PrEP provision in community organizations: a comparative study with conventional services
DOI:
https://doi.org/10.11606/s1518-8787.2024058005914Keywords:
HIV, Pre-Exposure Prophylaxis, Communitarian Organization, Adolescent, Intervention StudyAbstract
OBJECTIVE: 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 adolescents on PrEP from a conventional health service. In addition, evaluate whether these adolescents had more timely access to prophylaxis. METHOD: A study demonstrating the effectiveness of PrEP 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), travestis, transgender women, and transfeminine people (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. RESULTS: 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 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. CONCLUSION: The provision of PrEP in the COs facilitated access for vulnerable adolescents and may contribute to reducing inequities.
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Copyright (c) 2024 Alexandre Grangeiro, Paula Andrea Massa, Maria Mercedes Escuder, Eliana Miura Zucchi, Eliane Aparecida Sala, Eduardo Araujo de Oliveira, Raphaela Fini, Inês Dourado, Laio Magno, Beo Oliveira Leite, Katia Bruxvoort, Sarah MacCarthy, Marcia Thereza Couto, Maria Fernanda Tourinho Peres
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