Complementary Recruitment Strategies to Reach Men Who Have Sex with Men and Transgender Women: The Experience of a Large Brazilian HIV Prevention Service

Bezerra, Daniel C.; Jalil, Cristina Moreira; Jalil, Emilia Moreira; Coelho, Lara E.; Carvalheira, Eduardo; Freitas, J. P. de; Monteiro, Laylla; Santos, Toni; Souza, Cleo; Hoagland, Brenda; Veloso, Valdiléa G.; Grinsztejn, Beatriz; Cardoso, Sandra Wagner; Torres, Thiago Silva

doi:10.1007/s10461-022-03609-5

Cited by 13 publications

(13 citation statements)

References 28 publications

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“… 18 , 22 , 25 Alternative approaches to recruit and retain young populations in PrEP services should be explored, such as using new social media platforms (eg, TikTok), engaging them in development of digital campaigns, use of appropriate language, and having digital influencers to better communicate with these groups. 27 …”

Section: Discussionmentioning

confidence: 99%

Same-day initiation of oral pre-exposure prophylaxis among gay, bisexual, and other cisgender men who have sex with men and transgender women in Brazil, Mexico, and Peru (ImPrEP): a prospective, single-arm, open-label, multicentre implementation study

et al. 2023

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Section: Discussionmentioning

confidence: 99%

Same-day initiation of oral pre-exposure prophylaxis among gay, bisexual, and other cisgender men who have sex with men and transgender women in Brazil, Mexico, and Peru (ImPrEP): a prospective, single-arm, open-label, multicentre implementation study

et al. 2023

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“…Our findings on long‐term PrEP engagement reflect the difficulties that TGW face to remain engaged in services. Efforts should be taken to retain TGW, including support to their existing social networks [ 36 , 58 , 59 ] and building on the experience of TGW who do return for follow‐up visits. TGW remain highly marginalized, as evidenced by the rates of transphobia in Latin America.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with long‐term HIV pre‐exposure prophylaxis engagement and adherence among transgender women in Brazil, Mexico and Peru: results from the ImPrEP study

et al. 2022

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Introduction The HIV epidemic continues to disproportionately impact Latin‐American transgender women (TGW). We assessed factors associated with long‐term pre‐exposure prophylaxis (PrEP) engagement and adherence among TGW enrolled in the Implementation of PrEP (ImPrEP) study, the largest PrEP demonstration study in Latin America. Methods HIV‐negative TGW aged ≥18 years reporting 1+eligibility criteria in the 6 months prior to enrolment (e.g. sex partner known to be living with HIV, condomless anal sex [CAS], transactional sex or having a sexually transmitted infection [STI]) who could safely take PrEP were enrolled. Follow‐up visits were conducted at 4 weeks and then quarterly. We conducted logistic regression to identify factors associated with long‐term PrEP engagement (3+ follow‐up visits in 52 weeks) and complete self‐reported adherence (no missed pills in the past 30 days) during follow‐up. For both outcomes, we constructed multivariable models controlling for country, socio‐demographics, sexual behaviour, substance use, STIs and self‐reported adherence at 4 weeks (long‐term engagement outcome only). Results From March 2018 to June 2021, ImPrEP screened 519 TGW, enrolled 494 (Brazil: 190, Mexico: 66 and Peru: 238) and followed them for 52 weeks. At baseline, 27.5% of TGW were aged 18–24 years, 67.8% were mixed‐race and 31.6% had >secondary education. Most, 89.9% reported CAS, 61.9% had >10 sex partners and 71.9% reported transactional sex. HIV incidence was 1.82 cases per 100 person‐years (95% confidence interval [CI]: 0.76–4.38). Almost half of TGW (48.6%) had long‐term PrEP engagement, which was positively associated with reporting complete adherence at week 4 (aOR:2.94 [95%CI:1.88–4.63]) and was inversely associated with reporting CAS with unknown‐HIV partner (aOR:0.52 [95%CI:0.34–0.81]), migration (aOR:0.54 [95%CI:0.34–0.84]), and being from Mexico (aOR:0.28 [95%CI:0.14–0.53]). Self‐reported adherence was associated with TGW aged >34 (aOR:1.61 [95%CI:1.10–2.34]) compared to those aged 25–34 and those with >secondary education (aOR:1.55 [95%CI:1.10–2.19]) and was lower among TGW from Peru (aOR:0.29 [95%CI:0.21–0.41]) or reporting PrEP‐related adverse effects (aOR:0.63 [95%CI:0.42–0.92]). Conclusions Although TGW were willing to enrol in ImPrEP, long‐term PrEP engagement and complete self‐reported adherence were limited, and HIV incidence remained relatively high. A successful HIV prevention agenda should include trans‐specific interventions supporting oral PrEP and exploring long‐acting PrEP strategies for TGW.

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“…Furthermore, while telemedicine provides potential to reduce barriers in access to care—including transportation costs, stigma, and convenience [ 52 ]—some of the most marginalized populations may be less likely to benefit from it. Studies from our prevention cohort at INI have shown that TGW and those of lower education have less access to good internet connection and lack adequate privacy in their homes to conduct clinical visits remotely [ 49 , 50 , 53 ].…”

Section: Discussionmentioning

confidence: 99%

The Impact of COVID-19 on HIV Care in Rio de Janeiro, Brazil 2019–2021: Disparities by Age and Gender

et al. 2023

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We evaluated COVID-19’s impact on HIV care indicators among INI/FIOCRUZ’s HIV Clinical Cohort in Rio de Janeiro, Brazil: (1) Adequate care visits: two visits ≥ 90 days apart; (2) Adequate viral load monitoring: ≥ 2 viral load results ≥ 90 days apart; (3) Consistent viral suppression: all viral loads < 40 copies/mL; and (4) ART medication possession ratio (MPR) ≥ 95%. Chi-square tests compared the fraction of participants meeting each indicator per period: pre-pandemic (3/1/2019–2/29/2020) and post-pandemic (3/1/2020–2/28/2021). Logistic regression models were used to assess disparities in adequate care visits. Among 906 participants, care visits and viral load monitoring decreased pre-pandemic to post-pandemic: 77.0–55.1% and 36.6–11.6% (both p < 0.001), respectively. The optimal MPR rate improved from 25.5 to 40.0% (p < 0.001). Post-pandemic period (aOR 0.33, CI 0.28–0.40), transgender women (aOR 0.34, CI 0.22–0.53), and those aged 18–24 years (aOR 0.67, CI 0.45–0.97) had lower odds of adequate care visits. COVID-19 disrupted care access disproportionately for transgender women and younger participants. Supplementary Information The online version contains supplementary material available at 10.1007/s10461-023-03988-3.

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Complementary Recruitment Strategies to Reach Men Who Have Sex with Men and Transgender Women: The Experience of a Large Brazilian HIV Prevention Service

Cited by 13 publications

References 28 publications

Same-day initiation of oral pre-exposure prophylaxis among gay, bisexual, and other cisgender men who have sex with men and transgender women in Brazil, Mexico, and Peru (ImPrEP): a prospective, single-arm, open-label, multicentre implementation study

Same-day initiation of oral pre-exposure prophylaxis among gay, bisexual, and other cisgender men who have sex with men and transgender women in Brazil, Mexico, and Peru (ImPrEP): a prospective, single-arm, open-label, multicentre implementation study

Factors associated with long‐term HIV pre‐exposure prophylaxis engagement and adherence among transgender women in Brazil, Mexico and Peru: results from the ImPrEP study

The Impact of COVID-19 on HIV Care in Rio de Janeiro, Brazil 2019–2021: Disparities by Age and Gender

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