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1. Recent HIV infection and annualized HIV incidence rates among sexual and gender minorities in Brazil and Peru (ImPrEP seroincidence study): a cross-sectional, multicenter studyResearch in context

Author

Thiago S. Torres, Sylvia L.M. Teixeira, Brenda Hoagland, Kelika A. Konda, Monica Derrico, Ronaldo I. Moreira, Juan V. Guanira, Marcos Benedetti, Sandro Nazer, Gino M. Calvo, Silver Vargas, Carlos Benites, Álisson Bigolin, José Boullosa Alonso Neto, Alessandro Farias, Marcos Vinícius Guimarães Lacerda, Daila Alena Raenck Silva, Leidijany Costa Paz, José Valdez Madruga, Hector Javier Salvatierra Flores, Ginjaylan Prada Boluarte, Cesar Vidal Osco Tamayo, Hardy Teresa Castro Antezana, M. Cristina Pimenta, Annick Bórquez, Paula M. Luz, Beatriz Grinsztejn, Celia Landmann Szwarcwald, Carlos F. Cáceres, Valdilea G. Veloso, Tania Kristic, Carla Rocha, Willian da Silva Santos, Ana Paula Lovreto Santana, Renato Lima, Carolina Souza, Talita Andrade Oliva, Mônica dos Santos Valões, Jennifer Olivetto, Gabriel Lima Mota, Aline Barnabé Cano, Roberta Trefiglio, Carolina Coutinho, Oliver Elorreaga, Ximena Gutierrez, Fernando Olivos, Damaris Caviedes, Daniella Adriazola, Eduardo Juárez, Gabriela Mariño, Jazmin Qquellon, Francesca Vasquez, Jean Pierre Jiron, Sonia Flores, Karen Campos, and Maria Eguiluz

Subjects
HIV incidence rate, HIV seroincidence, HIV recency, Sexual and gender minorities, HIV, Latin America, Public aspects of medicine, RA1-1270
Abstract

Summary: Background: HIV incidence estimation is critical for monitoring the HIV epidemic dynamics and the effectiveness of public health prevention interventions. We aimed to identify sexual and gender minorities (SGM) with recent HIV infections, factors associated with recent HIV infection, and to estimate annualised HIV incidence rates. Methods: Cross-sectional multicentre study in HIV testing services in Brazil and Peru (15 cities). Inclusion criteria: 18+ years, SGM assigned male at birth, not using pre-/post-exposure prophylaxis. We identified recent HIV infection using the Maxim HIV-1 LAg-Avidity EIA assay as part of a recent infection testing algorithm (RITA). Annualized HIV incidence was calculated using the UNAIDS/WHO incidence estimator tool. Multivariable logistic regression models were used to estimate factors associated with recent HIV infection. Trial registration: NCT05674682. Findings: From 31-Jan-2021 to 29-May-2022, 6899 individuals participated [Brazil: 4586 (66.5%); Peru: 2313 (33.5%)]; 5946 (86.2%) cisgender men, 751 (10.9%) transgender women and 202 (2.9%) non-binary/gender diverse. Median age was 27 (IQR: 23–34) years. HIV prevalence was 11.4% (N = 784/6899); 137 (2.0%) SGM were identified with recent HIV infection. The overall annualized HIV incidence rate was 3.88% (95% CI: 2.86–4.87); Brazil: 2.62% (95% CI: 1.78–3.43); Peru: 6.69% (95% CI: 4.62–8.69). Participants aged 18–24 years had higher odds of recent HIV infection compared to those aged 30+ years in both countries. Interpretation: Our results highlight the significant burden of HIV epidemic among SGM in large urban centres of Brazil and Peru. Public health policies and interventions to increase access to effective HIV prevention methods such as PrEP are urgently needed in Latin America. Funding: Unitaid, WHO (Switzerland), Ministry of Health from Brazil and Peru.

Published
2023
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2. 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

