Demand creation and HIV self-testing delivery during COVID-19 contingency measures of physical distancing among adolescents' key population enrolled in PrEP in Brazil


BACKGROUND: HIV self-testing (HIVST) helps to prevent disruptions in the HIV testing services during COVID-19 pandemic especially among adolescent's key population (AKP) of men who have sex with men and transgender women. We aimed to analyze HIVST distribution to AKP in PrEP1519 cohort as part of the COVID-19 contingency plan.
DESCRIPTION: Data is from the first PrEP demonstration cohort study among AKP aged 15-19 years old ongoing in three large Brazilian cities (PrEP1519). During physical distancing measures (PDM), started in March 2019 in Brazil, demand creation via social media was intensified and an HIVST delivery strategy was adopted in PrEP1519 clinics. A package with an HIVST and guidance was made available for AKP to be pick-up at the clinics or by delivery services/mail to their preferred addresses. Video guidance was developed and publicized in PrEP1519 Instagram and YouTube. This analysis reports findings comparing the pre-pandemic (March 2019-March15th 2020) and pandemic (March 16th-December 2020) periods. Bivariate analysis and chi-square test were used to test differences in the HIVST distribution.
LESSONS LEARNED: 1,597 HIVST were delivered, 39.8% and 60.2% during the pre-pandemic and pandemic periods, respectively. The number of requests increased 86% during the pandemic, and 16% of these were delivered to home addresses. Among AKP who requested an HIVST before March 15th 2020, 27.1% reported private use, 24.0% gave to a sexual partner and 48.9% gave to a friend. COVID-19 pandemic changed these patterns: 78.7% reported private use, 8.9% gave to a sexual partner and 12.3% gave to a friend (p-value<0.001). Before the pandemic, most AKP used an HIVST because of condomless sex (34.0%) or as a checkup (34.0%). During PDM, condomless sex was reported by 49.6% as the main reason for self-testing.
CONCLUSIONS: HIVST requests among Brazilians AKP in PrEP1519 cohort increased significantly. Demand creation via social media made it possible to reach more AKP and will be sustained even after PDM restrictions are lifted. These experiences offer important lessons for other middle-income countries, as well as other countries scaling up PrEP.