Profilaxia pós-exposição sexual para HIV: uma análise retrospectiva sobre a adesão e o seguimento das pessoas assistidas

Abstract

Introduction: The HIV post-exposure prophylaxis (PEP) is part of a multiple-actionprevention plan against HIV/AIDS. It is recommended for situations involving failure or thenon-use of condoms. In the Brazilian program, this plan involves taking antiretroviralmedicines (ART) for 28 days, starting up to 72 hours of potential exposure to HIV, and athree-stage follow-up with the assisted individual. Although this technique is renowned inseveral countries, studies indicate the need for investment in research that seeks to elucidatefactors involved in the adherence to prophylaxis. The use of PEP is still recent and nationalpublications in this area are scarce. Objective: To analyse adherence to prophylaxis andcompliance with follow-up stages for the individuals assisted by the Programa Brasileiro deProfilaxia Pós-Exposição sexual ao HIV, as a result of consensual intercourse. Method:Observational study, retrospective, carried out between February 2011 and December 2017,with PEPs dispensed at a reference health centre, which is responsible for the largest numberof treatments in the city of Belo Horizonte, Minas Gerais Brazil. Secondary data collectioncarried out with a 68-variable instrument. The data was stored in the EPI-3.1 DATE softwareand analyzed by the statistical software SPSS 21.0. The sample was characterised throughfrequency calculation, measures of central tendency and variability. To assess the factorsassociated with adherence to prophylaxis and to the follow-up, the following have been used:the Pearson Chi-square test, the Mann-Whitney test and the binary logistic regression model,with estimates of the Odds Ratio value and confidence interval of 95%. All the analysisconsidered a significance level of 5%. Results: Out of the 1996-user sample, the majoritywere men, 30 years old on average, brown-coloured, with a higher education degree, andresidents of the city of Belo Horizonte. Exposures were predominantly due to condombreakage or failure (53.8%) arising from anal intercourse (56.3%), intercourse with unknownserology partners, but belonging to the population of high prevalence of HIV (57.4%). Morethan half of them (68.1%) received the antiretroviral drugs composed of Tenofovir,Lamivudine, Atazanavir and Ritonavir. Side effects were observed in 84.9%. 33.6% adheredto medications for 28 days. In cases of partial adherence, the side effect was the main reasonfor an interruption for 56.1%. Regarding the follow-up cases, 50.4% returned for at least oneof the stages - basal exams (32.0%); 1st HIV test (36.6%) and 2nd test (15.1%). A total of6.8% have completed all the stages. Higher adherence to PEP was associated with thefollowing factors: advanced age, residence in Belo Horizonte or its metropolitan region, beingbisexual, having had intercourse with a partner known to be HIV positive and not takingTenofovir, Zidovudine and Lamivudine antiretrovirals. The factors associated with the highestchances of follow-up completion were advanced age and having had intercourse with apartner known to be HIV positive and not taking the aforementioned antiretrovirals. Therehave been two cases of seroconversion to HIV one of them due to early interruption of theprophylaxis, and the other due to continuing risk exposure. Conclusion: Low rates ofadherence to PEP and follow-up procedures were observed, signposting that the effectivenessof this program is dependent on a combination of strategies, based on the predictors ofadherence and public measures that respond to the profiles and the specificities of population.Possible solutions involve increased access to treatment, incorporation of communicationtechnologies; the provision of educational material, expansion of treatment centres, choosingbetter tolerability antiretroviral drugs, campaigns targeting women and younger population, aswell as monitoring and offering guidance to assisted individuals. Further research into thisarea in other treatment centres and regions in Brazil may increase visibility of the Brazilianexperience for both the PEP and other combined HIV prevention strategies.Keywords: Post-exposure prophylaxis. HIV. Adherence.