Monica Garcia highlights the success of PrEP in the fight against HIV after five years of experience

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Monica Garcia emphasized: “PrEP represents an important milestone in HIV prevention and gives us the opportunity to significantly reduce the scale of a pandemic for which a successful solution has been found.”

At the event, the minister said that a total of 23,670 people have participated in the program in these five years. Over the past year, the number has increased by almost 10,000. More than 2,000 people are being monitored for monitoring and evaluation.

But there is a long way to go, as acknowledged by the minister, who assessed that achieving 100% success is difficult, which is why it is important to take measures such as improving accessibility and reaching all the most vulnerable.

It’s not just popping a pill, Monica Garcia said, but a much broader public health approach that includes preventing other sexually transmitted diseases, promoting condom use, vaccinations when possible, early detection and treatment.

“I am confident that we will continue to take steps forward in our fight against HIV and continue to find common spaces for learning, collaboration and commitment,” she said.

HIV pre-exposure prophylaxis (PrEP) consists of one tablet of tenofovir disoproxil and emtricitabine (TDF/FTC) given daily to people at risk of infection. It is part of a package of pharmacological and non-pharmacological interventions aimed at preventing HIV, called a combination prevention strategy.

The Minister stressed that “these five years of success are evidence that when policy goes hand in hand with science and evidence, it can produce good results.”

In Spain, PrEP was included as a pharmaceutical benefit in the basic portfolio of services of the National Health System on 30 September 2019. In March 2020, the HIV Pre-Exposure Prevention Program Information System (SIPrEP) was launched in Spain with the aim of monitoring the development and results of public PrEP programs in Spain and knowledge of the characteristics, their clinical evolution and the effectiveness of this new intervention among PrEP users in different autonomous communities.

This is a collective success, the minister noted, so she congratulated the initiators and implementers of this initiative.

A total of eleven autonomous communities are providing data to learn about the progress of this initiative, but today it was emphasized that more participation is needed.

“This is a success story. This is not a pill, this is a whole public health program, global STI prevention, a system agreed with WHO and UNAIDS, which works throughout Spain,” said ISCIII Director Marina Pollan. , who also emphasized that the SIPrEP information system is fundamental and facilitates the evaluation of the PrEP program.

“Evaluating the effectiveness of this public health measure in real-world and specific settings is key to further improvement,” he said.

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According to the report on the results of SIPrEP up to May 2023, the number of PrEP dispensing sites participating in SIPrEP varies across communities.

The majority of PrEP users were MSM, young people born in Spain. Most of them had compulsory secondary education, and half were employed.

In almost 20% of cases, the current PrEP program was accessed through a primary health care center or an HIV/STD testing center, respectively, highlighting its importance as a PrEP promotion tool and mode of program participation.

Of those who had previously taken PrEP, almost a quarter had not received medical supervision, mostly those who purchased the drugs online.

The characteristics of PrEP users in relation to risky practices show a high risk of HIV infection.

6-8% of patients were diagnosed with Chlamydia trachomatis, gonococcus, and syphilis at the first visit, highlighting the importance of these programs in identifying and treating undetected STIs.

Nearly a quarter of users reported using drugs in the previous 3 months. Additionally, up to 13% of PrEP users engaged in chemsex in the 3 months prior to the baseline visit. Because of the high prevalence of drug use, it is necessary to increase counseling about this use at each follow-up visit.

Of the total number of users, 13% interrupted the program for various reasons. The most common were lack of risk perception and user transfer.

Seroconversion to HIV was very rare but occurred in 3 cases; One in three users who became infected with HIV during the study period had problems adhering to PrEP.

Addressing the vulnerability of these groups to HIV requires coordination among participating organizations, tailoring responses to the specific characteristics and needs of these users.

Fountain: Moncloa