Determinants of human immuno-deficiency virus pre-exposure prophylaxis uptake and retention among sex workers in Nakuru town Kenya

Background: The purpose of this study was to assess factors associated with human immunodeficiency virus (HIV) pre-exposure prophylaxis uptake and retention among sex workers in Nakuru town, Kenya. The theory of planned behavior and the acquired immunodeficiency syndrome (AIDS) risk reduction model served as the study's theoretical framework. Methods: A cross-sectional research design was adopted for this study. The study targeted all the sex workers in Nakuru town who were 18 years old and above. A random sampling technique was used to get the hotspots where the sex workers were to be found. Snow balling sampling technique was then adopted to identify and recruit the study participants. Using primary sources. The quantitative data was obtained from the respondents using a questionnaire. Quantitative data was analyzed using descriptive and inferential statistics (regression analysis). The findings presented in table and graphical formats. Results: The analysis using multiple linear regression indicated that there was a collective significant effect between the awareness, health system factors, socio economic individual factors and use of pre-exposure prophylaxis (PrEP) among sex workers. A further analysis showed that, put together, the four predictor variables explained 35.7% of variation on PrEP uptake and retention. Conclusions: The study concluded that while use and none use PrEP can be explained by the four factors evaluated in this study, there are a lot of other factors that influence utilization of PrEP.

Concepciones de usuarios sobre nuevas vías de administración de profilaxis pre-exposición para el VIH / Users' expectations of the new pre-exposure prophylaxis for the HIV modalities

Resumen Este artículo tiene como objetivo discutir las concepciones de los Hombres Gay, Hombres Bisexuales y una Mujer Transgénero que usan o quieren usar profilaxis previa a la exposición por el virus de la inmunodeficiencia humana oral (PrEP) sobre nuevas vías de administración. Fueron entrevistados 17 usuarios del BCN Checkpoint. Las entrevistas fueron grabadas en audio, sometidas a análisis categorial temático teniendo en cuenta la perspectiva praxeográfica. Todos están adaptados al uso de la PrEP diaria y a demanda. En relación con las nuevas vías de administración (PrEP inyección intramuscular cada dos meses; pastilla mensual; inyección subcutánea cada seis meses) todos son muy receptivos a esas posibilidades, pero les falta información sobre las especificidades de cada una de ellas y una evaluación específica de sus necesidades. Tanto la satisfacción con el uso de PrEP oral, como las expectativas sobre las nuevas vías de administración son positivas. Sin embargo, lo más importante para los/a entrevistados/a es la garantía de que tendrán seguimiento para continuar cuidando de la salud afectivo-sexual, lo que no depende del tipo de vía de administración.

Abstract This article aims to discuss the expectations of Homosexual Men, Bisexual Men and a Transgender Woman, who use or want to use an oral pre-exposure prophylaxis (PrEP) for the human immunodeficiency virus (HIV) about PrEP modalities. Sixteen PrEP users, who are followed up in the BCN Checkpoint, were interviewed,. The interviews were audio-recorded, subjected to thematic categorical analysis within the theoretical framework from the praxiographic perspective. They are all adapted to the use of daily oral and event-based PrEP. In relation to the new PrEP modalities (monthly pill; intramuscular injection every two months; subcutaneous injection every six months), they are all very receptive to these possibilities, but they lack information on the specificities of each and specific assessment of their needs. Comments about the use of oral PrEP are positive, and expectations regarding the new PrEP modalities are visibly high. However, the most important thing for the interviewees is the guarantee that they will have follow-up appointments to continue taking care of their affective-sexual health, which is not dependent on the type of PrEP modalities.

Factores relacionados al interés e intención al uso de profilaxis preexposición al VIH en hombres gay y/o bisexuales, Colombia / Factors related to the interest and intention of using pre-exposure prophylaxis for HIV in gay and/or bisexual men, Colombia / Fatores relacionados ao interesse e intenção de usar profilaxia pré-exposição ao HIV em homens gays e/ou bissexuais, Colômbia

Resumen Introducción: la profilaxis preexposición al VIH (PrEP) ha demostrado disminuir la incidencia del VIH, pero su adopción en Colombia es aún incipiente. Para avanzar en la implementación de la PrEP como intervención de salud pública es necesario conocer el interés de las poblaciones en riesgo de VIH y los factores que facilitarían su uso. Objetivo: identificar los factores relacionados con el interés e intención de tomar PrEP en hombres gay/bisexuales. Metodología: estudio transversal analítico en una muestra no probabilística en ciudades principales de Colombia. Se exploraron las características sociodemográficas, conocimiento, motivaciones, habilidades conductuales y factores psicosociales, se utilizaron modelos logísticos para estimar la relación de estos factores con el interés y la intención de usar la PrEP. Resultados y conclusiones: participaron 552 hombres gay/bisexuales, 301 (54 %) reclutados en línea y 251 en persona. Solo el 40 % de la muestra sabía de la existencia de PrEP. 57.4 % (IC95%:54.9%-62.4%) reportaron interés e 52.9 % (IC95%: 48.5%-57.3%) intención de usar PrEP. El interés y la intención de usar la PrEP se relacionaron con actitudes y normas positivas hacia PrEP, así como con mayores habilidades relacionadas con servicios de PrEP. El estigma hacia la PrEP y los síntomas depresivos se relacionaron con menor interés e intención. Los resultados sugieren la necesidad de fomentar la información sobre PrEP, especialmente en poblaciones con más desventajas sociales y que experimentan más estigma, al igual que desarrollar intervenciones comunitarias que apoyen las motivaciones y las habilidades para usar la PrEP.

Abstract Introduction: HIV pre-exposure prophylaxis (PrEP) has been shown to reduce the incidence of HIV, but its adoption in Colombia is still beginning. To advance the implementation of PrEP as a public health intervention, it is necessary to know the interest of populations at risk of HIV and the factors that would facilitate its use. Objective: Identify factors related to interest and intention to take PrEP in gay/bisexual men. Methodology: Analytical cross-sectional study in a non-probabilistic sample in main cities of Colombia. Sociodemographic characteristics, knowledge, motivations, behavioral skills, and psychosocial factors were explored; logistic models were used to estimate the relationship of these factors with interest and intention to use PrEP. Results and conclusions: 552 gay/bisexual men participated, 301 (54%) recruited online and 251 in person. Only 40% of the sample knew of the existence of PrEP. 57.4% (95% CI: 54.9%-62.4%) reported interest and 52.9% (95% CI: 48.5%-57.3%) intention to use PrEP. Interest and intention to use PrEP were related to positive attitudes and norms toward PrEP, as well as greater skills related to PrEP services. Stigma toward PrEP and depressive symptoms were related to lower interest and intention. Our results suggest the need to promote information about PrEP, especially in populations with more social disadvantages and who experience more stigma, as well as to develop community interventions that support motivations and skills to use PrEP.

