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Introduction: The efficacy of pre-exposure prophylaxis (PrEP) in preventing sexual acquisition of human immunodeficiency virus (HIV) is well established. Little is known about the feasibility of PrEP implementation in middle-income settings with concentrated epidemics among men who have sex with men (MSM) and transgender women (TGW).Methods: PrEP Brasil is a prospective, multicentre, open-label demonstration project assessing PrEP delivery in the context of the Brazilian Public Health System. HIV-uninfected MSM and TGW in 3 referral centres in Rio de Janeiro and São Paulo were evaluated for eligibility and offered 48 weeks of daily emtricitabine/tenofovir for PrEP. Concentrations of tenofovir diphosphate in dried blood spot samples (DBS) at week 4 after enrolment (early adherence) were measured. Predictors of drug levels were assessed using ordinal logistic regression models considering the DBS drug level as a 3 level variable (<350 fmol/punch, ≥350–699 fmol/punch and ≥700 fmol/punch).Results: 1,270 individuals were assessed for participation; n = 738 were potentially eligible and n = 450 were offered PrEP (PrEP uptake was 60.9%). Eligible but not enrolled individuals were younger, had lower HIV risk perception and had lower PrEP awareness. At week 4, 424 participants (of the 450 enrolled) had DBS TFV-DP concentrations, 94.1% in the protective range (≥350 fmol/punch, consistent with ≥2 pills per week), and 78% were in the highly protective range (≥700 fmol/punch, ≥4 pills per week). Participants with ≥12 years of schooling had 1.9 times the odds (95%CI 1.10–3.29) of a higher versus lower drug level than participants with <12 years of schooling. Condomless receptive anal intercourse in the prior 3 months was also associated with higher drug levels (adjusted OR = 1.78; 95% CI 1.08–2.94).Conclusions: The high uptake and early adherence indicate that PrEP for high-risk MSM and TGW can be successfully delivered in the context of the Brazilian Public Health System. Interventions to address disparities on PrEP awareness and HIV risk perception among the younger and less educated are urgently needed in order to maximize the impact of this prevention strategy on the reduction of HIV infection among MSM and TGW in Brazil.

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ResumenAunque la participación es un concepto consensual, todavía permanece ambiguo. Una manera de hacer las intervenciones participativas más justas y basadas en la realidad es utilizando el análisis de la actividad. El Proyecto Matriosca es un ejemplo de una intervención participativa en la cual la utilización del análisis de la actividad por los consultores que condujeran la intervención, fue esencial. Esta intervención, enfocada en el incremento de la seguridad y salud en el trabajo, fue implementada en una empresa del sector químico y ha tenido un impacto visible y reconocido por los participantes. A pesar de la intención de seguir con el proceso internamente y de, incluso, haber sido definido un procedimiento organizacional para ello, no queda claro que ese objetivo se haya logrado. La discusión de este caso culmina con una reflexión sobre la importancia del análisis de la actividad y del recurso a profesionales que la dominen, además de otras condiciones metodológicas, contextuales y estratégicas que deberían ser consideradas en la concepción y análisis de este tipo de intervenciones. Palabras claveAnálisis de la actividad, Participación, Matriosca, Aprendizaje en la acción, Sostenibilidad. Pesquisa EmpíricaAnálise da atividade, participação e sustentabilidade da ação transformadora: reflexões a partir do Projeto Matriosca.

We found no statistically significant differences in serological response to treatment with doxycycline or benzathine penicillin among HIV-infected patients with early, late latent or latent syphilis of unknown duration. Our findings suggest that doxycycline is an acceptable treatment to HIV-infected patients with nontertiary stages of syphilis.

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