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PrEP15 - 19选择:一项在巴西性少数和性别少数青少年的现实环境中使用口服和长效注射卡博特韦进行HIV预防的实施研究方案。

PrEP15-19 Choices: an implementation study protocol of HIV prevention with oral and long-acting injectable cabotegravir PrEP in real-word settings among sexual and gender minority adolescents in Brazil.

作者信息

Dourado Ines, Dezanet Lorenza, Magno Laio, Westin Mateus, Soares Fabiane, Massa Paula, Zucchi Eliana Miura, Rossi Thais Regis Aranha, Caires Priscilla, Vasconcelos Ricardo de Paula, Couto Márcia Thereza, Tupinambas Unaí, Greco Dirceu, Grangeiro Alexandre D

机构信息

Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil

Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil.

出版信息

BMJ Open. 2025 Jan 20;15(1):e083146. doi: 10.1136/bmjopen-2023-083146.


DOI:10.1136/bmjopen-2023-083146
PMID:39832966
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11751826/
Abstract

INTRODUCTION: Long-acting injectable (LAI) cabotegravir is a promising new method for preventing HIV. Safe and effective long-acting agents for pre-exposure prophylaxis (PrEP) for HIV infection are needed to increase preventive options among sexual and gender minority adolescents. METHODS AND ANALYSIS: This is a multisite, prospective implementation study of three PrEP modalities (LAI-PrEP, event-driven (ED) and daily oral), using a mixed-method design with quantitative and qualitative approaches. The study will include a sample of 550 HIV-negative adolescent men who have sex with men, non-binary individuals assigned male at birth, transgender men and women, aged 15-19 years, in three Brazilian capital cities. Participants will be allocated into two arms, according to their choice of PrEP modalities, and followed up to 36 months. Switching between oral and LAI-PrEP will be allowed, according to the participants' needs and preferences. The qualitative studies will focus on investigating the processes involved in linkage and retention in care, switching between PrEP modalities and strategies of the implementation process of LAI-PrEP in the current PrEP programming and acceptability from health providers, policymakers and stakeholders' perspectives. ETHICS AND DISSEMINATION: The adolescent's autonomy for consenting to their participation and understanding of PrEP will be assessed by the project team before any care is given and will be recorded in their medical record. Adolescents aged 15-17 years will sign an informed assent form, waiving the need for the approval of a legal guardian, except in cases where the adolescent is found not to have the necessary autonomy. The study was approved by the WHO Ethics Review Committee and by the local IRBs from the universities coordinating the study, the University of São Paulo, the Federal University of Bahia and the Federal University of Minas Gerais. This project is part of an effort to expedite the inclusion of new modalities in the Brazilian PrEP Programme, based on the development of studies to evaluate the implementation of LAI-PrEP and ED-PrEP as a choice. The results will be published in peer-reviewed journals and presented to the study participants and communities. TRIAL REGISTRATION NUMBER: https://ensaiosclinicos.gov.br/rg/RBR-104736f4. The trial registration number: RBR-104736f4.

摘要

引言:长效注射用卡博特韦是一种很有前景的新型HIV预防方法。需要安全有效的长效暴露前预防(PrEP)药物,以增加性少数和性别少数青少年的预防选择。 方法与分析:这是一项对三种PrEP模式(长效注射PrEP、事件驱动型(ED)和每日口服型)进行的多中心前瞻性实施研究,采用定量和定性相结合的混合方法设计。该研究将纳入550名15至19岁的HIV阴性男男性行为青少年、出生时被指定为男性的非二元性别个体、跨性别男性和女性,来自巴西的三个首都城市。参与者将根据他们选择的PrEP模式分为两组,并随访36个月。根据参与者的需求和偏好,允许在口服PrEP和长效注射PrEP之间切换。定性研究将侧重于调查在当前PrEP规划中,与护理的联系和保留、PrEP模式之间的切换以及长效注射PrEP实施过程的策略相关的过程,以及从医疗服务提供者、政策制定者和利益相关者的角度评估其可接受性。 伦理与传播:在提供任何护理之前,项目团队将评估青少年同意参与和理解PrEP的自主性,并将记录在他们的病历中。15至17岁的青少年将签署知情同意书,无需法定监护人的批准,除非发现该青少年没有必要的自主性。该研究已获得世界卫生组织伦理审查委员会以及协调该研究的大学(圣保罗大学、巴伊亚联邦大学和米纳斯吉拉斯联邦大学)的当地机构审查委员会的批准。该项目是基于开展研究以评估长效注射PrEP和事件驱动型PrEP作为一种选择的实施情况,从而加快将新的模式纳入巴西PrEP计划的努力的一部分。研究结果将发表在同行评审期刊上,并向研究参与者和社区公布。 试验注册号:https://ensaiosclinicos.gov.br/rg/RBR-104736f4。试验注册号:RBR-104736f4。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/81c5/11751826/93b8396ecde7/bmjopen-15-1-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/81c5/11751826/cf0240d84dc3/bmjopen-15-1-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/81c5/11751826/93b8396ecde7/bmjopen-15-1-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/81c5/11751826/cf0240d84dc3/bmjopen-15-1-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/81c5/11751826/93b8396ecde7/bmjopen-15-1-g002.jpg

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引用本文的文献

[1]
Awareness and intention to use event-driven and long-acting injectable pre-exposure prophylaxis among adolescent and young men who have sex with men and transgender women in Brazil: a cross-sectional study.

J Int AIDS Soc. 2025-7

本文引用的文献

[1]
Oral Pre-Exposure Prophylaxis for HIV Discontinuation in a Large Cohort of Adolescent Men Who Have Sex With Men and Transgender Women in Brazil.

J Adolesc Health. 2023-12

[2]
Adherence, Safety, and Feasibility of HIV Pre-Exposure Prophylaxis Among Adolescent Men Who Have Sex With Men and Transgender Women in Brazil (PrEP1519 Study).

J Adolesc Health. 2023-12

[3]
When Ethics and the Law Collide: A Multicenter Demonstration Cohort Study of Pre-Exposure Prophylaxis Provision to Adolescent Men Who Have Sex With Men and Transgender Women in Brazil.

J Adolesc Health. 2023-12

[4]
Interdisciplinarity in HIV prevention research: the experience of the PrEP1519 study protocol among adolescent MSM and TGW in Brazil.

Cad Saude Publica. 2023

[5]
HIV incidence estimates by sex and age group in the population aged 15 years or over, Brazil, 1986-2018.

Rev Soc Bras Med Trop. 2022

[6]
Cabotegravir for HIV Prevention in Cisgender Men and Transgender Women.

N Engl J Med. 2021-8-12

[7]
Multicompartmental pharmacokinetic evaluation of long-acting cabotegravir in healthy adults for HIV preexposure prophylaxis.

Br J Clin Pharmacol. 2022-2

[8]
Characterization of Human Immunodeficiency Virus (HIV) Infection in Cisgender Men and Transgender Women Who Have Sex With Men Receiving Injectable Cabotegravir for HIV Prevention: HPTN 083.

J Infect Dis. 2021-11-16

[9]
HIV risk, risk perception, and PrEP interest among adolescent girls and young women in Lilongwe, Malawi: operationalizing the PrEP cascade.

J Int AIDS Soc. 2020-6

[10]
HIV Preexposure Prophylaxis Among Adolescents in the US: A Review.

JAMA Pediatr. 2020-11-1

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