Resumo Introdução: Foi demonstrado que a profilaxia pré-exposição ao VIH (PrEP) reduz a incidência do VIH, mas a sua adopção na Colômbia está apenas a começar. Para avançar na implementação da PrEP como intervenção de saúde pública, é necessário conhecer o interesse das populações em risco de VIH e os fatores que facilitariam a sua utilização. Objetivo: Identificar fatores relacionados ao interesse e intenção de tomar PrEP em homens gays/bissexuais. Metodologia: Estudo analítico transversal em amostra não probabilística nas principais cidades da Colômbia. Foram exploradas características sociodemográficas, conhecimentos, motivações, habilidades comportamentais e fatores psicossociais; modelos logísticos foram utilizados para estimar a relação desses fatores com o interesse e intenção de uso da PrEP. Resultados e conclusões: Participaram 552 homens gays/bissexuais, 301 (54%) recrutados online e 251 pessoalmente. Apenas 40% da amostra sabia da existência da PrEP. 57,4% (IC 95%: 54,9%-62,4%) relataram interesse e 52,9% (IC 95%: 48,5%-57,3%) intenção de usar a PrEP. O interesse e a intenção de usar a PrEP estavam relacionados com atitudes e normas positivas em relação à PrEP, bem como com maiores competências relacionadas com os serviços de PrEP. O estigma em relação à PrEP e os sintomas depressivos foram relacionados com menor interesse e intenção. Os nossos resultados sugerem a necessidade de promover informação sobre a PrEP, especialmente em populações com mais desvantagens sociais e que sofrem mais estigma, bem como desenvolver intervenções comunitárias que apoiem motivações e competências para usar a PrEP.

Profilaxia pré-exposição ao vírus da imunodeficiência humana na atenção primária à saúde: experiências da enfermagem / Pre-exposure prophylaxis to human immunodeficiency virus in primary health care: nursing experiences / Profilaxis pre-exposición al virus de inmunodeficiencia humana en atención primaria de salud: experiencias de enfermería

Objetivo: Relatar a experiência da implementação da oferta de Profilaxia Pré-Exposição em uma Unidade Básica de Saúde e destacar o protagonismo da enfermagem neste processo. Métodos: Relato de experiência realizada entre novembro de 2022 e outubro de 2023, em uma Unidade Básica de Saúde da capital do estado do Rio Grande do Norte, Brasil. Considerou como etapas para implementação: encontros e reuniões com a Coordenação Municipal e Estadual de Infecções Sexualmente Transmissíveis, oficinas de educação permanente, construção do fluxo de atendimento por enfermeiros, divulgação da oferta do serviço e busca ativa de pessoas vulneráveis à infecção pelo Vírus da Imunodeficiência Humana. Resultados: O serviço foi implementado na Unidade Básica de Saúde em maio de 2023, executado pelos enfermeiros da estratégia de saúde da família e possibilitou o cuidado integral de populações-chave vulneráveis à infecção pelo Vírus da Imunodeficiência Humana. Conclusão: A implementação da Profilaxia Pré-Exposição na Unidade Básica de Saúde endossa o protagonismo da enfermagem nos cuidados primários em saúde, com potencial de planejar, implementar, assistir e monitorar estratégias e ações de saúde para populações vulneráveis no âmbito da Atenção Primária. (AU)

Objective: To report the experience of implementing the provision of Pre-Exposure Prophylaxis in a Basic Health Unit and highlight the role of nursing in this process. Methods: Report of an experience carried out between November 2022 and October 2023, in a Basic Health Unit in the capital of the state of Rio Grande do Norte, Brazil. Considered as steps for implementation: meetings and meetings with the Municipal and State Coordination of Sexually Transmitted Infections, continuing education workshops, construction of the care flow by nurses, dissemination of the service offering and active search for people vulnerable to infection by the Immunodeficiency Virus Human. Results: The service was implemented in the Basic Health Unit in May 2023, carried out by nurses from the family health strategy and enabled comprehensive care for key populations vulnerable to infection by the Human Immunodeficiency Virus. Conclusion: The implementation of Pre-Exposure Prophylaxis in the Basic Health Unit endorses the role of nursing in primary health care, with the potential to plan, implement, assist and monitor health strategies and actions for vulnerable populations within the scope of Primary Care. (AU)

Objetivo: Relatar la experiencia de implementación de la prestación de Profilaxis Pre-Exposición en una Unidad Básica de Salud y resaltar el papel de la enfermería en este proceso. Métodos: Informe de una experiencia realizada entre noviembre de 2022 y octubre de 2023, en una Unidad Básica de Salud de la capital del estado de Rio Grande do Norte, Brasil. Se consideran como pasos para su implementación: reuniones y encuentros con la Coordinación Municipal y Estatal de Infecciones de Transmisión Sexual, talleres de educación continua, construcción del flujo de atención por parte de enfermeras, difusión de la oferta de servicios y búsqueda activa de personas vulnerables al contagio por el Virus de Inmunodeficiencia Humana. Resultados: El servicio fue implementado en la Unidad Básica de Salud en mayo de 2023, realizado por enfermeros de la estrategia de salud de la familia y posibilitó la atención integral a poblaciones clave vulnerables a la infección por el Virus de Inmunodeficiencia Humana. Conclusión: La implementación de la Profilaxis Pre-Exposición en la Unidad Básica de Salud refrenda el papel de la enfermería en la atención primaria de salud, con potencial para planificar, implementar, asistir y monitorear estrategias y acciones de salud para poblaciones vulnerables en el ámbito de la Atención Primaria. (AU)

Caracterização do perfil sociodemográfico dos usuários de profilaxia pré-exposição ao HIV (PrEP) no Ceará / Characterization of the sociodemographic profile of users of hiv pre-exposure prophylaxis (PrEP) in Ceará

Introdução: a PrEP é uma estratégia de prevenção biomédica que consiste no uso de antirretrovirais (ARV) orais com o objetivo de mitigar o risco de adquirir o HIV e, consequentemente, de desenvolver a AIDS. O presente estudo tem como objetivo descrever o perfil sociodemográfico dos usuários com dispensação da PrEP no Ceará, no período de 2018 a 2023. Métodos: trata-se de um estudo transversal descritivo. Os dados foram obtidos por meio do Departamento de HIV/Aids, Tuberculose, Hepatites Virais e Infecções Sexualmente Transmissíveis (DATHI) do Ministério da Saúde por meio do Painel de monitoramento da PrEP. Resultados: observou-se um predomínio de usuários gays e homens que fazem sexo com homens, mas não se consideram gays; autodeclarados como pardos, com alta escolaridade e com faixa etária entre 30 e 39 anos. As dispensações da PrEP apresentaram progressão no período analisado, apesar dos anos de pandemia. Conclusão: embora a PrEP tenha-se mostrado eficaz no controle e declínio no número de infecções pelo HIV, esses dados demonstram que há uma lacuna entre quem se beneficia dela. É um desafio fazer com que a PrEP chegue a quem se pode beneficiar dela e com maior probabilidade de exposição ao HIV indivíduos de baixa escolaridade, pessoas trans, travestis, jovens adultos /adolescentes e não brancos.

Introduction: PrEP is a biomedical prevention strategy that consists of the use of oral antiretrovirals (ARV) to mitigate the risk of acquiring HIV and, consequently, of developing AIDS. The present study aims to describe the sociodemographic profile of users dispensed with PrEP in Ceará from 2018 to 2023. Methods: this is a descriptive cross-sectional study. The data was obtained from the Department of HIV/Aids, Tuberculosis, Viral Hepatitis, and Sexually Transmitted Infections (DATHI) of the Ministry of Health through the PrEP Monitoring Panel. Results: there was a predominance of Gay users and Men who have Sex with Men but do not consider themselves gay; they self-declared as mixed race, highly educated, and aged between 30 and 39 years old. PrEP dispensations showed progression in the period analyzed despite years of pandemic. Conclusion: although PrEP is effective in controlling and declining the number of HIV infections, these data demonstrate that there is a gap between who benefits from it. It is a challenge to make PrEP reach those who can most benefit from it and who are most likely to be exposed to HIV, individuals with low education, trans people, transvestites, young adults/adolescents, and non-whites.

