Implementation of pre-exposure prophylaxis programme in Spain. Feasibility of four different delivery models

• DOI: 10.1371/journal.pone.0246129
• Publication Date: 2021-02-09T01:36:52Z
• Authors: Carlos Iniesta; Pep Coll; María Jesús Barberá; Miguel García Del...; Xabier Camino; Gabriela Fagúndez; Asunción Díaz; Rosa Polo
• Keywords: Adult; Male; Safe Sex; :Other subheadings::/methods [Other subheadings]; Anti-HIV Agents; Science; Health Personnel; Sexually Transmitted Diseases; HIV Infections; :Virus Diseases::Virus Diseases::Sexually Transmitted Diseases::Sexually Transmitted Diseases, Viral::HIV Infections [DISEASES]; Transgender Persons; Sexual and Gender Minorities; 03 medical and health sciences; 0302 clinical medicine; :Otros calificadores::/métodos [Otros calificadores]; Malalties de transmissió sexual - Prevenció; Humans; :Health Care Facilities, Manpower, and Services::Health Services::Preventive Health Services::Primary Prevention::Pre-Exposure Prophylaxis [HEALTH CARE]; Longitudinal Studies; :instalaciones, servicios y personal de asistencia sanitaria::servicios de salud::servicios preventivos de salud::prevención primaria::profilaxis preexposición [ATENCIÓN DE SALUD]; :localizaciones geográficas::Europa (continente)::España [DENOMINACIONES GEOGRÁFICAS]; Q; R; 16. Peace & justice; 3. Good health; Treatment Adherence and Compliance; :Geographic Locations::Europe::Spain [GEOGRAPHICALS]; Spain; :virosis::virosis::enfermedades de transmisión sexual::enfermedades virales de transmisión sexual::infecciones por VIH [ENFERMEDADES]; Medicine; Feasibility Studies; Female; Perception; Pre-Exposure Prophylaxis; Infeccions per VIH - Espanya; Research Article

Background Pre-exposure prophylaxis (PrEP) is an effective and cost-effective strategy for HIV prevention. Spain carried out an implementation study in order to assess the feasibility of implementing PrEP programmes within its heterogeneous health system.

Methods Observational longitudinal study conducted on four different types of health-care setting: a community centre (CC), a sexually transmitted infections clinic (STIC), a hospital-based HIV unit (HBHIVU) and a hospital-based STI unit (HBSTIU). We recruited gay, bisexual and other men who have sex with men (GBSM) and transgender women at risk of HIV infections, gave them PrEP and monitored clinical, behavioural PrEP-related and satisfaction information for 52 weeks. We collected perceptions on PrEP implementation feasibility from health-care professionals participating in the study.

Results A total of 321 participants were recruited, with 99.1% being GBMSM. Overall retention was 87.2% and it was highest at the CC (92.6%). Condom use decreased during the study period, while STIs did not increase consistently. The percentage of people who did not miss any doses of PrEP during the previous week remained at over 93%. No HIV seroconversions occurred. We observed overall decreases in GHB (32.5% to 21.8%), cocaine (27.5% to 21.4%), MDMA (25.7% to 14.3%), speed (11.4% to 5.7%) and mephedrone use (10.7% to 5.0%). The overall participant satisfaction with PrEP was 98.6%. Health-care professionals’ perceptions of PrEP feasibility were positive, except for the lack of personnel.

Conclusions PrEP implementation is feasible in four types of health-care settings. Local specificities have to be taken into consideration while implementing PrEP.