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Acesso dos doentes à profilaxia de pré-exposição (PrEP) para o VIH na Europa
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Resumo(s)
A profilaxia de pré-exposição (PrEP) para o Vírus da Imunodeficiência Humana (VIH) consiste na toma de medicamentos antirretrovirais por parte de pessoas não infetadas, para prevenir a sua infeção. Neste sentido, a PrEP tem demonstrado potencial para reduzir a pandemia de VIH, quando usada como parte de uma estratégia combinada de prevenção de saúde pública, onde estarão também incluídas outras medidas como a testagem precoce ao VIH, o acesso a cuidados de saúde, a disponibilização de preservativos ou o acompanhamento físico, psicológico, médico e social a pessoas com resultado positivo para o VIH. Contudo, o acesso a este tratamento profilático é limitado e com várias desigualdades existentes entre as distintas regiões do globo. A adoção de medidas que produzam uma mitigação de tais iniquidades de acesso é assim imperiosa, podendo ter um papel fundamental no combate à epidemia global do VIH. Com a presente dissertação pretendeu-se assim analisar o estado da implementação e o acesso à terapêutica nos diferentes países da região europeia, por forma a identificar os atuais modelos de acesso e as suas principais limitações. Ao conhecer as principais limitações de cada modelo de acesso, é assim possível propor eventuais oportunidades de melhoria, com o intuito de promover um acesso mais abrangente e com menos iniquidades. Neste âmbito verificou-se que ainda existe um longo caminho a percorrer: a terapêutica PrEP está numa fase precoce da sua implementação, com apenas uma associação medicamentosa a deter o aval do regulador europeu para poder ser administrado com este intuito. A complexidade e as particularidades inerentes à terapêutica têm culminado numa implementação da PrEP a diferentes velocidades nos países abordados: existem países onde a terapêutica assenta já num sistema robusto, onde a PrEP está acessível às populações de maior necessidade e existem outros países onde a mesma não está formalmente implementada. A promoção de alterações aos modelos de acesso atuais é assim urgente, por forma a fazer da PrEP mais uma ferramenta útil para contrariar a disseminação da infeção por VIH.
Pre-exposure prophylaxis (PrEP) against the infection with Human Immunodeficiency Virus (HIV) is based on the uptake of antiretroviral medicines by individuals with a negative status for HIV. In this field, PrEP has been demonstrating the potential to reduce the HIV pandemic, principally when it is included in a combined strategy of public health, where other measures are also incorporated such as HIV early testing, access to healthcare, distribution of condoms or the important follow-up and care for HIV-positive individuals. Nevertheless, the access to this prophylactic treatment is limited and presents several inequalities across the globe. The adoption of measures with the purpose of mitigate such inequalities is of extreme importance and might have a crucial role in the fight against the global epidemic of HIV. The present dissertation had as a principal objective to verify the implementation status of PrEP and the access to the therapeutic across the European region, to identify the models of access in place and its main limitations. By knowing the principal limitations of each model, it is possible to propose changes for betterment, with the purpose of promoting a wider and fair access to the therapeutic. It was possible to conclude that there is still much path ahead: PrEP is at an early phase of its implementation, with only one medicine (an association of two active substances) with the approval of the European regulatory body to be administrated with this purpose. The complexity and particularities inherent to the therapeutic are leading to an implementation of PrEP significantly different across the analyzed countries: there are countries where PrEP is already available to the populations in need, through a robust system, and there are also some other countries where the therapeutic is not implemented yet. Changes to the actual models of access are imperious and necessary to deem PrEP as another useful tool to fight against the spreading of the HIV infection.
Pre-exposure prophylaxis (PrEP) against the infection with Human Immunodeficiency Virus (HIV) is based on the uptake of antiretroviral medicines by individuals with a negative status for HIV. In this field, PrEP has been demonstrating the potential to reduce the HIV pandemic, principally when it is included in a combined strategy of public health, where other measures are also incorporated such as HIV early testing, access to healthcare, distribution of condoms or the important follow-up and care for HIV-positive individuals. Nevertheless, the access to this prophylactic treatment is limited and presents several inequalities across the globe. The adoption of measures with the purpose of mitigate such inequalities is of extreme importance and might have a crucial role in the fight against the global epidemic of HIV. The present dissertation had as a principal objective to verify the implementation status of PrEP and the access to the therapeutic across the European region, to identify the models of access in place and its main limitations. By knowing the principal limitations of each model, it is possible to propose changes for betterment, with the purpose of promoting a wider and fair access to the therapeutic. It was possible to conclude that there is still much path ahead: PrEP is at an early phase of its implementation, with only one medicine (an association of two active substances) with the approval of the European regulatory body to be administrated with this purpose. The complexity and particularities inherent to the therapeutic are leading to an implementation of PrEP significantly different across the analyzed countries: there are countries where PrEP is already available to the populations in need, through a robust system, and there are also some other countries where the therapeutic is not implemented yet. Changes to the actual models of access are imperious and necessary to deem PrEP as another useful tool to fight against the spreading of the HIV infection.
Descrição
Tese de mestrado, Regulação e Avaliação do Medicamento e Produtos de Saúde, 2022, Universidade de Lisboa, Faculdade de Farmácia.
Palavras-chave
PrEP VIH Acesso Europa Implementação Teses de mestrado - 2022