Caceres Carlos F, Pines Heather, Konda Kelika A, Borquez Annick, Moreira Ronaldo, Leite Iuri, Amparo Pedro, Cunha Marcelo, Torres Thiago S, Guanira Juan V, Jirón Jean-Pierre, Hoagland Brenda, Vermandere Heleen, Benedetti Marcos, Vega Hamid, Benites Carlos M, Pimenta Cristina, Grinztejn Beatriz, Veloso Valdiléa
Universidad Peruana Cayetano Heredia, Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Lima, Peru.
San Diego State University, San Diego, CA, USA.
Lancet Reg Health Am. 2025 Apr 25;46:101098. doi: 10.1016/j.lana.2025.101098. eCollection 2025 Jun.
Ongoing implementation of HIV pre-exposure prophylaxis (PrEP) in Latin America should consider lessons learned from implementation projects such as ImPrEP (Brazil/Mexico/Peru, 2018-2021). In this analysis we assessed the effect of variables ascertained in early appointments on HIV seroconversion among ImPrEP participants.
ImPrEP enrolled HIV-negative men who have sex with men and transgender women (MSM/TGW) aged 18+ years reporting recent condomless anal sex, anal sex with HIV-positive partners, transactional sex, or sexually transmitted infections (STI). Participants received a 30-day PrEP supply; at the 30-day visit and quarterly thereafter they completed behavioural assessments, underwent HIV testing, and received 3-month PrEP supplies if HIV-negative. PrEP adherence was measured using the medication possession ratio (MPR) at the 30-day visit. We used Cox's proportional hazards regression to examine the effect of our sociodemographic, behavioural, STI, and early PrEP care engagement variables of interest on time to HIV seroconversion.
Compared to participants in Brazil, the hazard ratio for HIV seroconversion was higher among those in Peru (HR = 7.91, 95% CI: 4.74-13.20). Compared to participants aged ≥35 years, the HR for HIV seroconversion was higher for those aged 18-24 (aHR = 4.84, 95% CI: 2.55-9.17 and 25-34 (aHR = 2.43, 95% CI: 1.21-4.91). HIV seroconversion was also associated with transgender identity (aHR = 2.28, 95% CI: 1.12-4.66), transactional sex (aHR = 1.88, 95% CI: 1.18-2.99), receptive condomless anal sex (aHR = 2.42, 95% CI: 1.42-4.12), STI diagnosis (aHR = 1.93, 95% CI: 1.25-2.99), and a MPR < 0.6 (aHR = 2.64, 95% CI: 1.52-4.60).
While moderate-high, HIV incidence among ImPrEP participants represented a considerable reduction from figures observed among MSM/TGW not using PrEP/PEP. Interventions to improve PrEP adherence are needed among new Latin American PrEP users, especially if baseline factors associated with seroconversion are present. Long-acting injectable PrEP can also become useful for this population.
This study was funded by UNITAID.
拉丁美洲正在实施的HIV暴露前预防（PrEP）应借鉴从诸如ImPrEP（巴西/墨西哥/秘鲁，2018 - 2021年）等实施项目中吸取的经验教训。在本分析中，我们评估了早期预约时确定的变量对ImPrEP参与者HIV血清转化的影响。
ImPrEP招募了年龄在18岁及以上、报告近期有无保护肛交、与HIV阳性伴侣进行肛交、交易性性行为或性传播感染（STI）的HIV阴性男男性行为者（MSM）和跨性别女性（TGW）。参与者获得30天的PrEP供应；在30天随访时以及之后每季度，他们完成行为评估、接受HIV检测，如果HIV检测呈阴性，则获得3个月的PrEP供应。在30天随访时使用药物持有率（MPR）来衡量PrEP依从性。我们使用Cox比例风险回归来研究我们感兴趣的社会人口学、行为、STI和早期PrEP护理参与变量对HIV血清转化时间的影响。
与巴西的参与者相比，秘鲁参与者的HIV血清转化风险比更高（HR = 7.91，95%CI：4.74 - 13.20）。与年龄≥35岁的参与者相比，18 - 24岁（调整后HR = 4.84，95%CI：2.55 - 9.17）和25 - 34岁（调整后HR = 2.43，95%CI：1.21 - 4.91）的参与者HIV血清转化风险比更高。HIV血清转化还与跨性别身份（调整后HR = 2.28，95%CI：1.12 - 4.66）、交易性性行为（调整后HR = 1.88，95%CI：1.18 - 2.99）、无保护接受肛交（调整后HR = 2.42，95%CI：1.42 - 4.12）、STI诊断（调整后HR = 1.93，95%CI：1.25 - 2.99）以及MPR < 0.6（调整后HR = 2.64，95%CI：1.
