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Towards a fair consideration of PrEP as part of combination HIV prevention in Latin America

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dc.contributor.author Ravasi, Giovanni
dc.contributor.author Grinsztejn, Beatriz
dc.contributor.author Baruch, Ricardo
dc.contributor.author Guanira, Juan-Vicente
dc.contributor.author Luque, Ricardo
dc.contributor.author Caceres, Carlos-F.
dc.contributor.author Ghidinelli, Massimo
dc.date.accessioned 2019-02-06T14:51:43Z
dc.date.available 2019-02-06T14:51:43Z
dc.date.issued 2016
dc.identifier.uri https://hdl.handle.net/20.500.12866/5244
dc.description.abstract INTRODUCTION: Despite progress in scaling up antiretroviral treatment, HIV prevention strategies have not been successful in significantly curbing HIV incidence in Latin America. HIV prevention interventions need to be expanded to target the most affected key populations with a combination approach, including new high impact technologies. Oral pre-exposure prophylaxis (PrEP) is recommended as additional prevention choice for individuals at higher risk of infection and could become a cost-effective prevention tool. We discuss the barriers and solutions for a fair consideration of PrEP as part of combination HIV prevention strategies in Latin America. DISCUSSION: Although demonstration projects are ongoing or being planned in a number of countries, to date no Latin American country has implemented a public PrEP programme. The knowledge of policymakers about PrEP implementation needs to be strengthened, and programmatic guidance and cost estimate tools need to be developed to support adequate planning. Despite high levels of awareness among health providers, especially if engaged in HIV or key population care, willingness to prescribe PrEP is still low due to the lack of national policies and guidelines. Key populations, especially men who have sex with men, transgender women and sex workers, have been engaged in demonstration projects, and qualitative research shows high awareness and willingness to use PrEP, especially if accessible in the public sector for free or at affordable price. Concerns of safety, adherence, effectiveness and risk compensation need to be addressed through targeted social communication strategies to improve PrEP knowledge and stimulate demand. Alliance among policymakers, civil society and representatives from key populations, healthcare providers and researchers will be critical for the design and successful implementation of PrEP demonstration projects of locally adapted delivery models. The use of mechanisms of joint negotiation and procurement of antiretrovirals could reduce costs and significantly increase the cost-effectiveness of PrEP. CONCLUSIONS: PrEP is an additional prevention tool and should be implemented in combination and synergy with other prevention interventions. PrEP programmes should target high-risk individuals from key populations for higher cost-effectiveness. Demonstration projects may generate strategic information for and lead to the implementation of full-scale PrEP programmes. en_US
dc.language.iso eng
dc.publisher Wiley
dc.relation.ispartof urn:issn:1758-2652
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject antiretrovirals en_US
dc.subject HIV en_US
dc.subject Latin America en_US
dc.subject pre-exposure prophylaxis en_US
dc.subject Pre-Exposure Prophylaxis/economics en_US
dc.subject prevention en_US
dc.subject Anti-HIV Agents/economics/therapeutic use en_US
dc.subject Awareness en_US
dc.subject Cost-Benefit Analysis en_US
dc.subject Female en_US
dc.subject Health Personnel en_US
dc.subject HIV Infections/drug therapy/prevention & control en_US
dc.subject Humans en_US
dc.subject Latin America en_US
dc.subject Male en_US
dc.subject Qualitative Research en_US
dc.subject Sex Workers en_US
dc.title Towards a fair consideration of PrEP as part of combination HIV prevention in Latin America en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.7448/IAS.19.7.21113
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.00 es_PE
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.03.08


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