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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.

espanolObjetivo. Evaluar las prevalencias de marcadores de infec-cion por T. pallidum en personas que viven con VIH y reciben tratamiento antirretroviral en el Programa de VIH/SIDA de la Ciudad de Mexico, asi como sus caracteristicas asociadas. Material y metodos. Se siguio el metodo del algoritmo reverso para el diagnostico de T. pallidum aplicado a 2 383 individuos VIH positivos, quienes contestaron un cuestionario sobre caracteristicas sociodemograficas, practicas sexuales, diagnostico previo de sifilis y tiempo de tratamiento anti-rretroviral. Las variables significativamente asociadas con los marcadores de sifilis se analizaron mediante un modelo de regresion logistica. Resultados. Las prevalencias de marcadores de infeccion “activa o resuelta” y “probable-mente activa” fueron 44.2 y 28.8%, respectivamente. Las caracteristicas asociadas con los marcadores fueron Clinica Especializada Condesa Iztapalapa (CECI), diagnostico previo de infeccion por sifilis, hombres que tienen sexo con hom-bres (HSH) y practicas sexuales receptivas. Conclusiones.Las prevalencias de marcadores de infeccion por T. pallidumfueron altas y estuvieron relacionadas con practicas sexuales especificas y con el diagnostico previo de sifilis, caracteristicas que requieren medidas preventivas dentro del programa. EnglishObjective. The aim of this study is to evaluate the prevalence of T. pallidum infection markers in HIV-positive individuals receiving highly active antiretroviral therapy (ART) in the Mexico City HIV/AIDS Program, as well as predictive characteristics. Materials and methods. The reverse serologic algorithm method was used for the T. pallidum diagnosis, and applied to 2 383 HIV-positive individuals. Sociodemographic characteristics, sexual practices, previous syphilis diagnosis, and length of antiretroviral treatment, were evaluated. Variables significantly associated with syphilis markers were analyzed using a logistic regression model. Results. Prevalence of “active or resolved” and “probable active” infection markers were 44.2 and 28.8%, respectively. Predictive factors were: Clinica Especializada Condesa Iztapalapa (CECI), previous syphilis diagnosis, men in who have sex with men (MSM), and receptive sex practices. Conclusions. The prevalence of T. pallidum infection markers was the highest ever reported in Mexico, and was related to specific sexual practices as well as previous syphilis diagnosis, elements which require preventive measures in the Mexico City HIV/AIDS Program.

Background: Human immunodeficiency virus (HIV) incidence should be calculated in cross-sectional studies using recent infection testing algorithms (RITA) that consider clinical variables and serological test results such as enzyme-linked immunosorbent assay (ELISA) and dried blood spot (DBS) analysis. Methods: The correlation between serum samples and DBS was evaluated using two commercial ELISA kits: SediaTM BED HIV-1 Incidence EIA (BED-Sedia) and Maxim HIV-1 Limiting Antigen Avidity (LAg-Avidity). Eight different RITAs were developed; all of them included serological assays. A combination of the variables viral load, antiretroviral therapy (ART) and CD4 count was used to build the RITAs. The sensitivity, specificity, Youden index, predictive positive value, predictive negative value, false recent rate (FRR) and false long-term rate were evaluated. Results: The correlations between serum samples and DBS were 0.990 and 0.867 for BED-Sedia and LAg-avidity, respectively. Using only serological assays, the Youden index was higher for LAg-avidity than BED-Sedia (82.1–83.0% versus 69.2–69.6%). The best RITA was ART-serology, which showed a Youden index of 91.2–93.9% and FRR of 1.8–2.2%. Conclusions: Using DBS samples to determine HIV incidence is a good tool for epidemiological surveillance. The RITA that included ART and serological tests (BED-Sedia or LAg-avidity) showed the highest sensitivity and specificity and a low FRR. Keywords: HIV serodiagnosis, Incidence, Dried blood spot testing, Serologic tests

Objective: To describe results of HIV, sexually transmitted diseases (STI) and CD4 counts at the HIV-specialized Condesa Clinic (CC) in Mexico City. Materials and methods: Individuals who requested voluntary counseling and testing at CC were studied. We identified antibodies against HIV, syphilis, hepatitis C, and hepatitis B HBsAg. CD4 cell counts and viral load of HIV positive individuals were also obtained. Late HIV infection diagnosis was established if CD4 counts were lower than 200 cells/μL. Results: Global seroprevalence of HIV, syphilis, HBsAg, and anti HCV markers was of 20.1, 6, 1 and 1, respectively. Men displayed higher seroprevalence of infection markers than women. Among men, HIV infection was related to age and with all STI markers. Late HIV diagnosis was 31.8%. The risk of late HIV diagnosis was higher among women and it increased as age increased. Conclusions: Differences between genders regarding HIV and STIs prevalence as well as risk factors for HIV infection and late HIV diagnosis were observed.