Integration of Teleprep in a Municipality in Southern Brazil Within the National Telehealth Strategy for Combined Hiv/AIds Prevention

The HIV/AIDS epidemic in Brazil, with approximately 1 million people living with the virus, remains a public health challenge, aggravated by socioeconomic and racial inequalities and stigma. Strategies such as PrEP and PEP face access barriers, especially among key and priority populations. Telehealth regulation emerges as an innovation to overcome these barriers, aligned with the PrEP:HIV ratio (numerator: PrEP users; denominator: new HIV cases). Municipalities with a ratio ≥3 show declines in HIV incidence, indicating that PrEP expansion combined with robust prevention networks is strategic. Analytical-descriptive study using data from the Ministry of Health’s PrEP Monitoring Panel, analyzing the user profile in a municipality in southern Brazil. Active users were defined as those with at least one dispensation in the last 12 months; “on PrEP” as those with valid dispensation; and “discontinued” as those without dispensation during the period. Between January 2019 and April 2025, 614 people initiated PrEP in the municipality, with 376 active users (67% on PrEP; 33% discontinued). Of these, 74.2% were cisgender gay/bisexual men, 78% White, 40.1% aged 30–39 years, and with high educational level (69% ≥12 years of schooling). In 2024, discontinuation was highest among Black users (80%), young people (<18 years 67%; 18–24 years 46%), and trans women (40%). TelePrEP nearly tripled the number of new active users since April 2025 compared with the same period in 2024 (46 vs. 19), increasing the local PrEP:HIV ratio from 2.62 to 3.75 (225:60) in the first half of 2025. The predominance of cisgender gay/bisexual men reflects the focus on key populations, but underrepresentation of Black and trans people highlights equity gaps. High discontinuation among young, Black, and trans users points to access barriers such as stigma and insufficient welcoming. TelePrEP, by offering teleconsultations and remote follow-up, seeks to mitigate these challenges, raising the local ratio to impactful levels in line with Ministry of Health targets. TelePrEP exemplifies how telehealth consolidates not only as an access tool but also as a pillar of social justice in addressing HIV. Achieving the goal of increasing PrEP users by 142% by 2027 will require replication of similar initiatives integrating technology, equity, and continuous monitoring.