Interdisciplinarity in HIV prevention research: the experience of the PrEP1519 study protocol among adolescent MSM and TGW in Brazil

Dourado, Ines; Magno, Laio; Greco, Dirceu Bartolomeu; Zucchi, Eliana Miura; Ferraz, Dulce; Westin, Mateus Rodrigues; Grangeiro, Alexandre

doi:10.1590/0102-311XEN143221

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Brasil

Cadernos de Saúde Pública

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Brasil

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Sumário

QUESTÕES METODOLÓGICAS • Cad. Saúde Pública 39 (Suppl 1) • 2023 • https://doi.org/10.1590/0102-311XEN143221 copy

Interdisciplinarity in HIV prevention research: the experience of the PrEP1519 study protocol among adolescent MSM and TGW in Brazil

Interdisciplinaridade na pesquisa sobre prevenção do HIV: a experiência do protocolo de estudo PrEP1519 entre HSH adolescentes e mulheres trans no Brasil

Interdisciplinariedad en la investigación de la prevención del VIH: la experiencia del protocolo de estudio PrEP1519 entre adolescentes HSH y TGW en Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

At the end of 2017, Brazil adopted HIV pre-exposure prophylaxis (PrEP) as part of a combination prevention strategy for the most at-risk populations. However, Brazil does not have specific guidelines for PrEP use among adolescents aged < 18 years. Therefore, researchers from different health disciplines conducted PrEP1519, the first PrEP demonstration cohort study, ongoing in three Brazilian cities - Salvador, Belo Horizonte, and São Paulo - among adolescent men who have sex with men and transgender women, aged 15-19 years. This study aims to evaluate the effectiveness of PrEP in real-world settings. Quantitative and qualitative methods were integrated to obtain data on PrEP acceptability, uptake, use, and adherence. Moreover, comprehensive services and friendly environments were implemented in the PrEP1519 clinics. This study aims to describe the collaborative efforts of interdisciplinary practices in the development of the PrEP1519 study. The articulation of researchers from different institutions and areas is challenging; but it also allows for a broader outlook on questions regarding the direction of the research, while enriching the decisions needed to be taken during the interactions and negotiations among the different individuals, including the youth team and participants. Furthermore, it reflects on the communication process between cultures and languages considering the trans-epistemic arena of knowledge production about HIV, sexually transmitted infections, PrEP, and other combination prevention strategies for adolescents.

Keywords:
HIV; Pre-Exposure Prophylaxis; Adolescents; Men Who Have Sex With Men; Transgender Women

RECRUITMENT AND PEER EDUCATION
Recruitment based on the activities of peer-educators with youth at venues and schools, on social media platforms (Instagram, Facebook, WhatsApp, YouTube, TikTok, Spotify), and on hook up apps (Grindr, Tinder, Hornet, and Badoo) Artificial intelligence via the Amanda Selfie chabot through sponsored posts in Instagram promoting key prevention messages (HIV and STI prevention) with focus on AMSM and ATGW Community mobilization by promoting PrEP at LGBTQIA+ parties and venues, promotional videos and flyers on social media platforms (Instagram and YouTube), and radio programs on Spotify Promotional videos on social media platforms, radio programs on Spotify and “livestreaming”, and IGTV in the Instagram, led by peer-educators featuring drag queens and digital influences. They use an LGBTQIA+ culture approach and talk about sex, hormone therapy, and art focused on AMSM and ATGW (https://www.instagram.com/preparasalvador/?hl=pt-br and https://instagram.com/vcprepsp?igshid=dyf76oj8lef7) Moreover, messages, photos, podcasts, playlists, and flyers posted in Project Instagram has had great success in reaching new and young LGBTQIA+ followers
NAVIGATION AND PEER NAVIGATION
After PrEP initiation, peer-navigators were assigned to follow-up the needs of each participant The follow-up is mostly online, through social media platforms and smartphone text messages Peer-navigators emphasize and monitors PrEP adherence at PrEP initiation, and PrEP continuation biweekly and monthly The nurse and the doctor supervise this work The communication channels between participants and peer-navigators are open to allow participants to initiate a conversation according to their needs Peer-navigators helps to schedule face-to-face appointments and/or telehealth
PrEP INITIATION
For PrEP enrollment, a mix of telehealth appointment and face to face appointments are scheduled by the participant, or walk-ins Eligibility assessment for PrEP use, clinical evaluation, HIV rapid tests, blood sample collection for STI tests and safety tests that assesses kidney and liver function for PrEP use, and distribution of PrEP for one month In-person interviews were conducted for sociobehavioral questionnaires. Nevertheless, online interviews were conducted during COVID-19 pandemic During COVID-19 pandemic some cares were adopted: on-site staff conducts phone calls to all participants scheduled for the day before their appointment to confirm their intention to attend the visit and to inquire about COVID-19 symptoms: fever (> 37.7ºC), cough, runny nose, shortness of breath or difficulty breathing, muscle pain, or anosmia. If any of these symptoms are reported, their visit is postponed and they receive guidance on COVID-19 management and resources. The team informs on COVID-19 protection for in-person appointments. The temperature of all participants is measured on arrival
PrEP CONTINUATION
Participants attended follow up visits after baseline (1^st month and then every three months). At each visit: clinical evaluation, HIV rapid tests, collection of blood samples for STI serological tests such as HIV, syphilis, viral hepatitis and HTLV, and for safety tests that assesses kidney and liver function for PrEP use; collection of dried blood spots (DBS) for direct assessing cumulative adherence to TDF based therapy; pharyngeal, rectal and urethral swabs for chlamydia and gonorrhea tests; and distribution of PrEP for three month During COVID-19 pandemic, for participants who chose telehealth to continue their use of PrEP, the health team evaluates them for any clinical impediments. If none, two HIVST and 120 PrEP pills are mailed to the preferred address on online forms that also contain an informed consent to be checked. Health team reinforce that it is necessary to perform the HIVST, to send the negative HIV test result to the doctor before opening a new PrEP bottle, and to repeat this procedure quarterly until quarantine measures are over In-person and sociobehavioral questionnaires are conducted. The online interviews (after COVID-19) are monitored by team members Site staff conducts a phone call to all participants scheduled for the day before their appointment to confirm their intention to attend the visit, and inquire about COVID-19 symptoms: fever (> 37.7ºC), cough, runny nose, shortness of breath or difficulty breathing, muscle pain, or anosmia. If any of these symptoms are reported, their visit is postponed and they receive guidance on COVID-19 management and resources. The team informs on COVID-19 protection for in-person appointments. The temperature of all participants is measured on arrival

Prevalence of PrEP adherence	Tolerable error margin	Sample size
49%	10%	816
	20%	203
	30%	89
	50%	31

Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz Rua Leopoldo Bulhões, 1480 , 21041-210 Rio de Janeiro RJ Brazil, Tel.:+55 21 2598-2511, Fax: +55 21 2598-2737 / +55 21 2598-2514 - Rio de Janeiro - RJ - Brazil
E-mail: cadernos@ensp.fiocruz.br

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[1] Correspondence
I. Dourado Instituto de Saúde Coletiva, Universidade Federal da Bahia. Rua Basílio da Gama s/n, Salvador, BA 40110-040, Brasil. ines.dourado@gmail.com