'Reaching adolescents where they are': Innovative recruitment strategies for PrEP enrolment of adolescent´s key population in Brazil

BACKGROUND: In Brazil, HIV incidence has been growing in the past decade among adolescent´s key population (AKP), such as men who have sex with men and transgender women. PrEP1519 is a demonstration study that offers HIV combination prevention, including oral daily PrEP, to these groups in three Brazilian capitals, and uses culturally appropriate recruitment strategies. We aimed to analyze the perceptions of AKP about the recruitment strategies implemented in the PrEP1519 study.
METHODS: Qualitative study nested in the PrEP1519 study. Seventy-one semi-structured interviews were conducted with AKP from Salvador (SSA) and São Paulo (SP) between June 2019-June 2020 (54 MSM and 17 TGW; 46 oral PrEP users and 25 users of other prevention methods). Participants were recruited by peer educators who engaged with MSM and TGW at social venues, in schools ' PE (16); online platforms and apps ' OP (15); direct referrals from health services ' RHS (20); referrals from friends and partners ' RFP (14); NGOs (06). Interviews were transcribed and coded by NVivo12.
RESULTS: In SP, the majority of respondents were recruited by RHS (20), while in SSA by RFP (13) and OP (12) stood out. MSM participants were recruited by all strategies in both cities, and TGW were recruited mostly by RHS in SP and by RFP in SSA. Participants perceived these different strategies as friendly, informative and contributing to their awareness of HIV prevention methods. Being reached by PE (12) was perceived as good strategy to raise awareness and interest in oral PrEP. Being reached by OP (15) was perceived as an innovative strategy capable of reaching AKP at substantial risk of HIV. All participants reported that recruitment actions for PrEP or other prevention methods broadened their perceptions of risk and knowledge about HIV prevention. The results show that adolescents feel more welcome, not judged, interested in care through these recruitment strategies.
CONCLUSIONS: Recruitment strategies implemented by PrEP1519 were perceived as friendly and informative, thus increasing adolescents' awareness of and interest on HIV prevention methods. Studies including MSM and TGW need to consider the sociocultural contexts of these two groups since different recruitment strategies may work better to each of them.