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Eligibility for Pre-exposure Prophylaxis According to Different Guidelines in a Cohort of HIV-Negative Men Who Have Sex with Men in Lisbon, Portugal

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Abstract

Objectives

Defining eligibility for preexposure prophylaxis (PrEP) is key to measuring the degree of PrEP implementation. While the clinical exclusion criteria are identical across different guidelines, definitions of substantial HIV risk are not. In this study, we aimed to estimate the proportion of men who have sex with men (MSM) being tested at a community-based voluntary human immunodeficiency virus (HIV) counseling and testing center in Lisbon that would be eligible for PrEP according to guidelines from the World Health Organization (WHO), the US Public Health Service and Centers for Disease Control and Prevention (US-CDC), the European AIDS Clinical Society (EACS), and the Portuguese National Health Service (PNHS).

Methods

We used baseline data from 3392 HIV-negative MSM with valid information on eligibility for PrEP enrolled in the Portuguese Lisbon Cohort of MSM—an observational study designed as an open prospective, noninterval cohort—between March 2014 and March 2018.

Results

At baseline, the proportion of MSM eligible for PrEP was 67.7% according to the US-CDC, 60.6% according to the PNHS guidelines, 58.9% according to the WHO, and 46.5% according to the EACS guidelines. The most frequently met criteria were those related to condomless anal intercourse.

Conclusions

In conclusion, in the same population, the proportion of men eligible for PrEP differed by guideline, ranging from 46.5% to 67.7%, though if they all seem to include the same well-known predictors of HIV seroconversion.

Policy implications

These results show that both the allocation of resources and the approaches to individual risk prediction are highly dependent on the chosen guideline. Moving the focus from assessing risk to assessing whether PrEP is a suitable option for a given individual in a given moment of his life might help to overcome guidelines limitations and create more equitable access.

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Acknowledgments

The authors acknowledge all participants in the Lisbon Cohort of Men Who Have Sex With Men; former and current staff from CheckpointLX and GAT, namely, Ricardo Fuertes, Nuno Pinto, Fernando Ferreira, Luís Veríssimo, Rui Guerreiro, Alexandre Gomes, Marcos Carvalho, Hugo Correia, Hugo Machado, Julio Esteves, Manuel Mateus, Ricardo Abrantes, Ricardo Jordão, Daniel Simões, Maria José Campos, and Luís Mendão; and Paulo Oliveira and Raquel Lucas from Instituto de Saúde Pública, Universidade do Porto.

Funding

This study was partially funded by FEDER funds through the Operational Programme for Competitiveness and Internationalization and by national funds of Fundação para a Ciência e Tecnologia (FCT), under the scope of the Research Unit of Epidemiology – Institute of Public Health of the University of Porto (EPIUnit) (POCI-01-0145-FEDER-006862; ref. UID/DTP/04750/2013); Paula Meireles was the recipient of PhD grant SFRH/BD/112867/2015 co-funded by the FCT and the Programa Operacional Capital Humano/Fundo Social Europeu (POCH/FSE) Program.

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Authors and Affiliations

  1. EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600, Porto, Portugal

    Paula Meireles & Henrique Barros

  2. Department of Medicine, Division of Infectious Diseases at Georgetown University Medical Center, Washington, DC, USA

    Michael Plankey

  3. GAT - Grupo de Ativistas em Tratamentos, Lisbon, Portugal

    Miguel Rocha, Jesus Rojas & João Brito

  4. Coalition PLUS Community-Based Research Laboratory, Patin, France

    Miguel Rocha, Jesus Rojas & João Brito

  5. Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal

    Henrique Barros

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  1. Paula Meireles
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  3. Miguel Rocha
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Correspondence to Paula Meireles.

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Meireles, P., Plankey, M., Rocha, M. et al. Eligibility for Pre-exposure Prophylaxis According to Different Guidelines in a Cohort of HIV-Negative Men Who Have Sex with Men in Lisbon, Portugal. Sex Res Soc Policy 17, 688–699 (2020). https://doi.org/10.1007/s13178-019-00426-9

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