Universidade de São Paulo. Faculdade de Medicina. São Paulo, SP, Brasil.
Secretaria de Estado da Saúde de São Paulo. Instituto de Saúde. São Paulo, SP, Brasil.
Rev Saude Publica. 2024 Oct 11;58(suppl 1):9s. doi: 10.11606/s1518-8787.2024058005914. eCollection 2024.
To evaluate whether adolescents from sexual minorities who initiated pre-exposure prophylaxis (PrEP) in community-based organizations (COs) are more socially and HIV-vulnerable compared with their counterparts from a conventional health service. In addition, to evaluate whether these adolescents had more timely access to prophylaxis.
A PrEP demonstration study was conducted in the city of São Paulo in two COs, located in the center (CO-center) and the outskirts (CO-outskirts), and a conventional HIV testing service (CTA-center). Between 2020 and 2022, cisgender male adolescents who have sex with men (aMSM), transgender and gender diverse adolescents (aTTrans) aged 15 to 19 years, HIV-negative, with higher-risk practices for HIV were eligible for PrEP. Indicators of timely access and vulnerabilities of adolescents initiating PrEP in COs were analyzed using CTA-center as a reference and multinomial logistic regression.
608 adolescents initiated PrEP in COs and CTA-center. Adolescents from COs were associated with a shorter time to PrEP initiation (1-7 days; CO-outskirts: ORa = 2.91; 95%CI 1.22-6.92; CO-center: ORa = 1.91; 95%CI 1.10-3.31); and a lower housing Human Development Index (HDI) (CO-center: ORa = 0.97; 95%CI 0.94-1.00; CO-outskirts: ORa = 0.82; 95%CI 0.78-0.86). In CO-outskirts, there was an increased chance of adolescents being younger (ORa = 3.06; 95%CI 1.63-5.75) and living closer to the service (ORa = 0.82; 95%CI 0.78-0.86, mean 7.8 km). While adolescents from the CO-center were associated with greater prior knowledge of PrEP (ORa = 2.01; 95%CI 1.10-3.91) and high-risk perception (ORa = 2.02; 95%CI 1.18-3.44), adolescents from the COs were not associated with higher-risk sexual practices and situations of vulnerability to HIV.
The provision of PrEP in the COs facilitated access for vulnerable adolescents and may contribute to reducing inequities.
评估在社区组织（COs）中启动暴露前预防（PrEP）的性少数群体青少年与来自传统卫生服务机构的同龄人相比，是否在社会和 HIV 方面更脆弱。此外，评估这些青少年是否能更及时地获得预防措施。
在圣保罗市的两个 COs（中心 CO-center 和郊区 CO-outskirts）和一个传统的 HIV 检测服务机构（CTA-center）中开展了 PrEP 示范研究。在 2020 年至 2022 年间，符合条件的青少年为年龄在 15 至 19 岁之间、跨性别和性别多样化的青少年（aTTrans）、与男性发生性关系的顺性别男性青少年（aMSM），他们 HIV 阴性，且具有更高的 HIV 风险行为。使用 CTA-center 作为参考，对 COs 中启动 PrEP 的青少年的及时获得和脆弱性指标进行了分析，并采用多项逻辑回归进行了评估。
608 名青少年在 COs 和 CTA-center 中启动了 PrEP。来自 COs 的青少年与更短的 PrEP 启动时间（1-7 天；CO-outskirts：ORa=2.91；95%CI 1.22-6.92；CO-center：ORa=1.91；95%CI 1.10-3.31）和较低的住房人类发展指数（HDI）（CO-center：ORa=0.97；95%CI 0.94-1.00；CO-outskirts：ORa=0.82；95%CI 0.78-0.86）有关。在 CO-outskirts，青少年更年轻（ORa=3.06；95%CI 1.63-5.75）和居住位置离服务机构更近（ORa=0.82；95%CI 0.78-0.86，平均距离 7.8 公里）的可能性增加。而来自 CO-center 的青少年与 PrEP 相关的先前知识（ORa=2.01；95%CI 1.10-3.91）和高风险认知（ORa=2.02；95%CI 1.18-3.44）更高有关，但他们的性风险行为和 HIV 脆弱性状况并没有增加。
在 COs 提供 PrEP 有助于弱势青少年获得预防措施，并可能有助于减少不平等现象。
