Banca de DEFESA: DIANA REYNA ZEBALLOS RIVAS

Uma banca de DEFESA de DOUTORADO foi cadastrada pelo programa.
STUDENT : DIANA REYNA ZEBALLOS RIVAS
DATE: 26/06/2023
TIME: 14:00
LOCAL: Sala 01 (térreo) - Instituto de Saúde Coletiva
TITLE:

Adherence and discontinuation of HIV pre-exposure prophylaxis (PrEP) among adolescent men who have sex with men, transvestites and transgender women aged 15-19 in Brazil. 2023.

KEY WORDS:

Adolescents, MSM, TGW, PrEP, discontinuation, adherence measures.

PAGES: 163
BIG AREA: Ciências da Saúde
AREA: Saúde Coletiva
SUMMARY:

Background: Since 2017, daily oral PrEP has been offered for free by the Brazilian National Health System, and in 2022, it was extended to adolescents from 15 years of age who are sexually active and at increased risk of acquiring HIV infection. To ensure effectiveness in the implementation of PrEP, it is essential to have cost-effective tools that provide information to identify adolescents who need additional adherence support, as well as to identify individual, social, and programmatic factors that may lead to early PrEP discontinuation. Objectives: 1) To summarize the evidence on measures for monitoring PrEP adherence; 2) To evaluate the performance of indirect adherence measures among men who have sex with men (MSM) and transgender women (TGW) in Brazil; 3) To study factors associated with PrEP discontinuation among MSM and TGW in the PrEP1519 cohort in Brazil. Methods: This doctoral thesis analyzed adherence data from the PrEP1519 study, the first demonstrative PrEP cohort that included MSM and TGW aged 15-19 in three Brazilian capitals: Salvador, Belo Horizonte, and São Paulo. The outcomes evaluated were PrEP adherence measures [self-report, pill count, medication possession ratio (MPR)] and discontinuation. In addition, individual, social, and behavioral factors associated with PrEP discontinuation were evaluated. Results: Three articles were developed to address our objectives. The first article is a systematic review on the accuracy of adherence measures for PrEP use. The second article is a diagnostic test study that evaluates the performance of three indirect measures, using tenofovir diphosphate (TFV-DP) quantification in Dried Blood Spots (DBS) as the gold standard. The third article is a cohort study that evaluates PrEP discontinuation and associated factors. Conclusions: The thesis presents important contributions to monitoring PrEP adherence among key population adolescents. The results suggest that indirect adherence measures are cost-effective tools for monitoring PrEP adherence in clinical practice. The combination of measures provides more accurate information. In addition, the PrEP discontinuation rate among adolescents is high, associated with risk perception and the vulnerability of transgender women. PrEP implementation in adolescents should be accompanied by effective strategies for adherence monitoring and to identify and address factors that may contribute to discontinuation.

COMMITTEE MEMBERS:
Externo à Instituição - THIAGO SILVA TORRES - Fiocruz - RJ
Externa à Instituição - VIVIAN HELENA IIDA AVELINO DA SILVA - USP
Interno - ***.958.265-** - LAIO MAGNO SANTOS DE SOUSA - UNEB
Interno - 1217741 - MARCOS PEREIRA SANTOS
Presidente - ***.340.735-** - MARIA INES COSTA DOURADO - UFBA