RESUMO OBJETIVO: Avaliar se adolescentes de minorias sexuais que iniciaram a profilaxia pré-exposição sexual (PrEP) em organizações comunitárias (OC) apresentam maior vulnerabilidade social e ao HIV em comparação com adolescentes em PrEP de um serviço de saúde convencional. Além disso, avaliar se esses adolescentes tiveram um acesso mais oportuno à profilaxia. MÉTODOS: Estudo demonstrativo da efetividade de PrEP, realizado na cidade de São Paulo, em duas OC, localizadas no centro (OC-centro) e na periferia (OC-periferia), e em um serviço convencional de testagem para o HIV (CTA-centro). Foram elegíveis para PrEP, entre 2020 e 2022, adolescentes homens cisgêneros que fazem sexo com homens (aHSH), travestis, mulheres transexuais e pessoas transfemininas (aTTrans), de 15 a 19 anos, HIV-negativos e com práticas de maior risco para o HIV. Indicadores de acesso oportuno e de vulnerabilidades dos adolescentes iniciando PrEP nas OC foram analisados, tendo por referência o CTA-centro e empregando regressão logística multinomial. RESULTADOS: 608 adolescentes iniciaram PrEP nas OC e CTA-Centro. Adolescentes das OC estiveram associados a um menor tempo de início de PrEP (1–7 dias; OC-periferia: ORa = 2,91; IC95% 1,22–6,92; OC-centro: ORa = 1,91; IC95% 1,10–3,31); e a um menor IDH de moradia (OC-centro: ORa = 0,97; IC95% 0,94–1,00; OC-periferia: ORa = 0,82; IC95% 0,78–0,86). Na OC-periferia houve aumento na chance de os adolescentes serem mais jovens (ORa = 3,06; IC95% 1,63–5,75) e morarem mais próximos ao serviço (ORa = 0,82; IC95% 0,78–0,86, média 7,8 km). Enquanto adolescentes da OC-centro estiveram associados ao maior conhecimento prévio de PrEP (ORa = 2,01; IC95% 1,10–3,91) e a alta percepção de risco (ORa = 2,02; IC95% 1,18–3,44). Não estiveram associadas aos adolescentes das OC as práticas sexuais de maior risco e as situações de vulnerabilidade ao HIV. CONCLUSÕES: A oferta de PrEP nas OC facilitou o acesso de adolescentes vulnerabilizados e pode contribuir para reduzir inequidades. OBJETIVO préexposição pré exposição (PrEP (OC disso MÉTODOS Paulo OCcentro (OC-centro OCperiferia, OCperiferia , (OC-periferia) CTAcentro. CTAcentro CTA . (CTA-centro) 202 2022 aHSH, aHSH (aHSH) travestis aTTrans, aTTrans (aTTrans) 1 anos HIVnegativos negativos analisados multinomial RESULTADOS 60 CTACentro. CTACentro Centro. Centro CTA-Centro 1–7 17 7 (1– dias 2,91 291 2 91 IC95 IC 1,22–6,92 122692 22 6 92 1,91 191 1,10–3,31 110331 10 3 31 1,10–3,31) 0,97 097 0 97 0,94–1,00 094100 94 00 0,82 082 82 0,78–0,86. 078086 0,78–0,86 78 86 0,78–0,86) 3,06 306 06 1,63–5,75 163575 63 5 75 8 7, km. km km) 2,01 201 01 1,10–3,91 110391 2,02 02 1,18–3,44. 118344 1,18–3,44 18 44 1,18–3,44) CONCLUSÕES inequidades (OC-periferia (CTA-centro 20 (aHSH (aTTrans 1– (1 2,9 29 9 IC9 1,22–6,9 12269 1,9 1,10–3,3 11033 0,9 09 0,94–1,0 09410 0,8 08 07808 0,78–0,8 3,0 30 1,63–5,7 16357 2,0 1,10–3,9 11039 11834 1,18–3,4 4 ( 2, 1,22–6, 1226 1, 1,10–3, 1103 0, 0,94–1, 0941 0780 0,78–0, 3, 1,63–5, 1635 1183 1,18–3, 1,22–6 122 1,10–3 110 0,94–1 094 078 0,78–0 1,63–5 163 118 1,18–3 1,22– 12 1,10– 11 0,94– 07 0,78– 1,63– 16 1,18– 1,22 1,10 0,94 0,78 1,63 1,18 1,2 1,1 0,7 1,6