"It was unusual but amazing": demand creation for PrEP among adolescents' men who have sex with men (MSM) and transgender women (TGW) in Brazil / "Foi inusitado, mas surpreendente": criação de demanda por PrEP entre homens adolescentes que fazem sexo com homens (HSH) e mulheres trans (MT) no Brasil / "Fue inusual, pero sorprendente": la creación de demanda por PrEP entre hombres adolescentes que tienen sexo con hombres (HSH) y mujeres trans (MT) en Brasil

Abstract: This study aimed to analyze the challenges in demand creation for participation in an HIV pre-exposure prophylaxis (PrEP) project in two Brazilian capitals. This qualitative study was conducted with men who have sex with men and transgender women aged 15 to 19 years who lived in two Brazilian state capitals. For this analysis, 27 semi-structured interviews carried out from 2019 to 2020 were evaluated by reflexive thematic content analysis. For participants, PrEP demand creation was essential for their interaction, mediation, bonding, and attachment and proved effective for PrEP acceptability and adherence. Adolescents' narratives showed that the strategies promoted HIV combination prevention, opened up opportunities for recruitment meetings, helped to negotiate with and convince individuals to use PrEP, strengthened peer education, and evoked a feeling of "being with" and "walking together" despite the challenges. Face-to-face or online interactions using social technologies played a crucial role in recruiting adolescents for the project, expanding knowledge on PrEP and other combination prevention strategies and access to health services and self-care.

Resumo: Este estudo analisou desafios na criação de demanda para participação em um projeto de profilaxia pré-exposição (PrEP) ao HIV em duas capitais brasileiras. Trata-se de um estudo qualitativo realizado com homens que fazem sexo com homens e mulheres transgênero de 15 a 19 anos residentes de duas capitais brasileiras. Para esta análise, foram avaliadas 27 entrevistas semiestruturadas realizadas entre 2019 e 2020 com análise temática de conteúdo reflexiva. Para os participantes, a criação de demanda por PrEP foi essencial para o processo de interação, mediação, vínculo e apego e mostrou-se eficaz para a aceitabilidade e adesão à PrEP. As narrativas dos adolescentes mostraram que as estratégias promoveram a prevenção combinada do HIV, abriram oportunidades para reuniões de recrutamento, ajudaram a negociar e convencer os indivíduos a usar a PrEP, fortaleceram a educação entre pares e evocaram um sentimento de "estar com" e "caminhar juntos", apesar dos desafios. As interações, sejam presenciais ou online, com o uso de tecnologias sociais, desempenharam um papel crucial no recrutamento de adolescentes para o projeto, na ampliação do conhecimento sobre PrEP e demais estratégias combinadas de prevenção, e no acesso a serviços de saúde e autocuidado.

Resumen: Este estudio analizó los desafíos para crear demanda para la participación en un proyecto de profilaxis pre-exposición (PrEP) al VIH en dos capitales brasileñas. Se trata de un estudio cualitativo realizado con hombres que tienen sexo con hombres y mujeres transgénero de 15 a 19 años residentes de dos capitales brasileñas. Para este análisis, se evaluaron 27 entrevistas semiestructuradas realizadas entre 2019 y 2020 con un análisis temático de contenido reflexivo. Para los participantes, crear la demanda por PrEP fue fundamental para el proceso de interacción, mediación, vínculo y apego y demostró ser eficaz para la aceptabilidad y adhesión de la PrEP. Los relatos de los adolescentes mostraron que las estrategias promovieron la prevención combinada del VIH, posibilitaron reuniones de reclutamiento, ayudaron a negociar y convencer a las personas a usar la PrEP, fortalecieron la educación entre pares y evocaron un sentimiento de "estar con" y "caminar juntos", a pesar de los desafíos. Las interacciones, ya sean de manera presencial o online, con el uso de las tecnologías sociales, tuvieron un papel fundamental en el reclutamiento de adolescentes para el proyecto, en la ampliación del conocimiento sobre la PrEP y las demás estrategias de prevención combinadas, y en el acceso a servicios de salud y autocuidado.

Lack of evidence of acute HEV infections as a sexually transmitted disease: Data from a German cohort of PrEP users

Abstract Background While the sexual transmissibility of HAV in MSM has been extensively described, the potential for sexual transmission of HEV has not been definitively established. Although HEV has been detected in the ejaculate of chronically infected men, studies among MSM PrEP users in France did not observe an elevated anti-HEV seroprevalence as an indicator of increased exposure risk by sexual intercourse. Patients and methods A total of 111 unselected PrEP users and 111 age- and sex-matched blood donors were tested for anti-HEV IgG, IgM and HEV (PCR). Of the participants 79/111 (71 %) responded to a questionnaire covering topics as sexual preferences, previous sexually transmitted diseases, profession, food consumption, and pet ownership. Results The anti-HEV IgG seroprevalence in PrEP users (22 %) did not differ significantly from the rate in controls (17 %). While one PrEP user and three controls tested positive for anti-HEV IgM, all PrEP users and controls tested PCR negative. Conclusion In immunocompetent individuals with frequent changes of sexual partners, the epidemiology of Hepatitis E Virus does not significantly involve the sexual transmission route.

Incorporação da PrEP no Brasil segundo a Teoria Fundamentada em Dados / Incorporation of PrEP in Brazil according to the Grounded Theory

Resumo A profilaxia pré-exposição ao HIV (PrEP) no Brasil é uma das estratégias da prevenção combinada aprovada para incorporação no SUS em 2017. Dada a sua importância, este artigo tem como objetivo descrever e analisar a incorporação da PrEP no Sistema Único de Saúde (SUS). Para tanto, apresenta uma abordagem qualitativa, baseada nos pressupostos da Teoria Fundamentada em Dados. O processo de incorporação da PrEP no SUS foi apresentado em forma de figura, demonstrando as principais ações e argumentos de maneira cronológica. As principais categorias foram: atuação das organizações da sociedade civil e movimentos sociais; desenvolvimento das pesquisas; incorporação; implementação e ampliação da PrEP no Brasil; limites da prevenção focada no discurso sobre o uso do preservativo; principais temas de debate sobre PrEP; comunicação e níveis de informação; e contexto de desmonte das políticas de HIV/Aids. O conhecimento sobre os aspectos decisórios e de participação de atores interessados na trajetória da incorporação da PrEP pode contribuir em futuras experiências de incorporação e acesso de inovações à prevenção do HIV para as populações mais vulneráveis.

