Pre-exposure prophylaxis (PrEP) is an innovative approach in the HIV prevention toolkit, involving the administration of antiretrovirals to individuals not living with HIV but at high risk of exposure to the virus. When used correctly, PrEP effectiveness in reducing the risk of HIV acquisition is up to 99%. Obtaining the maximum benefit from PrEP requires evidence-based implementation. The PrEP cascade model proposed by the World Health Organization is a helpful tool to monitor candidates and users throughout the PrEP continuum and identify potential “bottlenecks” in achieving adherence and retention of individuals who are eligible and are interested in using PrEP.
Since 2017, Portugal has made significant strides by making PrEP accessible to all populations at high risk of HIV exposure, free of charge, through the National Health Service. PrEP delivery was initially centralized in hospitals, but recognizing the need to bring services closer to communities, a decentralized model was implemented in 2021. This new approach extends hospital PrEP services to community-based organizations, while maintaining the hospital’s central role in PrEP provision. This project is set within this innovative context of PrEP provision, specifically in GAT Almada, one of the first community-based centers to integrate the decentralized offering network.
In the PrEP GAT Almada Research Project we aim to provide evidence to improve PrEP delivery by analyzing the HIV PrEP continuum as informed by PrEP candidates, beneficiaries, or providers’ experiences across the HIV PrEP Cascade in a hospital decentralized PrEP delivery setting. The general objective is to identify the main determinants of losses to follow-up along the PrEP continuum of care and to develop a predictive model for these losses.
We will conduct a multi-method study combining quantitative and qualitative approaches, drawing insights from the experiences of PrEP candidates, beneficiaries, and providers. The quantitative component of the study comprises an ambispective cohort study – the PrEP GAT Almada Cohort. This study involves a prospective phase, where participants are recruited and followed forward in time for six months, and a retrospective phase, which utilizes electronic health records to gather clinical data from the first PrEP medical consultation. The qualitative component involves conducting individual in-depth interviews with PrEP candidates, beneficiaries, and providers. These interviews are designed to explore the barriers and facilitators at each transition point of the HIV PrEP cascade. Once both, the quantitative and qualitative, components are complete, the PrEP GAT Almada research project will integrate these approaches by comparing and contrasting their results to produce valid and well-substantiated conclusions about the determinants of losses to follow-up throughout the PrEP cascade.
Start date:
01/10/2023
(Predicted) End date:
30/06/2025
Funding:
This study was funded through third party agreement with GAT Portugal and ISPUP under the project GATALMADA funded by the Gilead grant Zeroing In to End the HIV Epidemic (EHE).
Research Line
L2 – Syndemics, health inequalities and vulnerable populations
Laboratory:
HIV and other sexually transmitted infections
