Public health professionals can expand their knowledge on the use of oral Pre-Exposure Prophylaxis (PrEP), which since 2017 has proven to be one of the main HIV prevention strategies in Brazil. The training of professionals is an initiative of the Department of HIV/Aids, Tuberculosis, Viral Hepatitis and Sexually Transmitted Infections (STI) of the Health and Environment Surveillance Secretariat of the Ministry of Health (Dathi/SVSA/MS) in partnership with the Pan Organization -American Health Organization (PAHO/WHO), the Center for Disease Control and Prevention (CDC) and the Oswaldo Cruz Foundation (Fiocruz).
The course online and self-instructional Pre-Exposure Prophylaxis for the Risk of Oral HIV Infection was launched by the Fiocruz Virtual Campus. According to Fiocruz, the objective is to update health professionals so that they are better prepared and attentive to assertively recommend PrEP, identifying who can benefit from this prevention strategy and ensuring adequate access to medication, in addition to providing monitoring and support continuous.
Pre-Exposure Prophylaxis of Risk of Infection is carried out through the combination of two medications, which, according to Fiocruz, block some of the pathways that HIV uses to infect the body. “(PrEP) consists of the use of antiretrovirals – tenofovir and emtricitabine – by anyone at increased risk of HIV and, when taken correctly, prevent infection in the event of possible exposure to the virus”, says text released this Wednesday (2 ) by the foundation.
Since 2018, the Ministry of Health has recommended this type of prophylaxis as an addition to the combined prevention package, but, since 2022, the practice has been extended to adolescents over 15 years old, with a body weight equal to or greater than 35 kilos, sexually active and under increased risk of HIV infection.
According to Fiocruz, there are situations that may indicate the use of PrEP as a priority. “Not frequently using condoms during sexual intercourse (anal or vaginal); repeated use of HIV Post-Exposure Prophylaxis (PEP); history of episodes of Sexually Transmitted Infections (STIs); contexts of sexual relations in exchange for money, valuable objects, drugs, housing, etc. and chemsex, sexual practice under the influence of psychoactive drugs (methamphetamines, Gamma-hydroxybutyrate (GHB), MDMA, cocaine, poppers.”
In the opinion of the deputy director of Dathi/SVSA/MS, Artur Kalichman, the best form of prevention is the one that adapts to people’s needs and realities. For Kalichman, one of the strategies is PrEP. “Our intention with the new course is to offer healthcare professionals who prescribe this prophylaxis – doctors, nurses and pharmacists – guidance on when and how to offer it. The intention is to expand the supply of PrEP in health services to directly impact the reduction of new cases in Brazil, considering, mainly, people who are in a situation of greater vulnerability to HIV”, he informed.
The coordination of the course by Fiocruz is under the responsibility of researchers from the Sergio Arouca National School of Public Health (Ensp/Fiocruz) Vanda Cota and Marly Cruz, who are excited to participate in expanding knowledge and improving the provision of health services. For Marly Cruz, expanding access to prophylaxis has been the biggest challenge for the Ministry of Health to offer treatment universally throughout the HIV/AIDS care network of the Unified Health System (SUS), both through tele PrEP and in extramural actions.
“The implementation of this strategy requires greater investment in training capillarity for the updating and qualification of health professionals who are able to recommend and prescribe PrEP. Therefore, this offer aims, above all, to expand access to updated content on PrEP for students from all over Brazil and other countries, also offering the possibility of building capacities and skills aimed at reducing vulnerabilities and new cases of HIV, not just the key population”, says the Fiocruz text.
Researcher Vanda Cota stated that the course is a review, translation and adaptation of training originally carried out by the Pan American Health Organization (PAHO) on its platform, but the version released now was developed by Dathi/SVSA/MS in partnership with Ensp/Fiocruz. “Taking this course is crucial for training, updating and improving the quality of care, in addition to promoting the dissemination of essential information for HIV prevention.”
The course will also contribute to reducing the stigma associated with HIV and sexuality, expanding professionals’ knowledge about prevention and the importance of access to healthcare”, he reinforced, adding that the distance offering allows healthcare professionals from different regions to including remote areas, have access to updated information about PrEP, without having to travel and being able to combine training with their work routine.
Relevance
In Fiocruz’s view, the implementation of PrEP in the SUS represents an important milestone in the response to HIV/AIDS in Brazil, because it advances prevention for anyone at significant risk of HIV infection and/or who expresses a desire to use prophylaxis. According to Ministry figures, around 100,000 people in Brazil use PrEP. Of this total, more than 90% are free of charge through the SUS.
“The objective of the Ministry of Health is, by 2027, to increase the number of PrEP users by 142%, focusing on those people at greatest risk of HIV infection,” concluded Fiocruz.
