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

Carlos Iniesta, Pep Coll, María Jesús Barberá, Miguel García Deltoro, Xabier Camino, Gabriela Fagúndez, Asunción Díaz, Rosa Polo, Spanish Working Group for PrEP, Carlos Iniesta, Pep Coll, María Jesús Barberá, Miguel García Deltoro, Xabier Camino, Gabriela Fagúndez, Asunción Díaz, Rosa Polo, Spanish Working Group for PrEP

Abstract

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.

Conflict of interest statement

The participation of private companies in this study does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1. Percentage of participants diagnosed with…
Fig 1. Percentage of participants diagnosed with STI.
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Fig 2. Frequency of drug use.

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Fig 2. Frequency of drug use.

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Fig 2. Frequency of drug use.
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    1. Plan Nacional sobre el Sida—D.G. de Salud Pública Centro Nacional de Epidemiología. Área de Vigilancia de VIH y Comportamientos de Riesgo. Vigilancia Epidemiológica del VIH y sida en España 2018: Sistema de Información sobre Nuevos Diagnósticos de VIH y Registro Nacional de Casos de Sida [Internet]. Madrid; 2019 [cited 2017 Sep 28]. Available from: https://www.mscbs.gob.es/ciudadanos/enfLesiones/enfTransmisibles/sida/vi...
    1. McCormack S, Dunn DT, Desai M, Dolling DI, Gafos M, Gilson R, et al. Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial. Lancet [Internet]. 2016. January 2 [cited 2017 Oct 10];387(10013):53–60. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26364263 10.1016/S0140-6736(15)00056-2 - DOI - PMC - PubMed
    1. Molina J-M, Capitant C, Spire B, Pialoux G, Cotte L, Charreau I, et al. On-Demand Preexposure Prophylaxis in Men at High Risk for HIV-1 Infection. N Engl J Med [Internet]. 2015. December 3 [cited 2017 Oct 10];373(23):2237–46. Available from: http://www.nejm.org/doi/10.1056/NEJMoa1506273 - DOI - PubMed
    1. Cambiano V, Miners A, Dunn D, McCormack S, Ong KJ, Gill ON, et al. Cost-effectiveness of pre-exposure prophylaxis for HIV prevention in men who have sex with men in the UK: a modelling study and health economic evaluation. Lancet Infect Dis [Internet]. 2017. October 17 [cited 2017 Dec 20]; Available from: http://www.sciencedirect.com/science/article/pii/S1473309917305406 10.1016/S1473-3099(17)30540-6 - DOI - PMC - PubMed
    1. Hayes R, Schmidt AJ, Pharris A, Azad Y, Brown AE, Weatherburn P, et al. Estimating the “PrEP Gap”: how implementation and access to PrEP differ between countries in Europe and Central Asia in 2019. Euro Surveill. 2019. October 1;24(41). 10.2807/1560-7917.ES.2019.24.41.1900598 - DOI - PMC - PubMed
Show all 31 references
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This study has been conducted with the resources from the National AIDS Programme ant those from the participating study centers. Gilead donated the drug administered in the study. Donors had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Some authors are employed by BCN Checkpoint. BCN Checkpoint is a Community Centre run by an NGO. BCN Checkpoint did not play a role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript and only provided financial support in the form of author PC. The specific roles of this author is articulated in the ‘author contributions’ section.
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References

