Fiocruz coordena estudo sobre Profilaxia Pré-Exposição ao HIV
A implementação do estudo sobre Profilaxia Pré-Exposição (PrEP) na América Latina é objeto da mais nova parceria coordenada pelo Instituto Nacional de Infectologia Evandro Chagas (INI/Fiocruz), através do Laboratório de Pesquisa Clínica em DST/Aids (LaPClin-Aids). O projeto reúne instituições de saúde do Brasil, do México e do Peru e estuda o uso da truvada – combinação dos medicamentos tenofovir e emtricitabina em um único comprimido – como forma de prevenir a infecção por HIV em populações com risco considerável, como os homens que fazem sexo com homens (MSM), travestis e mulheres transexuais (TGW).
O estudo é fruto de um esforço conjunto do Ministério da Saúde brasileiro e da Fiocruz e prevê o desenvolvimento de políticas públicas e posterior disponibilização do medicamento visando reduzir o contágio pelo vírus HIV nos respectivos países. A iniciativa conta com financiamento da Unitaid, e apoio técnico da Fiotec.
O projeto foi apresentado e discutido durante um encontro de quatro dias realizado no INI/Fiocruz, de 23 a 26 de janeiro, onde diversos pesquisadores e profissionais envolvidos com estudos sobre HIV/Aids acertaram os pontos finais da parceria. No primeiro dia de atividades, no Auditório do Pavilhão de Ensino do Instituto, a pesquisadora do LaPClin-Aids, Valdiléa Veloso, coordenou a reunião onde foram apresentados os objetivos e metas da parceria tríplice entre Brasil, México e Peru.
Para o gerente geral da Fiotec, Adilson Gomes dos Santos, é positivo para todos reunir os agentes envolvidos no estudo que estão preocupados em resolver problemas de Saúde Pública nos seus respectivos países, comprovando assim o comprometimento de todos na luta contra o HIV. Já a representante da Unitaid, Judith Polzky, destacou o pioneirismo brasileiro em adotar a PrEP através dos estudos desenvolvidos no INI, auxiliando assim a Organização Mundial de Saúde na multiplicação dos resultados obtidos a outros países.
Já Giovanni Ravasi, da Organização Pan-americana de Saúde, afirmou que a parceria é fundamental para as novas estratégias de adoção da PrEP no combate a essa doença crítica para a saúde pública. Por fim, a diretora do Departamento de DST, Aids e Hepatites Virais do Ministério da Saúde, Adele Benzaken, citou o Brasil como exemplo no tratamento para todos os pacientes com HIV/aids e lembrou que o MS está trabalhando intensamente para a implementação efetiva da PrEP, aguardando apenas os trâmites técnicos para tal, o que deve ocorrer ainda esse ano.
Desenvolvimento do projeto
Coube a Valdiléa Veloso, pesquisadora do INI/Fiocruz, apresentar os objetivos e a estrutura do projeto, explicando os determinantes estruturais, programáticos e individuais que contribuem para as altas taxas de prevalência do HIV entre homens que fazem sexo com homens (MSM) e travestis e mulheres transexuais (TGW). Nos países que integram o estudo a prevalência de HIV é: MSM – Brasil (14,2%), México (16,9%) e Peru (12,4%). No caso das TGW – Brasil (33,1%), México (20%) e Peru (30%).
“O projeto abordará áreas estratégicas, visando fornecer as informações identificadas nos programas públicos desses países para sanar brechas estratégicas que dificultam o escalonamento dos planos, servindo como um catalisador para a preparação da implantação efetiva da PrEP”, explicou Valdiléa. A pesquisadora lembrou ainda que até dezembro de 2016, nenhum país da América Latina havia implementado a PrEP como uma política pública de saúde.
Ao todo, 19 cidades foram incluídas no estudo: oito no Brasil (São Paulo, Rio de Janeiro, Porto Alegre, Curitiba. Florianópolis, Recife, Manaus e Brasília), cinco no México (Cidade do México, Guadalajara, Puerto Vallarta, Oaxzaca e Juchitan) e seis no Peru (Lima/Callao – província que concentra 71% dos casos de Aids do país), Iquitos, Pucallpa, Tarapoto, Chiclayo e Trujillo.
“Nosso principal objetivo é contribuir para reduzir a incidência de HIV nessas populações específicas através da PrEP como um componente do serviço de saúde local”, disse. A expectativa é que participem do estudo 7.500 pessoas dos três países ao longo de três anos.
Perspectivas para Peru e México
O Peru enfrenta uma série de questões quanto à prevenção do HIV, relatou Carlos Cáceres, da Universidad Peruana Cayetano Heredia (UPCH), entre elas a queda no uso do preservativo, a pouca frequência na realização de exames de HIV/Aids, a barreira no acesso ao início do tratamento e o alto estigma da doença. O fortalecimento da estratégia geral de prevenção e incremento da cobertura PrEP, a partir da incorporação de novas tecnologias, o desenvolvimento do conceito de prevenção combinada, o maior potencial para abordar, de forma efetiva, a epidemia nessas populações (MSM e TGW), e a identificação de critérios para fortalecer o conhecimento e a capacidade das equipes de saúde em sua relação com a prevenção combinada e a PrEP são algumas das metas esperadas pelo representante peruano com essa parceria.
Já Hamid Vegas, da Clínica Especializada Condesa, do México, espera aproveitar as evidencias positivas do uso da PrEP no Brasil para incorpora-las no sistema de saúde mexicano, além de mudar o conceito e as propriedades de investimentos nessa área e promover a integração das diretrizes nacionais de diagnóstico e tratamento do HIV. O representante mexicano lembrou que no país a utilização da medicação é feita apenas para tratamento, não para prevenção da doença, e espera mudar esse conceito com o estudo.
Sobre a medicação da PrEP
O medicamento deve ser tomado diariamente fazendo com que o usuário desenvolva uma espécie de “barreia imunológica” contra o vírus HIV, oferecendo proteção ao manter relações sexuais. Entretanto, quem adotar a medicação não deverá abrir mão do uso da camisinha. A PrEP é uma recomendação da Organização Mundial da Saúde (OMS) mas é adotada apenas para o tratamento e não prevenção à doença em diversos países.
INI/Fiocruz, por Antonio Fuchs
Fonte: AFN
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