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
Thiago S. Torres, Sylvia Lopes Maia Teixeira, Brenda Hoagland, Kelika A. Konda, Mônica Derrico, Ronaldo I. Moreira, Juan V. Guanira, Marcos Benedetti, Sandro Nazer, G Calvo, Silver K. Vargas, Carlos Benites, Álisson Bigolin, José Boullosa Alonso Neto, Alessandro Farias, Marcos Vinicius Guimarães de Lacerda, Daila Alena Raenck da Silva, Leidijany Costa Paz, José Valdez Madruga, Hector Javier Salvatierra Flores, Ginjaylan Prada Boluarte, Cesar Vidal Osco Tamayo, Hardy Teresa Castro Antezana, Cristina Pimenta, Annick Bórquez, Paula M. Luz, Beatriz Grinsztejn, Célia Landmann Szwarcwald, Carlos F. Cáceres, Valdiléa G. Veloso, Tania Kristic, Carla Rocha, Willian da Silva Santos, Ana Paula Lovreto Santana, Renato Lima, Carolina Fischinger Moura de Souza, Talita Andrade Oliva, Mônica dos Santos Valões, Jennifer Olivetto, Gabriel Lima Mota, Aline Barnabé Cano, Roberta Trefiglio, Carolina Coutinho, Oliver Antonio Elorreaga Reyes, Ximena Gutierrez, Fernando Olivos, Damaris Caviedes, Daniella Adriazola, Eduardo Juárez, Gabriela Mariño, Jazmin Qquellon, Francesca Vasquez, Jean Pierre Jiron, Sonia C. Flores, Karen Campos, María Eguiluz
Abstract
Background: HIV incidence estimation is critical for monitoring the HIV epidemic dynamics and the effectiveness of public health prevention interventions. We aimed to identify sexual and gender minorities (SGM) with recent HIV infections, factors associated with recent HIV infection, and to estimate annualised HIV incidence rates. Methods: Cross-sectional multicentre study in HIV testing services in Brazil and Peru (15 cities). Inclusion criteria: 18+ years, SGM assigned male at birth, not using pre-/post-exposure prophylaxis. We identified recent HIV infection using the Maxim HIV-1 LAg-Avidity EIA assay as part of a recent infection testing algorithm (RITA). Annualized HIV incidence was calculated using the UNAIDS/WHO incidence estimator tool. Multivariable logistic regression models were used to estimate factors associated with recent HIV infection. Trial registration: NCT05674682. Findings: From 31-Jan-2021 to 29-May-2022, 6899 individuals participated [Brazil: 4586 (66.5%); Peru: 2313 (33.5%)]; 5946 (86.2%) cisgender men, 751 (10.9%) transgender women and 202 (2.9%) non-binary/gender diverse. Median age was 27 (IQR: 23-34) years. HIV prevalence was 11.4% (N = 784/6899); 137 (2.0%) SGM were identified with recent HIV infection. The overall annualized HIV incidence rate was 3.88% (95% CI: 2.86-4.87); Brazil: 2.62% (95% CI: 1.78-3.43); Peru: 6.69% (95% CI: 4.62-8.69). Participants aged 18-24 years had higher odds of recent HIV infection compared to those aged 30+ years in both countries. Interpretation: Our results highlight the significant burden of HIV epidemic among SGM in large urban centres of Brazil and Peru. Public health policies and interventions to increase access to effective HIV prevention methods such as PrEP are urgently needed in Latin America. Funding: Unitaid, WHO (Switzerland), Ministry of Health from Brazil and Peru.