ABSTRACT OBJECTIVE: To evaluate whether adolescents from sexual minorities who initiated pre-exposure prophylaxis (PrEP) in community-based organizations (COs) are more socially and HIV-vulnerable compared with their counterparts from a conventional health service. In addition, to evaluate whether these adolescents had more timely access to prophylaxis METHODS: A PrEP demonstration study was conducted in the city of São Paulo in two COs, located in the center (CO-center) and the outskirts (CO-outskirts), and a conventional HIV testing service (CTA-center). Between 2020 and 2022, cisgender male adolescents who have sex with men (aMSM), transgender and gender diverse adolescents (aTTrans) aged 15 to 19 years, HIV-negative, with higher-risk practices for HIV were eligible for PrEP. Indicators of timely access and vulnerabilities of adolescents initiating PrEP in COs were analyzed using CTA-center as a reference and multinomial logistic regression. RESULTS: 608 adolescents initiated PrEP in COs and CTA-center. Adolescents from COs were associated with a shorter time to PrEP initiation (1–7 days; CO-outskirts: ORa = 2.91; 95%CI 1.22–6.92; CO-center: ORa = 1.91; 95%CI 1.10–3.31); and a lower housing Human Development Index (HDI) (CO-center: ORa = 0.97; 95%CI 0.94–1.00; CO-outskirts: ORa = 0.82; 95%CI 0.78–0.86). In CO-outskirts, there was an increased chance of adolescents being younger (ORa = 3.06; 95%CI 1.63–5.75) and living closer to the service (ORa = 0.82; 95%CI 0.78–0.86, mean 7.8 km). While adolescents from the CO-center were associated with greater prior knowledge of PrEP (ORa = 2.01; 95%CI 1.10–3.91) and high-risk perception (ORa = 2.02; 95%CI 1.18–3.44), adolescents from the COs were not associated with higher-risk sexual practices and situations of vulnerability to HIV. CONCLUSION: The provision of PrEP in the COs facilitated access for vulnerable adolescents and may contribute to reducing inequities. OBJECTIVE preexposure pre exposure (PrEP communitybased community based (COs HIVvulnerable addition METHODS COcenter CO (CO-center COoutskirts, COoutskirts , (CO-outskirts) CTAcenter. CTAcenter CTA . (CTA-center) 202 2022 aMSM, aMSM (aMSM) aTTrans (aTTrans 1 years HIVnegative, HIVnegative negative, negative HIV-negative higherrisk higher risk regression RESULTS 60 center. 1–7 17 7 (1– days CO-outskirts 2.91 291 2 91 95CI CI 95 1.22–6.92 122692 22 6 92 1.91 191 1.10–3.31 110331 10 3 31 1.10–3.31) HDI (HDI 0.97 097 0 97 0.94–1.00 094100 94 00 0.82 082 82 0.78–0.86. 078086 0.78–0.86 78 86 0.78–0.86) outskirts, 3.06 306 06 1.63–5.75 163575 63 5 75 8 7. km. km km) 2.01 201 01 1.10–3.91 110391 highrisk high 2.02 02 1.18–3.44, 118344 1.18–3.44 18 44 1.18–3.44) CONCLUSION inequities (CO-outskirts (CTA-center 20 (aMSM 1– (1 2.9 29 9 1.22–6.9 12269 1.9 1.10–3.3 11033 0.9 09 0.94–1.0 09410 0.8 08 07808 0.78–0.8 3.0 30 1.63–5.7 16357 2.0 1.10–3.9 11039 11834 1.18–3.4 4 ( 2. 1.22–6. 1226 1. 1.10–3. 1103 0. 0.94–1. 0941 0780 0.78–0. 3. 1.63–5. 1635 1183 1.18–3. 1.22–6 122 1.10–3 110 0.94–1 094 078 0.78–0 1.63–5 163 118 1.18–3 1.22– 12 1.10– 11 0.94– 07 0.78– 1.63– 16 1.18– 1.22 1.10 0.94 0.78 1.63 1.18 1.2 1.1 0.7 1.6