On-Demand PrEP: Clinical Report of Pharmaceutical Care in HIV Pre-Exposure Prophylaxis
DOI:
https://doi.org/10.26694/repis.v9i1.4300Palavras-chave:
Pre-Exposure Prophylaxis, HIV, Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination, Pharmaceutical ServicesResumo
Introduction: Pre-Exposure Prophylaxis (PrEP) for HIV involves the combined use of antiretrovirals for individuals frequently exposed to HIV. Initially implemented in Brazil in 2018 with a daily dosing regimen of one pill, on-demand usage was recently (2022) incorporated into routine practice. Aim: To report the experience of providing pharmaceutical care to an on-demand PrEP patient in an outpatient pharmacy within Brazil's Unified Health System. Outlining: This experience report details of pharmaceutical care that included reception of the patient, conducting anamnesis, legally and technically prescription evaluation, dispensing PrEP with verbal guidance on potential adverse events related to pharmacotherapy, and scheduling a return visit to the service. Results: The patient was initially prescribed a daily regimen of PrEP. During the first return consultation, 30 days after starting PrEP, the patient reported adverse effects related to the gastrointestinal tract, leading to the recommendation of an on-demand PrEP regimen. Implications: As of the last pharmaceutical consultation (June 21, 2022), the patient maintained a negative HIV serology, was accustomed to the newly prescribed dosage, and reported reduced gastric discomfort associated with the use of on-demand PrEP. This facilitated adherence to pharmacotherapy and improved the preventive efficacy against HIV infection.
Referências
Ministério da Saúde (BR). Protocolo Clínico e Diretrizes Terapêuticas para Profilaxia Pré-Exposição (PrEP) de Risco à Infecção pelo HIV — Departamento de HIV/Aids, Tuberculose, Hepatites Virais e Infecções Sexualmente Transmissíveis [Internet]. 2018 [cited 2023 Mar 29]. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/protocolo_clinico_diretrizes_terapeuticas_profilaxia_pre_exposicao_risco_infeccao_hiv.pdf
Ministério da Saúde (BR). Protocolo Clínico e Diretrizes Terapêuticas para Profilaxia Pré-Exposição (PrEP) de Risco à Infecção pelo HIV — Departamento de HIV/Aids, Tuberculose, Hepatites Virais e Infecções Sexualmente Transmissíveis [Internet]. 2022 [cited 2023 Mar 29]. Available from: https://www.gov.br/aids/pt-br/centrais-de-conteudo/pcdts/2017/hiv-aids/pcdt-prep-versao-eletronica-22_09_2022.pdf/view
Ministério da Saúde (BR). Boletim Epidemiológico - HIV/Aids. Departamento de HIV/Aids, Tuberculose, Hepatites Virais e Infecções Sexualmente Transmissíveis [Internet].2022 [cited 2023 Mar 29]. Available from: https://www.gov.br/aids/pt-br/centrais-de-conteudo/boletins-epidemiologicos/2022/hiv-aids/boletim_hiv_aids_-2022_internet_31-01-23.pdf/view
Ministério da Saúde (BR). Secretaria de Vigilância em Saúde, Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis. Nota técnica Nº 563/2022-CGAHV/DCCI/SVS/MS [Internet]. 1 ed. Brasília: MS; 2022. [cited 2023 Mar 29]. Available from: http://azt.aids.gov.br/documentos/SEI_MS%20-%200030684487%20-%20Nota%20T%C3%A9cnica%20563.2022.pdf
US Public Health Service. Preexposure Prophylaxis for the Prevention of HIV Infection in the United States - 2021 Update: Clinical Providers’ Supplement [Internet]. US Department of Health and Human Services; 2021 [cited 2022 Apr 1]. Available from: https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2021.pdf
PrEP (Profilaxia Pré-Exposição) [Internet]. Departamento de HIV/Aids, Tuberculose, Hepatites Virais e Infecções Sexualmente Transmissíveis. 2023 [cited 2023 Mar 29]. Available from: https://www.gov.br/aids/pt-br/assuntos/prevencao-combinada/prep-profilaxia-pre-exposicao/prep-profilaxia-pre-exposicao
Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Ofício Circular nº 48/2023/SVSA [Internet]. 1 ed. Brasília: MS; 2023. [cited 2023 Mar 29]. Available from: http://azt.aids.gov.br/documentos/PREP%20PEP%20MS%20Of%20Circ%2048.2023.pdf
Myers JE, Farhat D, Guzman A, Arya V. Pharmacists in HIV Prevention: An Untapped Potential. Am J Public Health [Internet]. 2019 [cited 2023 Mar 29];109(6):859-861. Available from: https://doi.org/10.2105/AJPH.2019.305057
Lutz S, Heberling M, Goodlet KJ. Patient perspectives of pharmacists prescribing HIV pre-exposure prophylaxis: A survey of patients receiving antiretroviral therapy. J Am Pharm Assoc [Internet]. 2021 Mar [cited 2023 Mar 29];61(2):75–9. Available from: https://doi.org/10.1016/j.japh.2020.09.020
Lal L, Ryan K, Liu IY, Price B, Lockwood T, Aguirre I, et al. Transformation of Australian Community Pharmacies Into Good Clinical Practice Compliant Trial Pharmacies for HIV Pre-Exposure Prophylaxis. Front Pharmacol. [Internet]. 2019 Nov [cited 2023 Apr 1];10(1):1-12. Available from: https://doi.org/10.3389/fphar.2019.01269
Farmer EK, Koren DE, Cha A, Grossman K, Cates DW. The pharmacist's expanding role in HIV pre-exposure prophylaxis. AIDS Patient Care STDS [Internet]. 2019 [cited 2023 Apr 1];33(5):207-13. Available from: https://doi.org/10.1089/apc.2018.0294
Hill LA, Ballard C, Cachay ER. The Role of the Clinical Pharmacist in the Management of People Living with HIV in the Modern Antiretroviral Era. AIDS Reviews [Internet]. 2019 [cited 2023 Apr 1];21(4):195-210. Available from: https://doi.org/10.24875/aidsrev.19000089
Ministério da Saúde (BR). Boletim Epidemiológico - HIV/Aids. Departamento de HIV/Aids, Tuberculose, Hepatites Virais e Infecções Sexualmente Transmissíveis [Internet].2022 [cited 2023 Mar 29]. Available from: https://www.gov.br/aids/pt-br/centrais-de-conteudo/boletins-epidemiologicos/2022/hiv-aids/boletim_hiv_aids_-2022_internet_31-01-23.pdf/view
Molina JM, Charreau I, Spire B, Cotte L, Chas J, Capitant C, et al. Efficacy, safety, and effect on sexual behaviour of on-demand pre-exposure prophylaxis for HIV in men who have sex with men: an observational cohort study. Lancet HIV [Internet]. 2017 Sep [cited 2023 Mar 29];4(9):402-10. Available from: https://doi.org/10.1016/S2352-3018(17)30089-9
Fernandes JD. Revisão bibliográfica sobre a análise de custo-efetividade da profilaxia pré-exposição ao HIV (PrEP) sob demanda e as contribuições do profissional farmacêutico. UFRN; 2021 [cited 2023 Mar 29]; Available from: https://repositorio.ufrn.br/handle/123456789/48310
Ministério da Saúde (BR). Entricitabina + Fumarato de Tenofovir Desoproxila [package insert]. FIOCRUZ, RJ: Fundação Oswaldo Cruz/Instituto de Tecnologia em Fármacos (Farmanguinhos). ANVISA; 2022. [cited 2023 Mar 29]. Available from: https://consultas.anvisa.gov.br/#/medicamentos/25351316550201826/
