The Men Who Have Sex with Men HIV Care Cascade in Rio de Janeiro, Brazil

Area of Science:

• Public Health
• Epidemiology
• HIV/AIDS Research

Background:

• Brazil faces a concentrated HIV epidemic, with men who have sex with men (MSM) disproportionately affected.
• Limited data exists on the HIV care cascade specifically for the MSM population in Brazil.
• Innovative testing strategies are crucial for reaching high-risk populations.

Purpose of the Study:

• To assess the HIV care cascade among MSM and transgender women (transwomen) newly diagnosed in Rio de Janeiro.
• To identify factors associated with HIV diagnosis and engagement in care within this population.
• To inform targeted interventions for improving HIV care outcomes.

Main Methods:

• A cohort of 793 MSM and transwomen diagnosed with HIV through community-based testing was established.
• Longitudinal data on CD4 counts, viral load, and combination antiretroviral therapy (cART) were collected over 12 months.
• Generalized linear models were used to estimate relative risks for cascade stages.

Main Results:

• Of 793 individuals tested, 131 (16.5%) were diagnosed with HIV.
• One year post-diagnosis, 72.5% were linked to care, 68.7% retained, 61.1% on cART, and 38.2% virally suppressed.
• Non-white individuals and those with prior HIV testing were more likely to be diagnosed; older individuals (>30) showed higher linkage and retention.

Conclusions:

• Community-based testing effectively reached a high-risk MSM population.
• Despite Brazil's test-and-treat policy, significant gaps exist in the HIV care cascade for MSM.
• Interventions targeting non-white and younger MSM are urgently needed to improve linkage to care and cART initiation.