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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
29 Pages Posted: 5 Jul 2023
More...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 recent HIV infections and associated factors, and to estimate annualized HIV incidence rates.
Methods: Cross-sectional multicenter study in HIV testing services in Brazil and Peru (15 cities). Inclusion criteria: 18+ years, sexual and gender minorities (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 who have sex with 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 (17·5%) were classified as recent HIV infection. The overall annualized HIV incidence rate was 3·88% (95%CI:3·40-4·36); Brazil: 2·62% (95%CI:2·14-3·10); Peru: 6·69% (95%CI:5·57-7·81). Participants aged 18-24 years had higher odds of recent HIV infection compared to 30+ years in both countries.
Interpretation: High levels of recent HIV infection and incidence rate among SGM in Brazil and Peru highlight the burden of the HIV epidemic in these populations. Public health policies and interventions to increase access to effective HIV prevention methods such as PrEP are urgently needed in Latin America.
Trial Registration: The study was registered at ClinicalTrials.gov, NCT05674682.
Funding: Unitaid, WHO, Ministry of Health from Brazil and Peru.
Declaration of Interest: Nothing to declare.
Ethical Approval: Institutional review boards at Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (Rio de Janeiro, Brazil; #CAAE:20012619.9.1001.5262) and Universidad Peruana Cayetano Heredia (Lima, Peru; #104717) approved the study. Ethical approvals were also obtained from the WHO Research Ethics Review Committee ERC and local IRB at each Brazilian site. All study participants provided written informed consent in Portuguese (Brazil) or Spanish (Peru) before enrollment.
Keywords: HIV incidence rate, HIV seroincidence, HIV recency, sexual and gender minorities, HIV, Latin America, public health
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