Prep provision in community organizations: a comparative study with conventional services

Area of Science:

• Public Health
• HIV Prevention
• Adolescent Health

Background:

• Adolescents from sexual minorities face significant social and HIV vulnerabilities.
• Access to pre-exposure prophylaxis (PrEP) is crucial for HIV prevention in this demographic.
• Community-based organizations (COs) offer an alternative to conventional health services for PrEP delivery.

Purpose of the Study:

• To compare social and HIV vulnerability between adolescents initiating PrEP in COs versus conventional services.
• To assess the timeliness of PrEP access for adolescents in COs.
• To identify characteristics of adolescents accessing PrEP through different service models.

Main Methods:

• A demonstration study in São Paulo, Brazil, involving two COs and one conventional HIV testing service (CTA).
• Eligible participants: cisgender male adolescents who have sex with men (aMSM) and transgender/gender diverse adolescents (aTTrans), aged 15-19, HIV-negative, with high-risk practices.
• Multinomial logistic regression used to analyze timely access and vulnerability indicators.

Main Results:

• 608 adolescents initiated PrEP. COs offered quicker initiation (1-7 days) compared to CTA.
• Adolescents in COs, particularly CO-outskirts, were younger and lived closer to services.
• COs were not associated with higher HIV risk practices or vulnerability, and facilitated access for those with lower Human Development Index (HDI).

Conclusions:

• PrEP provision in COs enhances access for vulnerable adolescents.
• Community-based PrEP services can play a key role in reducing health inequities.
• COs effectively reach younger and potentially more marginalized adolescent populations for HIV prevention.