Nonoccupational post-exposure prophylaxis for HIV after sexual intercourse among women in Brazil: risk profiles and predictors of loss to follow-up

dc.creatorGrangeiro, Alexandre
dc.creatorNascimento, Maria Mônica Paulino do
dc.creatorZucchi, Eliana Miura
dc.creatorFerraz, Dulce Aurélia de Souza
dc.creatorEscuder, Maria Mercedes
dc.creatorArruda, Érico
dc.creatorLotufo, Denize
dc.creatorMunhoz, Rosemeire
dc.creatorCouto, Marcia Thereza
dc.date2020-09-18T16:08:12Z
dc.date2020-09-18T16:08:12Z
dc.date2019
dc.date.accessioned2023-09-26T22:35:25Z
dc.date.available2023-09-26T22:35:25Z
dc.identifierGRANGEIRO, Alexandre et al. Nonoccupational post-exposure prophylaxis for HIV after sexual intercourse among women in Brazil: risk profiles and predictors of loss to follow-up. Medicine, [Baltimore], v. 98, n. 39, p.1-9, 2019.
dc.identifier0025-7974
dc.identifierhttps://www.arca.fiocruz.br/handle/icict/43451
dc.identifier10.1097/MD.0000000000017071
dc.identifier.urihttps://repositorioslatinoamericanos.uchile.cl/handle/2250/8880737
dc.descriptionFundação Faculdade de Medicina e Ministério da Saúde
dc.descriptionAccess to antiretroviral-based HIV prevention has been marked by sex asymmetries, and its effectiveness has been compromised by low clinical follow-up rates. We investigated risk profiles of women who received nonoccupational post-exposure prophylaxis (nPEP), as well as the rates and predictive factors of loss to follow-up after nPEP initiation. Retrospective study evaluating 501 women who received nPEP between 2014 and 2015 at 5 HIV centers (testing centers-VCT, outpatient clinics, and infectious diseases hospital). Risk profiles were drawn based on the characteristics of the women and their sexual partners, and then stratified by sociodemographic indicators and previous use of HIV prevention services. Loss to follow-up (LTFU) was defined as not presenting for follow-up visits or for HIV testing after nPEP initiation. Predictors of LTFU were analyzed by calculating adjusted prevalence ratios (aPRs). Approximately 90% of women had sexual encounters that met the criteria established in the Brazilian guidelines for nPEP. Those who declared to be sex workers (26.5%) or drug users (19.2%) had the highest social vulnerability indicators. In contrast, women who had intercourse with casual partners of unknown HIV risk (42.7%) had higher education and less experience with previous HIV testing (89.3%) or nPEP use (98.6%). Of the women who received nPEP after sexual intercourse with stable partners, 75.8% had HIVinfected partners. LTFU rate was 72.8% and predictors included being Black (aPR=1.15, 95% confidence interval [CI]: 1.03–1.30), using drugs/alcohol (aPR=1.15, 95% CI: 1.01–1.32) and having received nPEP at an HIV outpatient clinic (aPR=1.35, 95% CI: 1.20–1.51) or at an infectious diseases hospital (aPR=1.37, 95% CI: 1.11–1.69) compared with a VCT. The risk of LTFU declined as age increased (aPR 41–59 years=0.80, 95% CI: 0.68–0.96). Most women who used nPEP had higher socioeconomic status and were not part of populations most affected by HIV. In contrast, factors that contribute to loss to follow-up were: having increased social vulnerability; increased vulnerability to HIV infection; and seeking nPEP at HIV treatment services as opposed to at a VCT. Abbreviations: aPRs = adjusted prevalence ratios, ART = antiretroviral therapy, HDI = Human Development Index, MSM = men who have sex with men, nPEP = nonoccupational post-exposure prophylaxis, PrEP = preexposure prophylaxis, VCT = HIV voluntary counseling and testing, Zres = standardized residual.
dc.formatapplication/pdf
dc.languagepor
dc.publisherWillams & Wilkins
dc.rightsopen access
dc.subjectAnti-Retroviral Agents
dc.subjectFollow-Up Studies
dc.subjectHIV Infections
dc.subjectMedication Adherence
dc.subjectPost-Exposure Prophylaxis
dc.subjectRetrospective Studies
dc.subjectRisk-Taking
dc.subjectSex Work
dc.subjectSocial Class
dc.subjectSubstance-Related Disorders
dc.subjectUnsafe Sex
dc.subjectCombination prevention
dc.subjectHIV
dc.subjectPost-exposure prophylaxis after sexual exposure
dc.subjectWomen
dc.subjectAntirretrovirais
dc.subjectSeguimentos
dc.subjectInfecções por HIV
dc.subjectAdesão à Medicação
dc.subjectProfilaxia Pós-Exposição
dc.subjectSexo sem Proteção
dc.titleNonoccupational post-exposure prophylaxis for HIV after sexual intercourse among women in Brazil: risk profiles and predictors of loss to follow-up
dc.typeArticle


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