{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T19:55:20Z","timestamp":1780689320357,"version":"3.54.1"},"reference-count":28,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2023,9,27]],"date-time":"2023-09-27T00:00:00Z","timestamp":1695772800000},"content-version":"vor","delay-in-days":26,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Pre\u2010exposure prophylaxis (PrEP) delivery based on user needs can enhance PrEP access and impact. We examined whether telehealth for daily oral PrEP delivery could change the indicators of care related to prophylactic use in five Brazilian public HIV clinics (testing centres, outpatient clinics and infectious disease hospitals).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Between July 2019 and December 2020, clients on PrEP for at least 6 months could transition to telehealth or stay with in\u2010person follow\u2010up. Clients were clinically monitored until June 2021. A desktop or mobile application was developed, comprising three asynchronous consultations and one annual in\u2010person consultation visit. Predictors influencing telehealth preference and care outcomes were examined. The analysis encompassed intent\u2010to\u2010treat (first choice) and adjustments for sexual practices, schooling, age, duration of PrEP use and PrEP status during the choice period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 470 users, 52% chose telehealth, with the adjusted odds ratio (aOR) increasing over time for PrEP use (aOR for 25\u2013months of use: 4.90; 95% CI: 1.32\u201318.25), having discontinued PrEP at the time of the choice (aOR: 2.91; 95% CI: 1.40\u20136.06) and having health insurance (aOR: 1.91; 95% CI: 1.24\u20132.94) and decreasing for those who reported higher\u2010risk behaviour (aOR for unprotected anal sex: 0.51; 95% CI: 0.29\u20130.88). After an average follow\u2010up period of 1.6 years (95% CI: 1.5\u20131.7), the risk of discontinuing PrEP (not having the medication for more than 90 days) was 34% lower with telehealth (adjusted hazard ratio: 0.66; 95% CI: 0.45\u20130.97). When adjusted by mixed linear regression, no differences in adherence (measured by mean medication possession rate) were found between in\u2010person and telehealth (<jats:italic>p<\/jats:italic> = 0.486) or at pre\u2010 and post\u2010telehealth follow\u2010ups (<jats:italic>p<\/jats:italic> = 0.245). Sexually transmitted infections increased between the pre\u2010follow\u2010up and post\u2010follow\u2010up choices and were not associated with in\u2010person or telehealth (<jats:italic>p<\/jats:italic> = 0.528). No HIV infections were observed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our findings indicate that telehealth for PrEP delivery can enhance service rationalization and reinforce the prevention cascade. This approach reduces prophylaxis interruptions and is mainly preferred by individuals with lower demands for healthcare services.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26173","type":"journal-article","created":{"date-parts":[[2023,9,28]],"date-time":"2023-09-28T06:09:14Z","timestamp":1695881354000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Telehealth effectiveness for pre\u2010exposure prophylaxis delivery in Brazilian public services: the Combine! Study"],"prefix":"10.1002","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5157-0597","authenticated-orcid":false,"given":"Alexandre","family":"Grangeiro","sequence":"first","affiliation":[{"name":"Faculdade de Medicina Universidade de S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorruan Alves do","family":"Santos","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina Universidade de S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denize Lotufo","family":"Estevam","sequence":"additional","affiliation":[{"name":"Centro de Refer\u00eancia e Treinamento DST\/Aids  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosemeire","family":"Munhoz","sequence":"additional","affiliation":[{"name":"Centro de Refer\u00eancia e Treinamento DST\/Aids  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c9rico","family":"Arruda","sequence":"additional","affiliation":[{"name":"Hospital S\u00e3o Jos\u00e9 de Doen\u00e7as Infecciosas  Fortaleza Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renata Amaral","family":"de Moraes","sequence":"additional","affiliation":[{"name":"Hospital S\u00e3o Jos\u00e9 de Doen\u00e7as Infecciosas  Fortaleza Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisiane","family":"de Quadros Winkler","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Aten\u00e7\u00e3o Especializada do Centro de Sa\u00fade IAPI  Porto Alegre Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lis Aparecida de Souza","family":"Neves","sequence":"additional","affiliation":[{"name":"Prefeitura Municipal de Ribeir\u00e3o Preto, Ribeir\u00e3o Preto  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliane Cardoso Villela","family":"Santos","sequence":"additional","affiliation":[{"name":"Centro de Orienta\u00e7\u00e3o e Aconselhamento  Curitiba Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariele","family":"Kruppa","sequence":"additional","affiliation":[{"name":"Centro de Orienta\u00e7\u00e3o e Aconselhamento  Curitiba Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eliana Miura","family":"Zucchi","sequence":"additional","affiliation":[{"name":"Programa de P\u00f3s\u2010Gradua\u00e7\u00e3o em Sa\u00fade Coletiva Universidade Catolica de Santos  Santos S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Mercedes","family":"Escuder","sequence":"additional","affiliation":[{"name":"Instituto de Sa\u00fade Secretaria de Estado da Sa\u00fade de S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9a Fachel","family":"Leal","sequence":"additional","affiliation":[{"name":"Instituto de Filosofia e Ci\u00eancias Humanas Universidade Federal do Rio Grande do Sul  Porto Alegre Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitti Ayako Hara","family":"Koyama","sequence":"additional","affiliation":[{"name":"Kamiyama Consultoria em Estat\u00edstica Ltda  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Fernanda Tourinho","family":"Peres","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina Universidade de S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcia Thereza","family":"Couto","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina Universidade de S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Eluf","family":"Neto","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina Universidade de S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"The Combine! 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