Abstract Pre-Exposure Prophylaxis (PrEP) is an approved HIV combined prevention strategy incorporated in Brazil in 2017. Given its importance, this article aims to describe and analyze the incorporation of PrEP into the Unified Health System (SUS). The study presents a qualitative approach, based on Grounded Theory. PrEP incorporation process was presented through an explanatory figure, describing the main actions and arguments in a chronological manner. The main actions and arguments gathered into categories are the performance of civil society organizations and social movements; research development; incorporation; implementation and enhancement of PrEP in Brazil; limits of prevention focused on the discourse of condom use; key topics of debate on PrEP; communication and information levels; and context of dismantling of HIV/Aids policies. Knowledge about stakeholders' decision-making and participation aspects in PrEP incorporation trajectory can contribute to future experiences in incorporating and accessing HIV prevention innovations for the most vulnerable populations.

Oferta de prep em organizações comunitárias: estudo comparativo com serviços convencionais / Prep provision in community organizations: a comparative study with conventional services

RESUMO OBJETIVO: Avaliar se adolescentes de minorias sexuais que iniciaram a profilaxia pré-exposição sexual (PrEP) em organizações comunitárias (OC) apresentam maior vulnerabilidade social e ao HIV em comparação com adolescentes em PrEP de um serviço de saúde convencional. Além disso, avaliar se esses adolescentes tiveram um acesso mais oportuno à profilaxia. MÉTODOS: Estudo demonstrativo da efetividade de PrEP, realizado na cidade de São Paulo, em duas OC, localizadas no centro (OC-centro) e na periferia (OC-periferia), e em um serviço convencional de testagem para o HIV (CTA-centro). Foram elegíveis para PrEP, entre 2020 e 2022, adolescentes homens cisgêneros que fazem sexo com homens (aHSH), travestis, mulheres transexuais e pessoas transfemininas (aTTrans), de 15 a 19 anos, HIV-negativos e com práticas de maior risco para o HIV. Indicadores de acesso oportuno e de vulnerabilidades dos adolescentes iniciando PrEP nas OC foram analisados, tendo por referência o CTA-centro e empregando regressão logística multinomial. RESULTADOS: 608 adolescentes iniciaram PrEP nas OC e CTA-Centro. Adolescentes das OC estiveram associados a um menor tempo de início de PrEP (1-7 dias; OC-periferia: ORa = 2,91; IC95% 1,22-6,92; OC-centro: ORa = 1,91; IC95% 1,10-3,31); e a um menor IDH de moradia (OC-centro: ORa = 0,97; IC95% 0,94-1,00; OC-periferia: ORa = 0,82; IC95% 0,78-0,86). Na OC-periferia houve aumento na chance de os adolescentes serem mais jovens (ORa = 3,06; IC95% 1,63-5,75) e morarem mais próximos ao serviço (ORa = 0,82; IC95% 0,78-0,86, média 7,8 km). Enquanto adolescentes da OC-centro estiveram associados ao maior conhecimento prévio de PrEP (ORa = 2,01; IC95% 1,10-3,91) e a alta percepção de risco (ORa = 2,02; IC95% 1,18-3,44). Não estiveram associadas aos adolescentes das OC as práticas sexuais de maior risco e as situações de vulnerabilidade ao HIV. CONCLUSÕES: A oferta de PrEP nas OC facilitou o acesso de adolescentes vulnerabilizados e pode contribuir para reduzir inequidades.

ABSTRACT OBJECTIVE: To evaluate whether adolescents from sexual minorities who initiated pre-exposure prophylaxis (PrEP) in community-based organizations (COs) are more socially and HIV-vulnerable compared with their counterparts from a conventional health service. In addition, to evaluate whether these adolescents had more timely access to prophylaxis METHODS: A PrEP demonstration study was conducted in the city of São Paulo in two COs, located in the center (CO-center) and the outskirts (CO-outskirts), and a conventional HIV testing service (CTA-center). Between 2020 and 2022, cisgender male adolescents who have sex with men (aMSM), transgender and gender diverse adolescents (aTTrans) aged 15 to 19 years, HIV-negative, with higher-risk practices for HIV were eligible for PrEP. Indicators of timely access and vulnerabilities of adolescents initiating PrEP in COs were analyzed using CTA-center as a reference and multinomial logistic regression. RESULTS: 608 adolescents initiated PrEP in COs and CTA-center. Adolescents from COs were associated with a shorter time to PrEP initiation (1-7 days; CO-outskirts: ORa = 2.91; 95%CI 1.22-6.92; CO-center: ORa = 1.91; 95%CI 1.10-3.31); and a lower housing Human Development Index (HDI) (CO-center: ORa = 0.97; 95%CI 0.94-1.00; CO-outskirts: ORa = 0.82; 95%CI 0.78-0.86). In CO-outskirts, there was an increased chance of adolescents being younger (ORa = 3.06; 95%CI 1.63-5.75) and living closer to the service (ORa = 0.82; 95%CI 0.78-0.86, mean 7.8 km). While adolescents from the CO-center were associated with greater prior knowledge of PrEP (ORa = 2.01; 95%CI 1.10-3.91) and high-risk perception (ORa = 2.02; 95%CI 1.18-3.44), adolescents from the COs were not associated with higher-risk sexual practices and situations of vulnerability to HIV. CONCLUSION: The provision of PrEP in the COs facilitated access for vulnerable adolescents and may contribute to reducing inequities.

Percepções e práticas de profissionais de saúde na oferta da profilaxia pré-exposição sexual ao HIV para adolescentes e jovens trans e homens que fazem sexo com homens / Perceptions and practices of healthcare providers in providing HIV pre-exposure prophylaxis to trans adolescents and young adults and men who have sex with men

RESUMO OBJETIVO: Compreender as percepções e práticas de profissionais de saúde no contexto da oferta de profilaxia pré-exposição ao HIV (PrEP) entre adolescentes e jovens gays e trans. MÉTODOS: Trata-se de pesquisa qualitativa desenvolvida como parte do estudo PrEP1519, realizada entre 2018 e 2021, com o objetivo de analisar a efetividade de PrEP entre adolescentes e jovens. Os dados foram produzidos de julho de 2020 a fevereiro de 2021 no sítio de São Paulo, combinando técnicas de observação-participante e entrevistas semiestruturadas. O processo analítico envolveu imersão no material empírico, codificação e categorização, com apoio do software NVivo®. A interpretação seguiu o princípio hermenêutico-dialético e teve como horizonte o conceito de cuidado inserido nas práticas de saúde. RESULTADOS: A construção do vínculo de confiança foi informada por práticas que reconheciam a singularidade dos/as adolescentes/jovens e suas demandas e buscavam impulsionar sua autonomia. A escuta sensível e solidária foi apontada como uma prática de acolhimento propulsora de ações de cuidado. Atitudes acolhedoras e suporte frente a situações de estigma e violências, relacionadas ou não ao uso de PrEP, convergiram para o reconhecimento da necessidade de apoio no desenvolvimento de autonomia para a prevenção entre adolescentes e jovens. O uso de linguagem próxima do cotidiano favoreceu a construção de relações de confiança, influenciando positivamente o desenvolvimento da autonomia e a adesão a PrEP. A tensão entre êxito técnico e sucesso prático foi observada na busca idealizada pela normatividade adultocêntrica em contraposição à intersubjetividade. CONCLUSÃO: As percepções e práticas dos/as profissionais de saúde se mostram coerentes com o conceito de cuidado, pois compreendem ações além dos saberes técnicos e reconhecem os contextos que aumentam a vulnerabilidade dos/as adolescentes e jovens ao HIV.

