BACKGROUND: Access to healthcare can impact PrEP uptake, adherence, and persistence, especially among racial and ethnic minorities. Black Brazilians historically have worse health outcomes compared to white Brazilians. We evaluated HIV incidence and factors related to PrEP non-adherence among MSM and TGW from Brazil according to self-reported race.
METHODS: ImPrEP was a prospective, single-arm, open-label, implementation study of same-day oral PrEP that enrolled 9509 MSM/TGW in Brazil, Mexico, and Peru (Feb/2018-June/2021). For this analysis, we used data from Brazil (n=3928 participants from 14 HIV/STI clinics in 11 cities). We calculated HIV incidence per 100 person-years using the Poisson model for black, pardo (mixed-race), and white races. We created two logistic regression models (black/pardo and white) to identify factors associated with PrEP non-adherence (medication possession ratio (MPR)<0.6).
RESULTS: From the 3928 enrolled, 47% were white, 36% pardo/mixed, and 15% black (Table 1).

HIV incidence rate was higher among black individuals [2.16(CI95%0.54-8.63)] compared to pardo [1.49(CI95%0.48-4.62)] and white [1.00(CI95%0.25-4.01)]. Non-adherence was higher among black (26.2%) compared to pardo (24.2%) and white (18.7%) participants. TGW and young participants presented higher odds of PrEP non-adherence across all races. Among black/pardo participants, those with less education and transactional sex had higher odds of PrEP non-adherence (Figure 1).

CONCLUSIONS: Higher HIV incidence and lower PrEP adherence among pardo and black individuals highlight race disparities and the impact of structural racism on health outcomes. The implementation of public policies to mitigate racial and social inequalities is urgent in Brazil, increasing equity in health access and promoting social justice.