Network meta-analytical evaluations of the performance of HIV combination prevention strategies for transsexual...

Combination HIV prevention approaches, integrating behavioral, biomedical, and social components, have shown promise but remain under-evaluated in trans-specific contexts. This work aimed to compare the effectiveness of different HIV prevention strategies among transgender populations through a network meta-analysis. A systematic search was conducted through PRISMA-NMA 2020 across PubMed, SciELO, LILACS, and Science Direct (2000-2025) using descriptors related to HIV, combined prevention, and Transgender populations. Only original quantitative studies reporting effect measures of interventions were included, using the condom usage behavior as common comparator: A) Restrictive sexual behavior + Safer sex self-efficacy; B) Restrictive sexual behavior + Safe sex with a condom; C) Restrictive sexual behavior + Safe sex with a condom + Social Support. Mean, SD, SE and 95% CI were estimated, and interventions were ranked using SUCRA radial. Four studies and 9 interventions were included. The most effective strategy was safer receptive sex with transgender people (SUCRA 84.3%), followed by safer sex with non-transgender males (SUCRA 66.11%). Direct and indirect comparisons indicated that interventions promoting safer receptive sex practices among transgender individuals were more effective than those targeting condom use behavior alone. The inclusion of gender-specific content and social support appears to enhance the impact of prevention strategies.