A reference in the implementation and expansion of pre-exposure prophylaxis (PrEP) to HIV in Brazil, Mexico and Peru, the ImPrEP project just had its main results presented in the December 21 edition of The Lancet HIV, one of the most prestigious world scientific publications. The full article is free and signed by the ImPrEP Study Group. In recognition of the importance of the study, the journal published a specific editorial about it, emphasizing its relevant contribution.
“ImPrEP was a PrEP implementation study, developed from 2018 to 2021, in which the main purpose was to assess the feasibility of immediately offering daily oral PrEP in these three countries, serving as a mirror for similar initiatives in Latin America. The fruitful partnership between the Evandro Chagas National Infectiology Institute [INI/Fiocruz] and the Department of Chronic Diseases and Sexually Transmitted Infections, of the Ministry of Health of Brazil, whose union of skills and efforts led to the good results achieved so far”, states Valdiléa Veloso, a researcher at Fiocruz and main surveyor of the study.
The project, carried out in 14 centers in Brazil, four in Mexico and 10 in Peru, focused on gay, bisexual and other cisgender men who have sex with men (MSM), transvestites and transgender women, populations most affected by the HIV and AIDS pandemic in Latin America. Individuals aged 18 years or older, with a negative HIV test result and reporting one or more pre-specified risk criteria were eligible to participate in the study. Volunteers considered fit received daily oral PrEP free of charge on the first visit. This was the largest PrEP study ever developed in Latin America and the second largest in the world in terms of number of participants.
ImPrEP demonstrated that the immediate offer of PrEP is feasible, with low early loss to follow-up, reinforcing the PrEP public policy strategy in Brazil, established in 2017. It has also contributed to the establishment of the national prophylaxis program in Mexico.
Main results: a total of 9,509 participants were included (3,928 in Brazil, 3,288 in Mexico and 2,293 in Peru), 94.3% MSM and 5.7% transvestites and trans women, most between 18 and 30 years old; adherence to PrEP and long-term service retention was good, being worse among the youngest and most vulnerable; and the incidence of HIV was very low, being higher in the most vulnerable populations and with low adherence to PrEP.
“PrEP has proven to be an important prevention technology, especially among populations such as MSM, transvestites and transgender women in Latin America. In this regard, the social and structural determinants of HIV risk need to be addressed for the full implementation of the benefits of prophylaxis”, analyzes Beatriz Grinsztejn, main co-researcher at ImPrEP and responsible for implementing the new stage of the project, named ImPrEP CAB Brasil. This is an implementation study of long-term cabotegravir as PrEP for MSM, transvestites, transgender women and men and non-binary individuals aged 18 to 30 years, which aims at gathering information for the potential offer of the injectable modality of prophylaxis in the Unified Health System (SUS), with operationalization scheduled for the beginning of 2023.
Partners and funders
The initial stage of ImPrEP, linked to offering daily oral PrEP, was an initiative by Fiocruz, through INI/Fiocruz, in partnership with the Department of Chronic Diseases and Sexually Transmitted Infections, of the Brazilian Ministry of Health, the Universidad Peruana Cayetano Heredia, from Peru, Clínica Condesa and the National Institute of Public Health, both from Mexico. ImPrEP CAB Brasil is a partnership between Fiocruz and the Brazilian Ministry of Health. The two stages of the project were and still are funded by Unitaid and the World Health Organization (WHO).