BACKGROUND: In recent years, human immunodeficiency virus (HIV) incidence has increased among adolescent men who have sex with men (aMSM) and transgender women (aTGW). Expanding prevention strategies, including daily oral HIV Pre-Exposure Prophylaxis (PrEP), is crucial for controlling the epidemic. Recently, PrEP offer in the Unified Health System was expanded to individuals aged between 15 and 17 years, sexually active and vulnerable to HIV. This study aimed to analyze the sociodemographic and behavioral characteristics of adolescent men who have sex with men (aMSM) and transgender women (aTGW) initiating oral PrEP in HIV prevention clinics.
METHODS: PrEP1519 is a prospective, multicenter, open-label PrEP demonstration cohort study of aMSM and aTGW aged 15–19 living in three large Brazilian capital cities. For this analysis, we included adolescents who enrolled in PrEP1519 from February 2019-August 2021 and were followed until February 2022 to assess PrEP initiation. Adolescents who visited the PrEP clinics were classified into four groups based on PrEP eligibility and on their decision to use PrEP: i) ineligible for PrEP; ii) eligible, initiated PrEP at first visit; iii) eligible, initiated PrEP after first visit; and iv) eligible, did not initiate. The groups were described and compared using the c2 and Fisher’s Exact tests.
RESULTS: Of the 1,254 adolescents who visited the PrEP clinics, 61 (4.9%) were clinically ineligible for PrEP initiation (37.7%) or had a low HIV risk (62.3%). Of the 1,193 eligible for PrEP initiation, 1,113 (93.3%) initiated PrEP, and 80 (6.7%) did not. Of the 1,113 adolescents who initiated PrEP, 87.3% did so on the same day and 12.7% later. Half of those who initiated PrEP in subsequent visits did so within 42 days from the first visit. Despite 90% of the PrEP decliners declaring a low risk of HIV infection, most reported condomless anal sex in the past six months (70%).
CONCLUSIONS: Same-day PrEP initiation among aMSM and aTGW was high, highlighting the importance and need for promoting effective PrEP offer and access among adolescents with increased vulnerability to HIV.