    1. Plan Nacional sobre el Sida—D.G. de Salud Pública Centro Nacional de Epidemiología. Área de Vigilancia de VIH y Comportamientos de Riesgo. Vigilancia Epidemiológica del VIH y sida en España 2018: Sistema de Información sobre Nuevos Diagnósticos de VIH y Registro Nacional de Casos de Sida [Internet]. Madrid; 2019 [cited 2017 Sep 28]. Available from:
    1. McCormack S, Dunn DT, Desai M, Dolling DI, Gafos M, Gilson R, et al. Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial. Lancet [Internet]. 2016. January 2 [cited 2017 Oct 10];387(10013):53–60. Available from: 10.1016/S0140-6736(15)00056-2
    1. Molina J-M, Capitant C, Spire B, Pialoux G, Cotte L, Charreau I, et al. On-Demand Preexposure Prophylaxis in Men at High Risk for HIV-1 Infection. N Engl J Med [Internet]. 2015. December 3 [cited 2017 Oct 10];373(23):2237–46. Available from:
    1. Cambiano V, Miners A, Dunn D, McCormack S, Ong KJ, Gill ON, et al. Cost-effectiveness of pre-exposure prophylaxis for HIV prevention in men who have sex with men in the UK: a modelling study and health economic evaluation. Lancet Infect Dis [Internet]. 2017. October 17 [cited 2017 Dec 20]; Available from: 10.1016/S1473-3099(17)30540-6
    1. Hayes R, Schmidt AJ, Pharris A, Azad Y, Brown AE, Weatherburn P, et al. Estimating the “PrEP Gap”: how implementation and access to PrEP differ between countries in Europe and Central Asia in 2019. Euro Surveill. 2019. October 1;24(41). 10.2807/1560-7917.ES.2019.24.41.1900598
    1. García LM, Iniesta C, Garrido J, Fuster MJ, Pujol F, Meulbroek M, et al. HIV pre-exposure prophylaxis (PrEP) in Spain: political and administrative situation. Enferm Infecc Microbiol Clin. 2019. December 1;37(10):656–60. 10.1016/j.eimc.2018.05.012
    1. Cohen SE, Vittinghoff E, Bacon O, Doblecki-Lewis S, Postle BS, Feaster DJ, et al. High interest in preexposure prophylaxis among men who have sex with men at risk for HIV infection: Baseline data from the US PrEP demonstration project In: Journal of Acquired Immune Deficiency Syndromes [Internet]. Lippincott Williams and Wilkins; 2015. [cited 2020 Jul 15]. p. 439–48. Available from: /pmc/articles/PMC4334721/?report = abstract
    1. Hosek SG, Landovitz RJ, Kapogiannis B, Siberry GK, Rudy B, Rutledge B, et al. Safety and Feasibility of Antiretroviral Preexposure Prophylaxis for Adolescent Men Who Have Sex With Men Aged 15 to 17 Years in the United States. JAMA Pediatr [Internet]. 2017. [cited 2019 Mar 1];171(11):1063–71. Available from: 10.1001/jamapediatrics.2017.2007
    1. Hoornenborg E, Coyer L, van Laarhoven A, Achterbergh R, de Vries H, Prins M, et al. Change in sexual risk behaviour after 6 months of pre-exposure prophylaxis use. AIDS [Internet]. 2018. July [cited 2018 Aug 28];32(11):1527–32. Available from: = 00002030-201807170-00016 10.1097/QAD.0000000000001874
    1. AEMPS. Ficha técnica Truvada [Internet]. 2017. Available from:
    1. Plan Nacional sobre el Sida. Grupo de Expertos PrEP. Ministerio de Sanidad, Servicios Sociales e Igualdad. Documento de consenso—Profilaxis Preexposición al VIH en España. 2018;
    1. Mir JF, Mazarío MF, Coll P. Implementation models and access to HIV pre-exposure prophylaxis in Spain Vol. 38, Enfermedades Infecciosas y Microbiologia Clinica. Elsevier Doyma; 2020. p. 234–7. 10.1016/j.eimc.2019.05.004
    1. McMahan VM, Violette LR, Andrasik MP, Martin A, Garske L, Stekler JD. “I make sure my doctor doesn’t know that i use meth”: Perceived barriers to pre-exposure prophylaxis (PrEP) uptake among community peer educators in Seattle (WA, USA). Sex Health [Internet]. 2020. [cited 2020 Jul 15];17(1):29–37. Available from: 10.1071/SH19083
    1. Iniesta C, Álvarez-del Arco D, García-Sousa LM, Alejos B, Díaz A, Sanz N, et al. Awareness, knowledge, use, willingness to use and need of Pre-Exposure Prophylaxis (PrEP) during World Gay Pride 2017. Lima VD, editor. PLoS One [Internet]. 2018. October 19 [cited 2019 Apr 8];13(10):e0204738 Available from: 10.1371/journal.pone.0204738
    1. Neumann MS, Finlayson TJ, Pitts NL, Keatley JA. Comprehensive HIV prevention for transgender persons [Internet]. Vol. 107, American Journal of Public Health. American Public Health Association Inc; 2017. [cited 2020 Jul 14]. p. 207–12. Available from:
    1. Vaccher SJ, Marzinke MA, Templeton DJ, Haire BG, Ryder N, McNulty A, et al. Predictors of Daily Adherence to HIV Pre-exposure Prophylaxis in Gay/Bisexual Men in the PRELUDE Demonstration Project. AIDS Behav [Internet]. 2019. May 15 [cited 2020 Jul 9];23(5):1287–96. Available from: 10.1007/s10461-018-2353-5
