Abstract
Brazil has a concentrated HIV epidemic and men who have sex with men (MSM) are disproportionately affected. Yet, no data is available on the HIV care cascade for this population. This study aimed to assess the HIV care cascade among MSM newly diagnosed through innovative testing strategies in Rio de Janeiro. Data from 793 MSM and travestites/transgender women (transwomen) tested for HIV at a non-governmental LGBT organization and a mobile testing unit located at a gay friendly venue were analyzed. A 12-month-after-HIV-diagnosis-censored cohort was established using CD4, viral load and combination antiretroviral therapy (cART) longitudinal data from those diagnosed with HIV. A cross-sectional HIV care cascade was built using this data. The relative risks of achieving each cascade-stage were estimated using generalized linear models according to age, self-declared skin-color, education, history of sexually transmitted diseases (STD), drug use and prior HIV testing. From Jan-2013 to Jan-2014, 793 MSM and transwomen were tested, 131 (16.5%) were HIV-infected. As of January 2015, 95 (72.5%) were linked to HIV care, 90 (68.7%) were retained in HIV care, 80 (61.1%) were on cART, and 50 (38.2%) were virally suppressed one year after HIV diagnosis. Being non-white (Relative risk [lower bound; upper bound of 95% confidence interval] = 1.709 [1.145; 2.549]) and having a prior HIV-test (1.954 [1.278; 2.986]) were associated with an HIV-positive diagnosis. A higher linkage (2.603 [1.091; 6.211]) and retention in care (4.510 [1.880; 10.822]) were observed among those who were older than 30 years of age. Using community-based testing strategies, we were able to access a high-risk MSM population and a small sample of transwomen. Despite universal care coverage and the test-and-treat policy adopted in Brazil, the MSM cascade of care indicates that strategies to increase linkage to care and prompt cART initiation targeted to these populations are critically needed. Interventions targeting non-white and young MSM should be prioritized.
Highlights
The HIV epidemic among men who have sex with men (MSM) and transgender women (TGW) are showing expanding trajectories [1,2]
This study aims to assess the HIV care cascade among MSM and transwomen newly diagnosed with HIV infection through the Quero Fazer Project in Rio de Janeiro, Brazil
In Rio de Janeiro, community-based out of health-care testing using HIV rapid tests were offered in two venues: 1) once a week, on Wednesday evenings, at a mobile testing unit located in front of a unique popular LGBT venue; 2) four days a week, from Monday to Thursday, after working hours, at the site of ArcoÍris Group, a well-known LGBT non-governmental organization (NGO)
Summary
The HIV epidemic among men who have sex with men (MSM) and transgender women (TGW) are showing expanding trajectories [1,2]. In Brazil, while the HIV prevalence in the general population is 0.6%, among MSM it is 14.2% [4], reinforcing that this population, especially the very young MSM [5], is disproportionately affected by HIV infection in the country [6]. TGW represent smaller population than MSM, they have extremely elevated HIV infection rates. A meta-analysis of data from 15 countries estimated an HIV prevalence of 17.7% (95% CI 15.6–19.8) in this population, with an odds ratio of 50.0 (95% CI 26.5–94.3) for HIV infection among TGW versus all adults of reproductive age in low- and middle-income countries [7]. In Brazil, HIV testing at no cost is available in public health care centers as well as in 383 voluntary counseling and testing (VCT) units across the country. Infrequent testing remains a barrier for maintaining accurate HIV serostatus awareness even among those who have previously been tested [13]
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