1. 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
July, 2019

2. 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

3. PrEP Implementation Timeline in Brazil

4. 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

5. Results from January 2018 to June 2019

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

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

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

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

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

12. 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

13. Adherence to PrEP (pill intake, last month)

14. Condom Use, in the last 3 months

15. Number of Sexual Partners, in the last 3 months

16. Adverse Events Related to PrEP on 30-day Return

17. 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

18. 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

19. Thank you!