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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.