Incorporation of PrEP into HIV prevention strategies completes seven years in SUS-DF

“It’s a lot of fear and a lot of shame too, because we are very oriented. In inconsistency, in madness, in drinking, in the midst of emotion, we end up becoming careless”, said general services assistant Fabiano Freire, 30, after being infected with a sexually transmitted infection (STI). Learning about public health services through friends, he went to the Specialized Center for Infectious Diseases (Cedin-DF), the former Hospital Dia located at 508 Sul, to receive care.

“Unfortunately, I didn’t take care of myself and ended up acquiring something that, thank God, is curable. And, even though it is inconsequential, we have such a good and pleasant environment to be welcomed, this is so important, being able to have a structure like this, access to a free quality service, where the employees provide very good service. Especially for those who, like me, don’t have the financial means. It’s bad if we get infected with something and don’t know where to go, because I don’t have a health plan that offers this service”, he added.

This service that welcomed Fabiano is part of a large assistance network. Among the health strategies offered by the public network in the Federal District is Pre-Exposure Prophylaxis (PrEP) for HIV (Human Immunodeficiency Virus), a measure that combats the virus that attacks the immune system and causes AIDS.

The prevention strategy is effective and safe in people at increased risk of acquiring the infection and consists of the use of antiretroviral (ARV) medications. Available free of charge in the public health network since 2018 in Brasília, PrEP completes seven years in the Unified Health System (SUS) and can currently be prescribed by any doctor or nurse in the DF.

Head of the Sexually Transmitted Infections Surveillance Management, Beatriz Maciel Luz explains that the function of PrEP and HIV Post-Exposure Prophylaxis (PEP) tablets is to block the pathways that HIV uses to infect the body. Since the start of distribution of this drug in 2018, there has been a reduction in new infections in the Federal District – from 735 new cases in 2018 to 674 in 2022.

“Since last year, the government has been expanding care and access to medicine, already released to some UBSs. Today, any health professional can prescribe PrEP in the DF and, in addition to other strategies, there is also inhibition of lactation for HIV-positive women, with the distribution of formula for children”, explains the manager. She emphasizes that, with the expansion of the program in 2023, new studies will be carried out to analyze the incidence of cases in the DF.

Access to medications

Both PrEP and strategic medications for patients with HIV are made available free of charge to the population by the Health Department of the Federal District, which, in partnership with the Ministry of Health, develops the HIV/Aids program.

To access medication, patients must meet the requirements established by the SUS and fit into the target audience, which encompasses certain population segments that, due to specific vulnerabilities, are at greater risk of becoming infected with HIV, in different social and contexts. types of epidemic.

The priority segments that are indicated for PrEP are people who frequently fail to use condoms during sexual intercourse, men who have sex with other men, trans people, sex workers, people who repeatedly use PEP and heterosexual or homosexual partnerships in which a of people is infected with HIV and the other is not.

The documents required to access the medicines are the SUS User Registration Form – PrEP and the PrEP Service Form. Access here.

Pickup Locations

Although the service and prescription can be carried out at any UBS, the withdrawal of medicines is carried out in specific places within the public network, namely: Farmácia Escola, Policlínicas do Lago Sul, Taguatinga and Ceilândia and also Cedin, which has a specialized PrEP outpatient clinic and is open on Wednesdays from 7:30 am to 11 am and from 1:30 pm to 5 pm.

Some UBSs are already part of the expansion of treatment, such as UBS 1 in Sobradinho, UBS 9 in São Sebastião, UBS do Gama, UBS 1 in Cruzeiro Novo, UBS 2 in Recanto das Emas, UBS 1 in Candangolândia and UBS 7 in Ceilândia.

Cedin manager, Leonardo de Sousa Ramos, states that there are vacancies open in the unit to serve the most vulnerable population. The manager also recalls that last week the Health Space was opened at the Plano Piloto Bus Station, which offers rapid testing and free self-test kits for the population.

“PrEP is not just a distribution of medication, it is an entire program that ranges from counseling to identifying the user’s risk. From this, we can provide guidance regarding the combination of medication, condoms, regular testing and other strategies. This is interesting so that people who are vulnerable and at risk of exposure seek the unit to prevent themselves”, highlighted Ramos.

Differences between PrEP and PEP

With PrEP being a preventive and planned strategy, PEP (HIV Post-Exposure Prophylaxis) works as an urgent prevention measure for HIV infection, viral hepatitis and other sexually transmitted infections (STIs), which consists of the use of medications to reduce the risk of acquiring these infections.

It should be used after any situation in which there is a risk of contagion, such as sexual violence, unprotected sexual intercourse (without the use of a condom or with a broken condom) or, even, an occupational accident (with sharp instruments or direct contact with biological material) .

As it is a medical emergency, it must be started as soon as possible – preferably within the first two hours after exposure and within 72 hours at most. The duration of PEP is 28 days and the person must be monitored by the healthcare team.

To access the medications, the patient must undergo a medical consultation at an emergency service so that the doctor can assess whether or not there is a need to start PEP. If the need is determined, the doctor must fill out the Medication Request Form – Prophylaxis and the medications will be dispensed in the hospitals and UPAS that are part of the SES DF network. It is also recommended to evaluate every patient with risky sexual exposure to HIV for a possible episode of acute infection with hepatitis A, B and C viruses.

In the case of an occupational accident (with sharp instruments or direct contact with biological material), the injured worker must be treated immediately at their workplace, in accordance with the Clinical Protocol and Therapeutic Guidelines for Post-Exposure Prophylaxis (PEP) of Risk to HIV infection, STI and Viral Hepatitis (BRASIL, 2018) and in compliance with Regulatory Standard No. 7 (BRASIL, 1978).

PEP is available at Cedin (formerly Hospital Dia); at the School Pharmacy of the Brasília University Hospital (HUB); at the Polyclinics of Taguatinga, Ceilândia, Gama, Planaltina and Lago Sul; in the emergency rooms of hospitals that are part of the SES-DF network; in emergency care units (UPAs) and basic health units (UBSs).

To access PEP medicines, it is necessary to present an identification document with a photo, the National Health Card – CNS (SUS card) and the Medicine Request Form – Prophylaxis.

Different strategies

It is important to reinforce that PrEP and PEP are part of combined HIV prevention strategies. The set of tools for preventing this and other sexually transmitted infections (STIs) also includes:

→ HIV testing offered in public health units;
→ Regular use of condoms (which are distributed free of charge);
→ Timely diagnosis and adequate treatment of sexually transmitted infections (STIs);
→ Damage reduction and vulnerability management;
→ Suppression of viral replication by antiretroviral treatment;
→ Immunizations against viral hepatitis.

Cedin also houses the Brasília Testing and Counseling Center (CTA), which operates on spontaneous demand or by appointment. According to the nurse at the PrEP outpatient clinic and the unit’s CTA, Leidijany Paz, every year more than a thousand people are diagnosed with HIV in the DF.

“That number didn’t need to be so high. People often arrive here worried and anxious due to unprotected sexual exposure or some STI symptoms. Then she undergoes the collection of exams, consultation with a professional who prescribes the treatment and she will certainly leave feeling calmer and more oriented”, she observes.

The nurse also points out that the unit offers counseling in this area, where the vulnerability that the person has is identified and guides which prevention strategies they may be using in their daily lives to prevent themselves.

“It is a very important service, both for me and for others, because we come here, we are well attended to, the exam is quick and we already have the results. I have diabetes, I am depressed and, in addition to taking the HIV test, I follow up with the doctors and receive my treatment correctly. We can only be grateful for the SUS”, highlights retired Carlos Antônio de Lima, 59 years old.