ABSTRACT OBJECTIVE: This study aims to understand the perceptions and practices of healthcare providers regarding the offer of HIV pre-exposure prophylaxis (PrEP) to gay and trans adolescents and young adults. METHODS: This qualitative research was developed as part of the PrEP1519 study, which was conducted from 2018 to 2021 to analyze the effectiveness of PrEP in adolescents and young adults. Data were collected from July 2020 to February 2021 at the municipality of São Paulo by combining participant observations and semi-structured interviews. The analytical process involved immersion in the empirical material and coding and categorizing it with the support of NVivo®. Interpretation followed the hermeneutic-dialectical principle and had the concept of Care in health practices as its horizon. RESULTS: The construction of trust-based relationships followed practices that acknowledge the uniqueness of youth and their demands and sought to strengthen their autonomy. Sensitive and supportive listening was pointed out as a welcoming practice that propelled care actions. Welcoming attitudes and support in facing stigma and violence (related or not to the use of PrEP) acknowledged the need to support adolescents and young adults to develop autonomy for prevention. The use of language close to young people's everyday life favored the construction of relationships of trust and positively influenced the development of autonomy and adherence to PrEP. The tension between technical and practical success occurred in the idealized search for adult-centric normativity as opposed to intersubjectivity. CONCLUSION: The perceptions and practices of healthcare providers are aligned with the concept of Care as they include actions beyond technical knowledge and recognize the contexts that increase the vulnerability of adolescents and young adults to HIV.

Trans/Travesti/+: PrEP em serviços especializados antes e durante a pandemia de covid-19 / Trans/Travesti/+: PrEP in specialized services before and during the COVID-19 pandemic

RESUMO OBJETIVO: Compreender as percepções e experiências de mulheres transexuais, travestis e pessoas não binárias ou de gênero fluido (MTrT+) em serviços de saúde que fazem segmento de profilaxia pré-exposição sexual (PrEP), antes e durante o contexto de pandemia, quanto às ressignificações na relação com os serviços e à continuidade da prevenção ao HIV por meio da PrEP. MÉTODOS: Investigação qualitativa e análise de material empírico produzido no âmbito de estudos mais amplos. Realizaram-se 45 entrevistas semiestruturadas com MTrT+ usuárias da PrEP da cidade de São Paulo, aplicando-se posteriormente a análise de conteúdo temática iterativa. RESULTADOS: As MTrT+ entrevistadas, com relação à pandemia de covid-19; protagonizam e ressignificam suas próprias lutas, seus cotidianos e suas formas de cuidar da saúde. Com suas particularidades, a pandemia se torna um acontecimento a mais dentre todos os demais que as MTrT+ enfrentam quotidianamente. Paralelamente, transitam pela epidemia de HIV, mas com a possibilidade de se prevenir por meio da PrEP. CONCLUSÃO: Por uma perspectiva situada e consciente, mais explícita no contexto da crise sanitária, as MTrT+ entrelaçam ações conscientes e práticas de cuidado em diálogo com os serviços de saúde. Aprofundar as investigações sobre esses grupos, a partir de uma dinâmica espaço-temporal situada em contextos específicos de produção de sentido, possibilita avançar em estratégias de prevenção e cuidado, especialmente em momentos de crise sanitárias.

ABSTRACT OBJECTIVE: To understand the perceptions and experiences of transsexual and travesti women and non-binary or gender-fluid people (TGWT+) in health services where they took pre-exposure prophylaxis (PrEP) in the periods before and during the pandemic, focusing on the resignification in the relationship with services and the continuity of HIV prevention via PrEP. METHODS: Qualitative research and analysis of empirical material generated in the context of broader studies were conducted. A total of 45 semi-structured interviews were conducted with TGWT+ PrEP users in the city of São Paulo and analyzed using iterative thematic content analysis. RESULTS: The TGWT+ interviewees gave new meanings to their struggles, daily lives and ways of caring for their health and played a central role within them. With its particularities, the COVID-19 pandemic became one more event among all the others that TGWT+ face daily. Alongside the COVID-19 pandemic, the TGWT+ were faced with the HIV epidemic, but with the possibility of prevention via PrEP. CONCLUSION: Based on a situated and conscious perspective, more explicit in the context of the health crisis, the TGWT+ intertwined conscious actions and care practices in dialog with health services. Further research on these groups from a spatiotemporal dynamic situated in specific contexts of meaning production would make it possible to advance prevention and care strategies, especially in times of health crisis.

Conciliando vantagens e dificuldades: conhecimentos e percepções da PrEP sob demanda entre jovens / Reconciling advantages and difficulties: knowledge and perceptions of event-driven PrEP among young people

RESUMO OBJETIVO: O objetivo deste estudo é analisar o conhecimento sobre o esquema de Profilaxia Pré-Exposição ao HIV sob demanda (PrEP-SD) e a percepção do seu uso potencial entre jovens homens que fazem sexo com homens (HSH), travestis e mulheres trans (TrMT) em acompanhamento na coorte. MÉTODOS: O estudo qualitativo incluiu 50 entrevistas com participantes das cidades de Salvador e São Paulo, entre 15 e 19 anos, que estavam usando PrEP diária ou outros métodos preventivos. Eles foram abordados por meio de diferentes estratégias de criação de demanda. As entrevistas em profundidade abordaram temas como práticas sexuais, conhecimento sobre PrEP-SD, aceitabilidade e motivações para o uso. Foi realizada análise temática em duas fases usando o software Nvivo versão 12. RESULTADOS: A maioria dos participantes desconhecia a PrEP-SD e muitos questionaram a sua efetividade e segurança ao receberem informações sobre ela. No entanto, ao conhecer o esquema, muitos jovens perceberam vantagens, como a não obrigatoriedade diária de medicamentos e a possibilidade de uso apenas em momentos de maior risco. Barreiras para o uso da PrEP-SD também foram identificadas pelos participantes, como a imprevisibilidade das relações sexuais e a dificuldade em administrar as dosagens nessa modalidade. CONCLUSÕES: O conhecimento limitado e as experiências com a PrEP oral diária influenciaram o interesse por ela, o que aponta a necessidade de estratégias informativas que permitam o letramento dos jovens HSH e TrMT na PrEP-SD. Os jovens valorizaram a autonomia e a gestão da prevenção mais alinhada à dinâmica de sua vida sexual propiciada pela nova modalidade, mas enfrentam desafios na gestão da PrEP-SD.

ABSTRACT OBJECTIVE: This study aims to analyze the knowledge about the HIV event-driven pre-exposure prophylaxis (event-driven PrEP) scheme and the perception of its potential use among young men who have sex with men (MSM), travestis, and transgender women (TrTW) who were followed up in the cohort. METHODS: This qualitative study included 50 interviews with participants from the municipalities of Salvador and São Paulo, aged 15 to 19 years, who made daily use of PrEP or other preventive methods. They were addressed by different demand creation strategies. The in-depth interviews covered topics such as sexual practices, event-driven PrEP knowledge, acceptability, and motivations for its use. A two-stage thematic analysis was carried out on Nvivo, version 12. RESULTS: Most participants were unaware of event-driven PrEP, and many questioned its effectiveness and safety when receiving information about it. However, on learning about the program, many young people saw advantages, such as not having to take daily medication and the possibility of using it only at times of greater risk. Participants also found barriers to using event-driven PrEP, such as the unpredictability of sexual relations and the difficulty in administering dosages in this modality. CONCLUSION: Limited knowledge and experiences with daily oral PrEP influenced interest in event-driven PrEP, which highlights the need for information strategies that enable young MSM and TrTW to read about event-driven PrEP. Young people valued the autonomy and management of preventive methods provides by this new modality, which is more in line with the dynamics of their sexual lives, but they face challenges in managing event-driven PrEP.