    1. Grinsztejn B, Hoagland B, Moreira RI, Kallas EG, Madruga J V., Goulart S, et al. Retention, engagement, and adherence to pre-exposure prophylaxis for men who have sex with men and transgender women in PrEP Brasil: 48 week results of a demonstration study. Lancet HIV [Internet]. 2018. March 1 [cited 2020 Jul 15];5(3):e136–45. Available from: 10.1016/S2352-3018(18)30008-0
    1. Grant RM, Anderson PL, McMahan V, Liu A, Amico KR, Mehrotra M, et al. Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: A cohort study. Lancet Infect Dis [Internet]. 2014. [cited 2020 Jul 14];14(9):820–9. Available from: /pmc/articles/PMC6107918/?report = abstract 10.1016/S1473-3099(14)70847-3
    1. Blumenthal J, Pasipanodya EC, Jain S, Sun S, Ellorin E, Morris S, et al. Comparing Self-Report Pre-Exposure Prophylaxis Adherence Questions to Pharmacologic Measures of Recent and Cumulative Pre-Exposure Prophylaxis Exposure. Front Pharmacol [Internet]. 2019. July 5 [cited 2020 Jul 14];10 Available from: /pmc/articles/PMC6624646/?report = abstract 10.3389/fphar.2019.00721
    1. Unidad de vigilancia del VIH y conductas de riesgo. Vigilancia epidemiológica de las infecciones de transmisión sexual, 2017. Madrid: Centro Nacional de Epidemiología, Instituto de Salud Carlos III/Plan Nacional sobre el Sida, Dirección General de Salud P; 2019.
    1. Traeger MW, Cornelisse VJ, Asselin J, Price B, Roth NJ, Willcox J, et al. Association of HIV Preexposure Prophylaxis With Incidence of Sexually Transmitted Infections Among Individuals at High Risk of HIV Infection. JAMA [Internet]. 2019. April 9 [cited 2020 Jul 15];321(14):1380–90. Available from: /pmc/articles/PMC6459111/?report = abstract 10.1001/jama.2019.2947
    1. Kojima N, Davey DJ, Klausner JD. Pre-exposure prophylaxis for HIV infection and new sexually transmitted infections among men who have sex with men. AIDS [Internet]. 2016. [cited 2020 Jul 15];30(14):2251–2. Available from: 10.1097/QAD.0000000000001185
    1. Montaño MA, Dombrowski JC, Dasgupta S, Golden MR, Duerr A, Manhart LE, et al. Changes in Sexual Behavior and STI Diagnoses Among MSM Initiating PrEP in a Clinic Setting. AIDS Behav [Internet]. 2019. February 15 [cited 2020 Jul 22];23(2):548–55. Available from: /pmc/articles/PMC6368873/?report = abstract 10.1007/s10461-018-2252-9
    1. Jansen K, Steffen G, Potthoff A, Schuppe AK, Beer D, Jessen H, et al. STI in times of PrEP: High prevalence of chlamydia, gonorrhea, and mycoplasma at different anatomic sites in men who have sex with men in Germany. BMC Infect Dis [Internet]. 2020. February 7 [cited 2020 Jul 22];20(1). Available from:
    1. Werner RN, Gaskins M, Nast A, Dressler C. Incidence of sexually transmitted infections in men who have sex with men and who are at substantial risk of HIV infection–A meta-analysis of data from trials and observational studies of HIV pre-exposure prophylaxis. PLoS One [Internet]. 2018. December 1 [cited 2020 Jul 15];13(12). Available from: /pmc/articles/PMC6277101/?report = abstract 10.1371/journal.pone.0208107
    1. Hoornenborg E, Coyer L, Achterbergh RCA, Matser A, Schim van der Loeff MF, Boyd A, et al. Sexual behaviour and incidence of HIV and sexually transmitted infections among men who have sex with men using daily and event-driven pre-exposure prophylaxis in AMPrEP: 2 year results from a demonstration study. Lancet HIV. 2019. July 1;6(7):e447–55. 10.1016/S2352-3018(19)30136-5
    1. Vuylsteke B, Reyniers T, De Baetselier I, Nöstlinger C, Crucitti T, Buyze J, et al. Daily and event-driven pre-exposure prophylaxis for men who have sex with men in Belgium: results of a prospective cohort measuring adherence, sexual behaviour and STI incidence. J Int AIDS Soc [Internet]. 2019. October 1 [cited 2020 Nov 30];22(10). Available from: /pmc/articles/PMC6819896/?report = abstract
    1. Zablotska IB, Vaccher SJ, Bloch M, Carr A, Foster R, Grulich A, et al. High Adherence to HIV Pre-exposure Prophylaxis and No HIV Seroconversions Despite High Levels of Risk Behaviour and STIs: The Australian Demonstration Study PrELUDE. AIDS Behav [Internet]. 2019. July 15 [cited 2020 Nov 30];23(7):1780–9. Available from: 10.1007/s10461-018-2290-3
    1. Keen P, Hammoud MA, Bourne A, Bavinton BR, Holt M, Vaccher S, et al. Use of HIV Pre-exposure Prophylaxis (PrEP) Associated With Lower HIV Anxiety Among Gay and Bisexual Men in Australia Who Are at High Risk of HIV Infection. JAIDS J Acquir Immune Defic Syndr [Internet]. 2020. February 1 [cited 2020 Jun 18];83(2):119–25. Available from:
    1. The EMIS Network. EMIS-2017 –The European Men-Who-Have-Sex-With-Men Internet Survey [Internet]. Stockholm; 2019 [cited 2019 Sep 6]. Available from:
    1. Spanish Working Group for PrEP. Guidelines for the implementation of PrEP proframs in Spain; 2020 Feb [Internet]. Available from:

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