Author

Valdiléa G Veloso, Carlos F Cáceres, Brenda Hoagland, Ronaldo I Moreira, Hamid Vega-Ramírez, Kelika A Konda, Iuri C Leite, Sergio Bautista-Arredondo, Marcus Vinícius de Lacerda, José Valdez Madruga, Alessandro Farias, Josué N Lima, Ronaldo Zonta, Lilian Lauria, Cesar Vidal Osco Tamayo, Hector Javier Salvatierra Flores, Yovanna Margot Cabrera Santa Cruz, Ricardo Martín Moreno Aguayo, Marcelo Cunha, Júlio Moreira, Alessandra Ramos Makkeda, Steven Díaz, Juan V Guanira, Heleen Vermandere, Marcos Benedetti, Heather L Ingold, M Cristina Pimenta, Thiago S Torres, Beatriz Grinsztejn, J. David Urbaez-Brito, Polyana d'Albuquerque, Claudio Palombo, Paulo Ricardo Alencastro, Raquel Keiko de Luca Ito, João L. Benedetti, Fabio V. Maria, Paula M. Luz, Lucilene Freitas, Kim Geraldo, Monica Derrico, Sandro Nazer, Tania Kristic, Renato Girade, Renato Lima, Antônio R. Carvalho, Carla Rocha, Pedro Leite, Marcio Lessa, Marilia Santini-Oliveira, Daniel R.B. Bezerra, Cleo de Oliveira Souza, Jacinto Corrêa, Marcelo Alves, Carolina Souza, Camilla Portugal, Mônica dos Santos Valões, Gabriel Lima Mota, Joyce Alves Gomes, Cynthia Ferreira Lima Falcão, Fernanda Falcão Riberson, Luciano Melo, Talita Andrade Oliveira, Agnaldo Moreira Oliveira Júnior, Bruna Fonseca, Leonor Henriette Lannoy, Ludymilla Anderson Santiago Carlos, João Paulo Cunha, Sonia Maria de Alencastro Coracini, Thiago Oliveira Rodrigues, Emília Regina Scharf Mettrau, Kelly Vieira Meira, Heder Tavares, Ana Paula Nunes Viveiros Valeiras, Taiane Miyake Alves de Carvalho Rocha, Alex Amorim, Patrícia Sabadini, Luiz Gustavo Córdoba, Caio Gusmão, Erika Faustino, Julia Soares da Silva Hansen, Agatha Mirian Cunha, Neuza Uchiyama Nishimura, Jaime Eduardo Flygare Razo Prereira Santos, Aline Barnabé Cano, Willyam Magnum Telles Dias, Magô Tonhon, Tania Regina Rezende, Alex Gomes, Eloá dos Santos Rodrigues, Maria das Dores Aires Carneiro, Alexandre Castilho, Mariana Carvalho, Dulce Diaz-Sosa, Centli Guillen-Diaz-Barriga, Lorena Hernández, Rebeca Robles, Maria Elena Medina-Mora, Marcela González, Ivonne Huerta Icelo, Araczy Martinez Davalos, José Gomez Castro, Luis Obed Ocampo Valdez, Fernanda Ramírez Barajas, Verónica Ruiz González, Galileo Vargas Guadarrama, Israel Macías, Jehovani Tena Sánchez, Juan Pablo Osuna Noriega, H. Rodrigo Moheno M, Jorge M. Bernal Ramírez, Víctor Dante Galicia Juarez, Gerardo Vizcaíno, Francisco Javier Arjona, Gino Calvo, Silver Vargas, Oliver Elorreaga, Ximena Gutierrez, Fernando Olivos, Damaris Caviedes, Daniella Adriazola, Eduardo Juárez, Gabriela Mariño, Jazmin Qquellon, Francesca Vasquez, Jean Pierre Jiron, Sonia Flores, and Karen Campos

Subjects
Oral, Prophylaxis, Epidemiology, Immunology, Sex with men, Cisgender, Gay, Infectious Diseases, Virology, Peru, Transgender women, Bisexual, Mexico, Brazil
Abstract

Although gay, bisexual, and other cisgender men who have sex with men (MSM) and transgender women have the highest HIV burden in Latin America, pre-exposure prophylaxis (PrEP) implementation is poor. We aimed to assess the feasibility of same-day oral PrEP delivery in Brazil, Mexico, and Peru.Implementation PrEP (ImPrEP) was a prospective, single-arm, open-label, multicentre PrEP implementation study conducted in Brazil (14 sites), Mexico (four sites), and Peru (ten sites). MSM and transgender women were eligible to participate if they were aged 18 years or older, HIV-negative, and reported one or more prespecified criteria. Enrolled participants received same-day initiation of daily oral PrEP (tenofovir disoproxil fumarate [300 mg] coformulated with emtricitabine [200 mg]). Follow-up visits were scheduled at week 4 and quarterly thereafter. We used logistic regression models to identify factors associated with early loss to follow-up (not returning after enrolment), PrEP adherence (medication possession ratio ≥0·6), and long-term PrEP engagement (attending three or more visits within 52 weeks). This study is registered at the Brazilian Registry of Clinical Trials, U1111-1217-6021.From Feb 6, 2018, to June 30, 2021, 9979 participants were screened and 9509 were enrolled (Brazil n=3928, Mexico n=3288, and Peru n=2293). 543 (5·7%) participants were transgender women, 8966 (94·3%) were cisgender men, and 2481 (26·1%) were aged 18-24 years. There were 12 185·25 person-years of follow-up. 795 (8·4%) of 9509 participants had early loss to follow-up, 6477 (68·1%) of 9509 were adherent to PrEP, and 5783 (70·3%) of 8225 had long-term PrEP engagement. Transgender women (adjusted odds ratio 1·60, 95% CI 1·20-2·14), participants aged 18-24 years (1·80, 1·49-2·18), and participants with primary education (2·18, 1·29-3·68) had increased odds of early loss to follow-up. Transgender women (0·56, 0·46-0·70), participants aged 18-24 years (0·52, 0·46-0·58), and those with primary education (0·60, 0·40-0·91) had lower odds of PrEP adherence. Transgender women (0·56, 0·45-0·71), participants aged 18-24 years (0·56, 0·49-0·64), and those with secondary education (0·74, 0·68-0·86) had lower odds of long-term PrEP engagement. HIV incidence was 0·85 per 100 person-years (95% CI 0·70-1·03) and was higher for transgender women, participants from Peru, those aged 18-24 years, Black and mixed-race participants, and participants who were non-adherent to PrEP.Same-day oral PrEP is feasible for MSM and transgender women in Latin America. Social and structural determinants of HIV vulnerability need to be addressed to fully achieve the benefits of PrEP.Unitaid, WHO, and Ministries of Health in Brazil, Mexico, and Peru.For the Portuguese and Spanish translations of the abstract see Supplementary Materials section.

Published
2023
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