Impact of HIV pre-exposure prophylaxis (PREP) on health-related quality of life (QOL) of patients followed up at a reference center in São Paulo, Brazil

Abstract Background: HIV Pre-Exposure Pophylaxis (PrEP) is provided free of charge by the Brazilian national health system. Though effective in preventing HIV infection, little is known about its impact on the health-related Quality of Life (QoL) of users. Objective: The present study aimed at assessing the impact of PrEP on the QoL of its users. Methods: Prospective cohort study with 114 HIV-negative participants aged 18 years or older. Participants' QoL was assessed before starting PrEP and after 7 months of use, using the self-responsive WHOQOL-bref questionnaire. Sociodemographic and behavioral aspects were described and the Wilcoxon signed-rank test with p ≤ 0.05 was considered statistically significant. Results: Improvement was seen in QoL scores for the environment domain (p = 0.02), which addresses feeling of physical safety, access to information and health services, and participation in leisure activities. Furthermore, participants reported improved satisfaction with their sex life, when questioned about the social relationships domain. There was no statistically significant change in the global QoL score, in the global health score, in the physical and psychological domains, nor in the total score for the social relationships domain. As for their sociodemographic profile, most participants were white and highly educated young cisgender men who have sex with men. 76.3% had unprotected sex in the 3 months before starting PrEP. 60.5% had reported substance use: marijuana (42.1%), club drugs (35.1%), and poppers (20.2%). Conclusions: This study unveiled that PrEP benefited our cohort beyond its effectiveness in preventing HIV infection, having improved environmental aspects of QoL and self-satisfaction with sex life.

Adherence to HIV pre-exposure prophylaxis (PrEP) among key populations (KPs): an analytical cross-sectional study in Matayos Sub County, Busia County, Kenya

Background: A large percentage of the new cases of HIV/AIDs in Kenya are attributed to Key Populations (KPs). In Kenya, KPs contribute 33% of all new infections of HIV. It is with this realization that in 2017 the government of Kenya launched The Pre-Exposure Prophylaxis (PrEP) for HIV. The study aimed at assessing the factors influencing adherence to PrEP by KPs in Matayos sub-county, Busia County, Kenya. Methods: An analytical cross-sectional study that utilized a mixed-method data collection approach (n=343) was used to assessing the factors influencing adherence to PrEP by KPs in Matayos sub-county, Busia County, Kenya. Results: The level of adherence to PrEP using the Morisky Medical Adherence Scale-4 was established to be 37% among all KPs and 36%, 37% and 52% among CSWs, MSMs and PWIDs respectively. Chi-square analysis revealed significant relationship between Level of education (p=0.05), marital status (p=0.001), KP category (p=0.034), occupation (p=0.014), stigma (p=0.00), the perceptions of side effects (p=0.011), facility accessibility (P= 0.00), side effects (p=0.001) and adherence to PrEP. Among the MSMs condom use was established to have association to PrEP adherence (p=0.00). Conclusions: The study concluded that socio-demographic, individual characteristics, and clinical factors influence adherence to pre-exposure prophylaxis among key populations. The study recommended that key populations need more information on how to use pre-exposure prophylaxis, how it works, the side effects, what to do in case they experience the side effects and why adherence to pre-exposure prophylaxis is important.

Analysis of combined prevention measures on HIV/AIDS incidence in Brazil (1980-2020) / Análise de medidas de prevenção combinadas sobre a incidência de HIV/AIDS no Brasil (1980­2020)

Introduction: The Human Immunodeficiency Virus (HIV) attacks the immune system, with acquired immunodeficiency syndrome (AIDS) being the most advanced clinical manifestation. Prevention strategies have evolved over time in response to scientific advancements. From an institutional perspective, the Unified Health System (SUS) provides tools for Combined Prevention to the entire Brazilian population, universally and free of charge. However, despite therapeutic advances, HIV/AIDS remains a significant public health problem. Objective: To analyze the impact of Combined Prevention measures on the incidence of HIV/AIDS in Brazil from 1980 to 2020. Methods: Quantitative, observational, longitudinal, and retrospective study. Descriptive and multivariate analyses were conducted, specifically employing linear regression techniques. The variables of interest included case incidence and the distribution of: tests for sexually transmitted infections (STIs), condoms, post-exposure prophylaxis for HIV (PEP), and pre-exposure prophylaxis for HIV (PrEP). Publicly available data were sourced from governmental repositories. Results: The country has accumulated 1,037,878 infection cases, with an average of 25,947 new cases per year. Regarding prophylaxis inputs, five out of six variables demonstrated a negative correlation with the incidence rate, with only the distribution of male condoms showing a positive correlation. The analysis of the effect of PrEP was not statistically significant. Conclusion:Brazil has reduced the incidence of the disease as Combined Prevention measures have advanced. More time is needed to assess the impact of PrEP on the incidence of new cases.

Introdução: O vírus da imunodeficiência humana (HIV) ataca o sistema imunológico. A síndrome da imunodeficiência adquirida (AIDS) é a manifestação clínica mais avançada. As estratégias de prevenção evoluíram ao longo do tempo conforme os avanços científicos. Do ponto de vista institucional, o Sistema Único de Saúde (SUS) disponibiliza ferramentas de prevenção combinada a toda a população brasileira de forma gratuita e universal. Contudo, apesar de todos os avanços terapêuticos, o HIV/AIDS continua sendo um grave problema de saúde pública. Objetivo: Analisar as medidas de prevenção combinada sobre a incidência de HIV/AIDS no Brasil no período entre 1980 e 2020. Métodos: Quantitativo, observacional, longitudinal e retrospectivo. Estatisticamente, foram realizadas análises descritiva e multivariada, mais especificamente a técnica de correção linear. As variáveis de interesse foram a incidência de caso e as distribuições de: testes para infecções sexualmente transmissíveis (IST), preservativos, profilaxia pós-exposição sexual ao HIV (PEP) e a profilaxia pré-exposição ao HIV (PrEP). Os dados utilizados são de caráter público e obtidos em repositórios governamentais. Resultados: O país acumula 1.037.878 casos de infecção, com média de 25.947 novos casos por ano. Quanto aos insumos de profilaxia, cinco das seis variáveis demonstraram correlação negativa com a taxa de incidência. Apenas a distribuição de preservativos masculinos teve correlação positiva. A análise do efeito da PrEP não foi estatisticamente significativa. Conclusão: O Brasil tem reduzido a incidência da doença à medida que avançam as medidas de prevenção combinada. É necessário mais tempo para analisar o impacto da PrEP na incidência de novos casos

Discrepancy between behavioral-indicated and perceived candidacy for HIV pre-exposure prophylaxis among men who have sex with men in Chengdu, China / 北京大学学报(医学版)

