Avaliação de fatores preditores de sífilis e adesão a PrEP oral diária entre gays, bissexuais e outros homens que fazem sexo com homens (HSH), mulheres transgênero e travestis (MTTr) com risco substancial de infecção pelo HIV em estudo multicêntrico demonstrativo da efetividade da profilaxia pré-exposição (PrEP). Estudo PrEP1519 Brasil.

Abstract

Young people and adolescents are a group disproportionately affected by HIV. Being a gay, bisexual, travesti, or transgender teenager means facing even greater challenges in terms of risk and vulnerability to HIV and other sexually transmitted infections, a fact for which these groups represent a key population for the implementation of structural, behavioral, and biomedical interventions. PrEP is a strategy that has proven to be safe and effective in preventing HIV infection among this population and other key populations. However, very little is known about the real impact of its use on the daily life of young people and adolescents. The aim of present study was to evaluate sociodemographic factors and baseline sexual practices related to the prevalence of syphilis at entry and to predictors of adherence to PrEP by self-report among adolescents which self-identified as Gay, Bisexual, and other Men who have Sex with Men (MSM), Travesti and Transgender Women (TGW) aged 15-19 years at risk of HIV Infection. The PrEP 15–19 project is a Brazilian multicenter demonstrative study approved by the WHO Ethics Review Committee, and by the Brazilian Research Ethics Commission and by the local Research Ethics Committees of the participating universities (UFMG, UFBA and USP). Inclusion was voluntary after the informed consent form was singed. Participants were allocated into two groups: with or without PrEP use, according to vulnerability assessment and preference. The analyses were carried out with different dimensions of vulnerability to HIV infection, and logistic regression models were constructed to estimate the odds ratios of the association between the predictive variables and the levels of adherence at visits M1, M6, and M12, as well as its association with a positive treponemal test for syphilis at study entry. In total, 935 participants were analyzed. The median age was 19 years (IQR: 18–19); 69% (645) self-identified as black; 91.1% (852) as cisgender men; and 8.8% (82) as travesti or trans women. Approximately 26% (251) of the participants showed, over the 12 months of follow-up, insufficient adherence, or less than 90% by self-report. In the final multivariate analysis, a greater chance of poor adherence was associated with being unemployed (OR = 1.34; 95%CI: 1.00–1.8), having transactional sex (OR = 1.75; 95%CI: 1.10–2.79), and having a self-perceived risk of HIV infection <5 (OR = 1.51; 95%CI: 1.06-2.16). On the other hand, the baseline prevalence of syphilis was 21.3%. In the final logistic regression model, the following variables were associated with higher odds of syphilis: self-report of an STI episode in the last 12 months (OR = 5.92; 95%CI: 3.74–9.37), being a sex worker (OR = 3.39; 95%CI: 1.32–8.78), and less than 11 years of schooling (OR = 1.76; 95%CI: 1.13-2.74). This data reiterates known vulnerability factors and point to the need to strengthen PrEP programs in public health with adequate discussion on social class, race, gender, sexuality, and combination prevention, as well as expanding and facilitating access to all combination prevention tools, including PrEP, for this age group.