Telemedicine was the strategy adopted by the Clinical Research Laboratory on STDs and AIDS of the Evandro Chagas National Infectology Institute, INI/Oswaldo Cruz Foundation, Fiocruz to continue the programs of Pre-Exposure Prophylaxis ( Profilaxia Pré-exposição, PrEP) to HIV during the Covid-19 pandemic. The Infectologist and Researcher at the Institute, Brenda Hoagland, reported that about 1,600 people currently use PrEP in some of the programs offered by Fiocruz (Brazilian Universal Care System, SUS or the Project for the Implementation of Pre-exposure Prophylaxis, Care, ImPreP) and that it involved two stages in order to implement telemedicine care: one semi-presential and one virtual.

Telemedicine consists in the use of technological devices (especially mobiles) to enable consultations between doctors and patients in different places, without the need for displacement. It was implemented by the Laboratory team in March this year (2020), shortly after the onset of the new coronavirus pandemic. “For the semi-presential visit, on the day prior, the user receives a telephone call where a questionnaire is applied to assess whether he or she presents signs or symptoms of Covid-19. Those who do not have complaints have their visit confirmed at the service unit. The appointment is postponed for those who present symptoms, and the person still receives guidance on the need for quarantine. Those who attend the service, before performing any procedure, are assessed again for Covid-19 symptoms and have their body temperature measured by a screening nurse. Symptomatic patients have their appointment canceled and receive clinical guidance; asymptomatic patients move on to collect the rapid HIV test sample,” Brenda explained.

While awaiting the test result, in the external tent of the service unit, these users receive a telephone call from the adviser who makes the evaluation of PrEP monitoring, which includes, among other matters, adherence and presence for adverse events. Upon receiving negative results from the HIV test, he or she receives, by phone, a photo of the PrEP prescription to collect in the pharmacy, along with two HIV self-test kits, which will be used in the future for the virtual visit.

“We have to point out that the amount of tablets offered has increased. We went from 90 to 120 in order to reduce the need for more visits to our research center at Fiocruz campus. The same goes for the provision of self-tests, everything to increasingly preserve the safety of our user,” the Researcher said. Users who are eventually diagnosed with HIV have an on-site visit with the physician and anti-retroviral therapy is started on the same day.

According to Brenda, “the follow-up telemedicine appointments will remain as long as the isolation measures for Covid-19 are in place. In addition, health professionals are available at all times between telemedicine appointments to answer questions regarding PrEP.” It is important to emphasize that at any stage of care, participants who present symptoms of Covid-19 have their visit canceled and, at the end of their isolation, whenever the symptoms subside, telemedicine appointments are scheduled again.