OBJECTIVE@#To explore the discrepancy between behavioral-indicated candidacy and perceived candidacy (behavioral-perceived gap) and its associated factors of human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM), so as to identify the focus population of PrEP interventions and to design and implement targeted interventions.@*METHODS@#We recruited a sample of 622 HIV-negative MSM who were regular clients of a community-based organization located in Chengdu, China, from November to December 2021. A cross-sectional questionnaire was used to collect the participants' information on social demographics, PrEP-related knowledge and cognitions, and risk behaviors. In this study, behaviorally eligible for PrEP was defined as performing at least one type of high-risk behavior in the past six months, including inconsistent condom use, sex with an HIV-positive partner, confirmed sexual transmitted infections (STI) diagnosis, substance use, and post-exposure prophylaxis (PEP) experience. Logistic regression models were fitted, and multivariate analyses were adjusted for social demographics.@*RESULTS@#Among the 622 eligible participants, 52.6% (327/622) were classified as behaviorally eligible for PrEP. Only 37.9% (124/327) of the participants perceived themselves as appropriate candidates for PrEP and 62.1% (203/207) had discrepancy between behavioral-indicated and perceived candidacy. 85.9% (281/327) had heard of PrEP, and 14.2% (40/281) accessed PrEP information through health care providers. Of the 327 participants eligible for behavior-indicated PrEP use, about half (47.1%) knew how to obtain PrEP medication and 33.0% had a professional PrEP counseling experience. The majority (93.3%) had no or few friends using PrEP. 54.1% scored eight or above in PrEP knowledge level. 66.7% reported having two or more sexual partners in the past six months. After adjusting for age and recruitment channel, we found six factors that were associated with perceived candidacy for PrEP, including PEP use [adjusted odds ratio (ORA)=2.20; 95% confidence interval (CI): 1.33-3.63], PrEP availability (ORA=1.69; 95%CI: 1.06-2.68), a greater number of PrEP-using friends (ORA=4.92; 95%CI: 1.77-13.65), PrEP know-ledge (ORA=2.21; 95%CI: 1.38-3.56), multiple sexual partnership (ORA=1.77; 95%CI: 1.07-2.94), and perceiving a higher risk of HIV infection (ORA=4.02; 95%CI: 1.73-9.32). Substance use during sex and PrEP information channel were not statistically associated with this beha-vioral-perceived gap.@*CONCLUSION@#We observed a high discrepancy between behavioral-indicated and perceived candidacy for PrEP among Chengdu MSM in China. Future PrEP implementation efforts should be made in skills training in assessing HIV infection risk, increasing PrEP knowledge, providing professional PrEP counselling, and fostering PrEP support environment.

Comparison of immunization strategies for human rabies pre-exposure prophylaxis in laboratory animals / 中华微生物学和免疫学杂志

Objective:To compare the differences in the safety, efficacy and protective effects of rabies vaccine using the current pre-exposure prophylaxis schedule in China (0-7-21 or 28) and the newly recommended immunization program of WHO (0-7), aiming to provide data support for modifying the related content of Technical Guideline for Human Rabies Prevention and Control. Methods:The mice were randomly divided into five groups, namely 0-7-21 group (3-injection regimen), 0-7 group (2-injection regimen), 0-14 group, 0-21 group and control group, according to the current 3-injection regimen (0-7-21) in China and the 2-injection regimen (0-7) recommended by WHO. The survival status of the mice was observed. The mice were weighed every five days to compare the safety of different immunization procedures. Rabies virus neutralizing antibodies (RVNA) were detected 7, 14, 21, 28 and 35 d after the initial immunization. On day 35, the mice in each group were challenged with lethal dose of CVS-11 rabies virus to evaluate the protective effects of different pre-exposure immunization procedures.Results:There was no significant difference in weight gain of mice after vaccination. The positive rate of RVNA was 100% in all immunized groups from day 14, which could provide complete protection to mice. There was a significant difference in RVNA levels between 0-7-21 and 0-7 groups at 35 d( P<0.05), but there was no statistical difference at other time points ( P>0.05). RVNA level had a significant difference between 0-7 and 0-21 groups at 21 d and 35 d ( P<0.05). There was no statistical difference in RVNA level between other groups at each time point ( P>0.05). In the protective test, the survival rates of mice in all immune groups were 100%. Conclusions:The current 3-injection pre-exposure immunization procedure for rabies vaccine (0-7-21) and the newly recommended 2-injection immunization procedure (0-7) had similar efficacy and protective effects in animal tests. In view of the cost saving and better compliance of the 2-injection immunization procedure, it was recommended that relevant departments should conduct clinical trials as soon as possible to promote the implementation of this program.

Safety and immunogenicity of pre-exposure prophylaxis of approved freeze-dried rabies vaccine(Vero cell) for human use in adults ≥18 years of age / 中国生物制品学杂志

@#Objective To evaluate the safety and immunogenicity of pre-exposure prophylaxis of the approved freeze-dried rabies vaccine(Vero cell)(rabies vaccine in brief)for human use in adults ≥18 years of age.Methods Participants aged ≥18 years in Guizhou and Shanxi provinces from June 2022 to September 2022 were enrolled,vaccinated with 1 dose of rabies vaccine at 0,7,28 d respectively,and collected for 5. 0 mL of venous blood before the first dose and 14 d after the third dose. Immunofluorescence foci assay was used to detect rabies virus neutralizing antibodies,and adverse events were collected 0～7 d after each dose of vaccine.Results A total of 120 participants were enrolled,120 participants received the first dose of rabies vaccine,119 participants received the second dose and 118 participants received the third dose.Before the first dose of rabies vaccine,the seropositive rate of antibody was 2. 54% and the geometric mean concentration(GMC)was 0. 40 IU/mL. After the third dose of rabies vaccine,the seropositive rate and seroconversion rate were 100%,the GMC was 9. 68 IU/mL,and the geometric mean increase(GMI)was 23. 99. The incidence of adverse events 0～7 d after the first,second and third doses of rabies vaccine were 22. 50%,13. 45% and 4. 24%,respectively. The local adverse events were mainly pain,and the systemic adverse events were mainly fever,fatigue/weakness,dizziness,joint pain,and diarrhea.Conclusion Approved rabies vaccine showed good safety and immunogenicity in pre-exposure prophylaxis of people ≥ 18 years old.

