Recent HIV infections and estimated HIV incidence among adolescents from key populations
DOI:
https://doi.org/10.11606/s1518-8787.2024058005997Palavras-chave:
Adolescent, Sexual and Gender Minorities, HIV infectionsResumo
OBJETIVE: To identify recent HIV-1 infection and estimate HIV incidence among adolescent men who have sex with men (AMSM) and transgender women (ATGW) in Brazil.
METHODS: From January to December 2020, a cross-sectional analysis was conducted with baseline data from the PrEP1519 study, an HIV pre-exposure prophylaxis (PrEP) demonstration cohort in Brazil among sexually active AMSM/ATGW aged 15–19. For enrollment, participants were screened with a fourth-generation HIV rapid test. The recent infection testing algorithm (RITA) included a recency assay in blood specimens, viral load, and CD4 cell count prior to antiretroviral treatment use. Among these participants, RITA-based HIV incidence was estimated using a mean duration of recency infection of 214 days and a false-recent rate of 0.02. RESULTS: Out of the 494 participants screened, 21 tested positive for HIV. Following RITA, five adolescents had a recent HIV infection, 14 had long-term infections, and two did not have blood specimens available. We classified these two participants as long-term infection cases due to CD4 cell counts and previous use of antiretroviral treatment. Among those who tested positive, all but one were AMSM (94.7%), 73.6% were aged 18–19, and 76.2% were non-White. The HIV prevalence was 4.2%, and the estimated HIV incidence was 1.7%.
CONCLUSIONS: The estimated incidence highlights the need for targeted HIV prevention interventions, such as PrEP, for sexual minority adolescents. Integrating RITA into routine HIV testing services for this population provides valuable information on the current HIV epidemic. This strategy can aid in monitoring the effectiveness of prevention efforts and improving early entry to HIV care.
Referências
United Nations Programme on HIV/AIDS. UNAIDS epidemiological estimates, 2023. Geneva: UNAIDS; 2023 [cited Oct 31, 2023]. Available from: https://aidsinfo.unaids.org/.
Stutterheim SE, van Dijk M, Wang H, Jonas KJ. The worldwide burden of HIV in transgender individuals: An updated systematic review and meta-analysis. PLoS One. 2021 Dec;16(12): e0260063.
Coelho LE, Torres TS, Veloso VG, Grinsztejn B, Jalil EM, Wilson EC, McFarland W. The Prevalence of HIV Among Men Who Have Sex With Men (MSM) and Young MSM in Latin America and the Caribbean: A Systematic Review. AIDS Behav. 2021 Oct; 25(10):3223-37.
Ministério da Sáude (BR). Boletim Epidemiológico - HIV/AIDS 2022. Brasília, DF: Ministério da Saúde; 2022.
Szwarcwald CL, Júnior PRB de S, Pascom ARP, Coelho RA, Ribeiro RA, Damacena GN, et al. HIV incidence estimates by sex and age group in the population aged 15 years or over, Brazil, 1986-2018. Rev Soc Bras Med Trop. 2022; 55(Suppl. 1). https://doi.org/10.1590/0037-8682-0231-2021
Hosek SG, Landovitz RJ, Kapogiannis B, Siberry GK, Rudy B, Rutledge B, Liu N et al. Safety and feasibility of antiretroviral preexposure prophylaxis for adolescent men who have sex with men aged 15 to 17 years in the United States. JAMA Pediatr. 2017 Nov;171(11):1063-71.
Pettifor A, Stoner M, Pike C, Bekker L-G. Adolescent lives matter: preventing HIV in adolescents. Curr Opin HIV AIDS 2018 May;13(3):265-73.
Magno L, Marinho LFB, Zucchi EM, Amaral AMS, Lobo TCB, Paes HCS, et al. School-based sexual and reproductive health education for young people from low-income neighbourhoods in Northeastern Brazil: the role of communities, teachers, health providers, religious conservatism, and racial discrimination. Sex Educ. 2022 Feb;23:409-24. https://doi.org/10.1080/14681811.2022.2047017
Phillips G, Wang X, Ruprecht MM, Stephens R, Costa D, Beach LB, Janulis P. Associations between HIV Testing and Consent Policies among Sexually Active Adolescents: Differences by Sexual Behavior. AIDS Care. 2022 Jul;34(7):862-8.
Chandra-Mouli V, Svanemyr J, Amin A, Fogstad H, Say L, Girard F, Temmerman M. Twenty years after international conference on population and development: Where are we with adolescent sexual and reproductive health and rights? J Adolesc Health. 2015 Jan;56(1 Suppl):S1-6.
Damacena GN, Szwarcwald CL, Motta LR, Kato SK, Adami AG, Paganella MP, et al. A portrait of risk behavior towards HIV infection among Brazilian Army conscripts by geographic regions, 2016. Rev bras epidemiol. 2019;22(Suppl 1). https://doi.org/10.1590/1980-549720190009.supl.1
World Health Organization. HIV and adolescents: guidance for HIV testing and counselling and care for adolescents living with HIV. Geneva: WHO; 2013 [cited June 2024, 11]. Available from: www.who.int.
