Crepalde-Ribeiro Kennedy, Braga Maria das Graças, Silveira Micheline Rosa, Moura Alexandre Sampaio, Vaz-de-Melo Pedro O S, Ferraz Matheus Marchesotti Dutra, Pearson Sallie-Anne, Costa Juliana de Oliveira
Postgraduation Program in Medicines and Pharmaceutical Policy, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Department of Social Pharmacy, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
AIDS Care. 2025 Feb;37(2):289-299. doi: 10.1080/09540121.2024.2443824. Epub 2024 Dec 27.
The goal of this study was to evaluate characteristics associated with Pre-exposure Prophylaxis for HIV infection (PrEP) non-adherence or discontinuation in Brazil and assess the association between these outcomes and HIV seroconversion. We used linked national dispensing and pathology data to identify people aged 14+ years initiating PrEP in 2018. We estimated non-adherence using the proportion of days covered (PDC), defining non-adherence as PDC < 60%. We defined discontinuation as a gap in therapy of at least 120 days. We used logistic regression models to assess characteristics associated with non-adherence or discontinuation within 365 days and to assess HIV seroconversion and its association with non-adherence or discontinuation. In 2018, 5100 people initiated PrEP; 34.4% (95%CI 33.1%; 35.7%) were non-adherent and 34.3% (95%CI 33.0%; 35.6%) discontinued. People aged 34 years or less, women, people with lower education levels, or living in the Northern region of Brazil were more likely to be non-adherent or discontinue therapy. Thirty people (0.6% 95%CI 0.4%; 0.8%) seroconverted. HIV seroconversion was associated with PrEP non-adherence or discontinuation (OR = 6.2 for both). Non-adherence and discontinuation were common in people initiating PrEP and strongly associated with HIV seroconversion. Our work identifies populations at higher risk of non-adherence or discontinuation which could be targeted in interventions to reduce new HIV cases in Brazil.
本研究的目的是评估巴西与艾滋病毒感染暴露前预防（PrEP）不依从或停药相关的特征，并评估这些结果与艾滋病毒血清转化之间的关联。我们使用全国关联的配药和病理数据来识别2018年开始接受PrEP治疗的14岁及以上人群。我们使用服药天数比例（PDC）来估计不依从情况，将不依从定义为PDC＜60%。我们将停药定义为至少120天的治疗中断。我们使用逻辑回归模型来评估365天内与不依从或停药相关的特征，并评估艾滋病毒血清转化及其与不依从或停药的关联。2018年，5100人开始接受PrEP治疗；34.4%（95%CI 33.1%；35.7%）不依从，34.3%（95%CI 33.0%；35.6%）停药。34岁及以下的人群、女性、教育水平较低的人群或居住在巴西北部地区的人群更有可能不依从或停止治疗。30人（0.6%，95%CI 0.4%；0.8%）发生血清转化。艾滋病毒血清转化与PrEP不依从或停药相关（两者的OR均=6.2）。在开始接受PrEP治疗的人群中，不依从和停药情况很常见，并且与艾滋病毒血清转化密切相关。我们的研究确定了不依从或停药风险较高的人群，这些人群可作为巴西减少新艾滋病毒病例干预措施的目标人群。
