and SQV;
EFZ became alternative choice in case of contraindication to DTG;
Even with all changes, MoH’s budget remained the same.
Poster discussion session– Title “Keeping it up: National ownership and financial sustainability”. 25 July at 13:00-14:00 - Session room G

4. Scaling Up DTG in Brazil - 2018
Switch may occur:
Few adverse events
Adherence improvement
Few drug interactions
Certain comorbidities
Not recommended:
Detectable VL
Previous virological failure
Well adapted patients
Pregnant women
Contraindication to DTG:
TB;
<12 yo;
drug interactions
The switch must respect person’s choice
ARV switched to DTG
#PLHIV*
EFV
7.120
PI (ATVr, DRVr, LPVr)
3.036
*from April 16 to July 4
2018: new price negotiation = U$ 1.00

5. Brazilian Rapid Response - Review of Recommendations
May 18th, 2018 (same date as WHO)
WLHIV of childbearing potential age:
Should NOT receive DTG
Subject to effective contraceptive method (i.e. IUD; hormonal implant)
Pregnant WLHIV (initiating ARV):
EFV or ATVr if <14 weeks of pregnancy
RAL if ≥14 weeks of pregnancy
Women of childbearing potential age and PEP:
Should NOT receive DTG
Indication: ATV/r

6. Partnership: MoH-Brazil/Fiocruz/Vanderbilt U/NIH
Initial Findings – Pregnant WLHIV DTG Exposed - Brazil, 2018
Distribution WLHIV with pre-conception exposure to DTG (Jan 2017 – May 2018):
All 27 states
204 municipalities
491 cases
DTG and pregnancy outcomes among ART-recipients in Brazil: a national population study.
Partnership: MoH-Brazil/Fiocruz/Vanderbilt U/NIH
National database linkage
Outreach: phone calls and quick questionnaire (local programmes)
Preliminary Results
Outcome N %
Live birth 91
53.8
Stillbirth 2
1.2
Abortion 8
4.7
Still pregnant 68
40.2
Total
169
100
No neural tube defects identified
Source: MoH- Brazil

7. www.saude.gov.br www.aids.gov.br
Thank you!