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Effectiveness of strategies for generating demand for PrEP and combination prevention among adolescent´s men who have sex with men and transgender women in Brazil

Title
Effectiveness of strategies for generating demand for PrEP and combination prevention among adolescent´s men who have sex with men and transgender women in Brazil
Presenter
Laio Magno
Authors
L. Magno * (1,2), F. Soares (2), M. Eustorgio (2), A. Grangeiro (3), D. Ferraz (4,5), E. Zucchi (6), P. Massa (3), M.M. Escuder (3), I. Dourado (2)
Institutions
(1) Universidade do Estado da Bahia, Departamento de Ciências da Vida, Salvador, Brazil, (2) Universidade Federal da Bahia, Instituto de Saúde Coletiva, Salvador, Brazil, (3) Universidade de São Paulo, Departamento de Medicina Preventiva, São Paulo, Brazil, (4) Fundação Oswaldo Cruz, Escola FIOCRUZ de Governo, Brasília, Brazil, (5) Université Lumière Lyon 2, Groupe de Recherche en Psychologie Sociale (UR Greps), Bron, France, (6) Universidade Católica de Santos, Programa de Pós-Graduação em Saúde Coletiva, Mestrado Profissional em Psicologia e Políticas Públicas, Salvador, Brazil

BACKGROUND: As adolescent men who have sex with men (aMSM) and transgender women (aTGW) face many barriers to HIV prevention, appropriate and effective recruitment strategies are essential. We analyzed the effectiveness of strategies to reach and recruit aMSM and aTGW for HIV pre-exposure prophylaxis (PrEP) and other prevention measures in Brazil.
METHODS: PrEP1519 is the first PrEP demonstration study with adolescents done in Brazil. It takes place in three cities (São Paulo, Salvador, and Belo Horizonte) and it includes aMSM and aTGW aged 15 to 19. Participants were actively recruited between March/2019-December/2020 by: peer educators (PE) who engaged with aMSM/aTGW at social venues, in schools, and on virtual platforms and apps; referrals from health services or friends and partners; and NGOs. A cross-sectional analysis of the baseline data from the PrEP1519 cohort was carried out. The outcome variable for the bivariate and multivariate analyses was the recruitment strategy, categorized into virtual and face-to-face. Adjusted odds ratio and 95% confidence intervals (95%CI) were estimated.
RESULTS: A total of 3,675 aMSM and aTGW were reached by the study. Most were recruited via PE virtual strategies (2598/3675=70.7%), followed by PE in face-to-face contact (408/3675=11.1%), direct referrals (335/3675=9.1%), and NGOs (135/3675=3.7%). Of the total number of adolescents reached, 19.8% were enrolled in the cohort (729/3675=19.8%). The most successful strategies for enrolling participants in PrEP involved peer recruitment in virtual settings. There were no differences in the profile of sexual and HIV prevention behaviors across the recruitment strategies. The odds of being enrolled in the cohort through a virtual strategy were greater among aMSM (OR=5.17; 95%CI: 2.07-12.93), with a higher socioeconomic level (OR=6.44; 95%CI: 4.07-10.26), and more education (OR=1.43; 95%CI: 1.00-2.04).
CONCLUSIONS: PE were the most effective strategy to reach aMSM/aTGW, with virtual strategies being more effective, especially among MSM. Combining different recruitment strategies allowed for reaching and enrolling aMSM/aTGW with diverse socioeconomic and behavioral profiles. Our findings reinforce the need for recruitment strategies that actively reach out to the population at greatest risk for HIV infection, adopting measures to generate demand for PrEP.