Awareness of and willingness to use pre-exposure prophylaxis to prevent HIV infection among female sex workers in Anambra State, south-eastern Nigeria

Background: Pre-exposure prophylaxis (PrEP) is a highly effective preventive measures against HIV infection but its success is strongly based on adherence, which in turn depends on willingness to use. This study is aimed at assessing the level of awareness and willingness to use PrEP to prevent HIV infection among female sex workers (FSWs) in Anambra State, Nigeria, and to identify factors that influence willingness to use PrEP. Methodology: The study was a cross-sectional survey involving 265 brothel-based FSWs recruited through snowballing technique. A structured questionnaire was used to collect relevant information on demographic characteristics, awareness of HIV/AIDS and transmission route, attitudes/behavior related to HIV/AIDS, and awareness of and willingness to use PrEP. Univariate and bivariate analyses with Chi square test (with Odds ratio and 95% confidence interval) was used to determine association of socio-demographic and predictive factors with willingness to use PrEP. Statistical significance was considered when p value was less than 0.05. Results: Of 265 FSW respondents, only 81 (31.2%) have heard of PrEP, 10 (3.9%) indicated they have previously used PrEP while 91.0% indicated willingness to use PrEP. Univariate analysis showed that FSWs in Onitsha had a significantly higher odds (OR=28.6, 95% CI=1.718-476.82, p=0.0006) while those from Awka had a significantly lower odds (OR=0.184, 95% CI=0.0704-0.1812, p=0.0004) of willingness to use PrEP. Also, FSWs with monthly income less than 18,000 Naira had a lower odd of willingness to use PrEP (OR=0.3980, 95% CI=0.1593-0.9945, p=0.08). Bivariate analysis shows that FSWs who wish to have more knowledge of HIV/AIDS had higher odd of willingness to use PrEP than those who did not wish to have more knowledge (OR=4.235, 95% CI=1.577­11.374, p=0.0066). Similarly, FSWs who are worried of being discriminated against have a lower odd of willingness to use PrEP than those who are not worried of being discriminated against (OR=0.3921, 95% CI=0.1582-0.9718, p=0.0439). Conclusion: Our study showed low awareness but high willingness to use PrEP among FSWs in Anambra State,Nigeria. Cost, HIV/AIDS knowledge and fear of discrimination are significant predicting factors of willingness to use HIV PrEP and should be considered when formulating PrEP policy. Adequate enlightenment on PrEP should be emphasized among FSWs.

Prevalence of syphilis and sexual behavior and practices among adolescents MSM and TrTGW in a Brazilian multi-center cohort for daily use of PrEP / Prevalência de sífilis e comportamento e práticas sexuais entre adolescentes HSH e travestis e mulheres transgênero em um estudo de coorte multicêntrico brasileiro sobre uso diário de PrEP / Prevalencia de sífilis, comportamiento sexual y prácticas entre adolescentes HSH y TrTGW en una cohorte multicéntrica brasileña para el uso diario de PrEP

Syphilis has reemerged as a serious public health problem in Brazil and worldwide, disproportionately affecting men who have sex with men (MSM) and travestis and transgender women (TrTGW). Studies on sexually transmitted infections (STI) in adolescents from these key populations are relatively scarce. This is a Brazilian multi-center, cross study with prevalence analysis, using as baseline the PrEP1519 cohort of sexually active MSM and TrTGW adolescents, recruited from April 2019 to December 2020. Analyses were made using the dimensions of vulnerability to STI/HIV and logistic regression models were conducted to estimate the odds ratios of the association between the predictor variables and positive treponemal test for syphilis at the moment of entry in the study. In total, 677 participants were analyzed; participants' median age was 18.9 years (IQR: 18.1-19.5); 70.5% (477) self-declared as black; 70.5% (474), as homosexuals/gays; and 48 (7.1%), as trans women or travestis. The baseline prevalence of syphilis was 21.3%. In the final logistic regression model, higher chance of syphilis was associated with: self-reported episode of STI in the last 12 months (OR = 5.92; 95%CI: 3.74-9.37), sex worker (OR = 3.39; 95%CI: 1.32-8.78), and < 11 years of schooling (OR = 1.76; 95%CI: 1.13-2.74). The prevalence of syphilis among MSM/TrTGW adolescents aged from 15 to 19 years was alarming, much higher than the described for the general population within this age range and associated with vulnerability factors. This reinforces the urgent need to strengthen public health programs to debate about race, gender, sexuality, and prevention.

A sífilis reemergiu enquanto problema sério de saúde pública no Brasil e no mundo, afetando de maneira desproporcional homens que fazem sexo com homens (HSH), travestis e mulheres transgênero. São relativamente escassos os estudos sobre infecções sexualmente transmissíveis (IST) entre adolescentes pertencentes a essas populações-chave. O estudo transversal multicêntrico brasileiro analisou a prevalência de sífilis na linha de base da coorte PrEP15-19 de HSH, travestis e mulheres transgênero adolescentes, sexualmente ativos, recrutados entre abril de 2019 e dezembro de 2020. As análises foram realizadas com as dimensões de vulnerabilidade a ISTs/HIV, e modelos de regressão logística foram construídos para estimar as razões de chances da associação entre as variáveis preditoras e um teste treponêmico positivo para sífilis na entrada do estudo. Foram analisados 677 participantes. A idade mediana era 18,9 anos (IIQ: 18,1-19,5), 70,5% (477) se autoidentificaram como pretos, 70,5% (474) como homossexuais/gays e 48 (7,1%) como mulheres trans ou travestis. A prevalência de sífilis na linha de base era 21,3%. No modelo final de regressão logística, as seguintes variáveis estiveram associadas com chances maiores de sífilis: autorrelato de episódio de IST nos últimos 12 meses (OR = 5,92; IC95%: 3,74-9,37), profissional do sexo (OR = 3,39; IC95%: 1,32-8,78) e menos de 11 anos de escolaridade (OR = 1,76; IC95%: 1,13-2,74). A prevalência de sífilis entre HSH, travestis e mulheres transgênero adolescentes entre 15 e 19 anos de idade foi alarmante, muito acima da taxa relatada na população geral nesta faixa etária, e esteve associada a fatores de vulnerabilidade. Os achados reforçam a necessidade urgente de fortalecer os programas de saúde pública com a discussão sobre raça, gênero, sexualidade e prevenção.

La sífilis ha resurgido como un problema serio de salud pública en Brasil y en todo el mundo, afectando desproporcionadamente a hombres que tienen sexo con hombres (HSH), travestis y mujeres transgénero (TrTGW). Los estudios de las enfermedades trasmitidas sexualmente (ETS) en adolescentes de estas poblaciones clase son relativamente escasos. Se trata de un estudio transversal brasileño multicéntrico, con análisis de prevalencia de la base de referencia de la cohorte PrEP1519 de hombres activos sexualmente que mantienen sexo con hombres y adolescentes TrTGW, reclutados desde abril de 2019 a diciembre de 2020. Se hicieron análisis, usando las dimensiones de vulnerabilidad a las ETS/VIH, y se realizaron modelos de regresión logística para estimar las odds ratios de la asociación entre las variables predictoras y la prueba treponémica positiva para la sífilis al comenzar el estudio. Se analizaron a 677 participantes. La media de edad fue 18,9 años (IQR: 18,1-19,5), 70,5% (477) se autodeclararon como negros, 70,5% (474) como homosexuales/gays y 48 (7,1%) como mujeres trans o travestis. La base de referencia de prevalencia de sífilis fue 21,3%. En el modelo final de regresión logística, se asociaron con una posibilidad más alta de sífilis: un episodio autoinformado de ETS en los últimos 12 meses (OR = 5,92; IC95%: 3,74-9,37), trabajadores sexuales (OR = 3,39; IC95%: 1,32-8,78) y < 11 años de estudio (OR = 1,76; IC95%: 1,13-2,74). La prevalencia de sífilis entre adolescentes HSH/TrTGW con edades de 15 a 19 años fue alarmante, mucho más que lo descrito para la población general en este rango de edad y asociado con factores de vulnerabilidad. Esto refuerza la urgente necesidad de fortalecer los programas de salud pública, discutiendo cuestiones de raza, género, sexualidad y prevención.