World Health Organization. Using recency assays for HIV surveillance 2022 technical guidance. Geneva: WHO; 2022 [cited June 2024, 11]. Available from: https://www.who.int/publications/i/item/9789240064379.
Parkin N, Gao F, Grebe E, Cutrell A, Das M, Donnell D, et al. Facilitating Next-Generation Pre-Exposure Prophylaxis Clinical Trials Using HIV Recent Infection Assays: A Consensus Statement from the Forum HIV Prevention Trial Design Project. Clin Pharmacol Ther. 2023 Jul;114(1):29-40.
Magno L, Soares F, Zucchi EM, et al. Reaching Out to Adolescents at High Risk of HIV Infection in Brazil: Demand Creation Strategies for PrEP and Other HIV Combination Prevention Methods. Arch Sex Behav. 2023 Feb;52(2):703-19.
Dourado I, Magno L, Greco DB, Zucchi EM, Ferraz D, Wextin MR, Grangeiro A. Interdisciplinarity in HIV prevention research: the experience of the PrEP1519 study protocol among adolescent MSM and TGW in Brazil. Cad Saude Publica. 2023;39(Suppl 1). https://doi.org/10.1590/0102-311XEN143221
Sempa JB, Welte A, Busch MP, Hall J, Hampton D, Facente SN, et al. Performance comparison of the Maxim and Sedia Limiting Antigen Avidity assays for HIV incidence surveillance. PLoS One. 2019;14. https://doi.org/10.1371/journal.pone.0220345
Szwarcwald CL, Ferreira Júnior OC, Brito AM, Luhm KR, Ribeiro CEL, Silva AM, et al. Estimation of HIV incidence in two Brazilian municipalities, 2013. Rev Saude Publica. 2016;50. https://doi.org/10.1590/S1518-8787.2016050006310
De Castro CAV, Grinsztejn B, Veloso VG, Bastos FI, Pilotto JH, Morgado MG. Prevalence, estimated HIV-1 incidence and viral diversity among people seeking voluntary counseling and testing services in Rio de Janeiro, Brazil. 2004;10. https://doi.org/10.1186/1471-2334-10-224
Teixeira SL, Jalil CM, Jalil EM, et al. Evidence of an untamed HIV epidemic among MSM and TGW in Rio de Janeiro, Brazil: a 2018 to 2020 cross-sectional study using recent infection testing. J Int AIDS Soc. 2021 Jun;24(6):e25743. https://doi.org/10.1002/jia2.25743
Torres S, Teixeira SLM, Hoagland B, Konda KA, Derrico M, Moreira RI, et al. Recent HIV infection and annualized HIV incidence rates among sexual and gender minorities in Brazil and Peru (ImPrEP seroincidence study): a cross-sectional, multicenter study. Lancet. 2023 [cited June 2024, 11]. Available from: https://ssrn.com/abstract=4496145.
Dourado I, Soares F, Magno L, Amorim L, Eustorgio Filho M, Leite B, et al. Adherence, Safety, and Feasibility of HIV Pre-Exposure Prophylaxis Among Adolescent Men Who Have Sex With Men and Transgender Women in Brazil (PrEP1519 Study). J Adolesc Health. 2023 Dec;73(6S):S33-42.
Dourado I, Mullick S, Magno L, Grangeiro A. Implementing Differentiated and Integrated PrEP Services for Adolescent Key Populations: What Works and What Is the Way Forward? J Adolesc Health. 2023 Dec;73(6S):S4-7. https://doi.org/10.1016/j.jadohealth.2023.08.045
Magno L, Pereira M, de Castro CT, Rossi TA, Azevedo LMG, Guimarães NS, Dourado I. HIV Testing Strategies, Types of Tests, and Uptake by Men Who have Sex with Men and Transgender Women: A Systematic Review and Meta-analysis. AIDS Behav. 2023 Feb;27(2):678-707.
Katirayi L, Akuno J, Kulukulu B, Masaba R. “When you have a high life, and you like sex, you will be afraid”: a qualitative evaluation of adolescents’ decision to test for HIV in Zambia and Kenya using the health belief model. BMC Public Health. 2021;21. https://doi.org/10.1186/s12889-021-10391-x
Magno L, de Medeiros DS, Soares F, Grangeiro A, Caires P, Fonseca T, et al. Factors associated to HIV prevalence among adolescent men who have sex with men in Salvador, Bahia State, Brazil: baseline data from the PrEP1519 cohort. Cad Saude Publica. 2023;39(Suppl 1). https://doi.org/10.1590/0102-311XEN154021
Dourado I, Magno L, Soares F, Massa P, Nunn A, Dalal S, et al. Adapting to the COVID-19 Pandemic: Continuing HIV Prevention Services for Adolescents Through Telemonitoring, Brazil. AIDS Behav. 2020;24(7): 1994-9.
Downloads
Publicado
Edição
Seção
Licença
Copyright (c) 2024 Diana Zeballos, Fabiane Soares, Laio Magno, Celia Landmann Szwarcwald, Orlando Ferreira, Mateus Westin, Dirceu Greco, Alexandre Grangeiro, Inês Dourado
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
