A demonstration project for pre-exposure prophylaxis (PrEP) in Brazil has provided real-world evidence that men who have sex with men (sometimes referred to as MSM) and transgender women could benefit from the ground-breaking HIV prevention tool.

The results, published in the Lancet this month, found PrEP to be effective, well adhered to, and did not result in risk compensation in these two population groups.

‘PrEP Brazil’ assessed the delivery of PrEP (tenofovir and emtricitabine to prevent HIV) over 48-weeks in 450 gay men and transgender women living in Sao Paulo and Rio de Janeiro.

At the start of the study, all participants were HIV-negative and referred to the programme after reporting at-risk sexual activities – defined as having anal sex without a condom, two or more episodes of anal sex with an HIV-infected partner, or a history of sexually transmitted infections (STIs).

Overall, 83% of the participants were retained at week 48, and of this group, three-quarters (74%) had protective drug concentrations consistent with high levels of adherence, meaning they took at least four doses per week. But young MSM of black race, and those with less schooling, were less likely to have protective concentrations at week 48 – suggesting interventions were needed to help these sub-groups more specifically.

While sexual risk behaviour was high for the study participants overall, receptive anal sex without a condom did not change significantly over time – from 45% at enrolment, to 49% at week 48. At the same time the mean number of sexual partners decreased negligably from 11.4 in the previous three months to enrolment, to 8.3 at week 48. Just two people became HIV-positive during the study follow-up, and they had undetectable tenofovir concentrations in their blood.

This underlines the need for increased access to innovative HIV prevention tools, such as PrEP, to keep HIV epidemics at bay among high-risk populations. Read more via Avert