ABSTRACT OBJECTIVE: Viral hepatitis and sexually transmitted infections disproportionally affect men who have sex with men (MSM) and transgender women (TGW). However, only a few studies have evaluated the prevalence of hepatitis in these populations, especially in youths and adolescents. This study aimed to estimate the prevalence of biomarkers for hepatitis A, B, and C among young and adolescent MSM and TGW in three Brazilian municipalities. METHODS: Baseline data were collected from a combination of HIV prevention cohort of young and adolescent MSM (AMSM) and TGW (ATGW) aged 15-19 years in three Brazilian municipalities. A social behavioral questionnaire was applied, and immunoassays were performed to detect antibodies against hepatitis A (anti- HAV IgG and IgM), hepatitis B (anti-HBc and anti-HBs), and hepatitis C virus (anti-HCV); testing for the active hepatitis B marker, HBsAg, was also performed. The prevalence of reactive tests and 95% confidence interval (CI) for proportions were measured. RESULTS: The prevalence of naturally or artificially acquired immunity for hepatitis A totaled 17.7% (95%CI: 15.4-20.4), whereas that of acute infection, 0.4% (95%CI: 0.2-1.2). For hepatitis B and C, prevalence rates totaled 2.8% (95%CI: 1.8-4.4) and 0.2% (95%CI: 0.1-1.1), respectively. About 25.7% (95%CI: 22.4-29.4) of participants were non-reactive for anti-HBc and reactive for anti-HBs, the latter being a vaccine marker for hepatitis B. CONCLUSIONS: The investigation of viral hepatitis biomarkers among vulnerable populations enables the early identification of infections, the provision of timely treatment, and an opportunity to point out the need to expand vaccination coverage.

ABSTRACT OBJECTIVE: Viral hepatitis and sexually transmitted infections disproportionally affect men who have sex with men (MSM) and transgender women (TGW). However, only a few studies have evaluated the prevalence of hepatitis in these populations, especially in youths and adolescents. This study aimed to estimate the prevalence of biomarkers for hepatitis A, B, and C among young and adolescent MSM and TGW in three Brazilian municipalities. METHODS: Baseline data were collected from a combination of HIV prevention cohort of young and adolescent MSM (AMSM) and TGW (ATGW) aged 15-19 years in three Brazilian municipalities. A social behavioral questionnaire was applied, and immunoassays were performed to detect antibodies against hepatitis A (anti- HAV IgG and IgM), hepatitis B (anti-HBc and anti-HBs), and hepatitis C virus (anti-HCV); testing for the active hepatitis B marker, HBsAg, was also performed. The prevalence of reactive tests and 95% confidence interval (CI) for proportions were measured. RESULTS: The prevalence of naturally or artificially acquired immunity for hepatitis A totaled 17.7% (95%CI: 15.4-20.4), whereas that of acute infection, 0.4% (95%CI: 0.2-1.2). For hepatitis B and C, prevalence rates totaled 2.8% (95%CI: 1.8-4.4) and 0.2% (95%CI: 0.1-1.1), respectively. About 25.7% (95%CI: 22.4-29.4) of participants were non-reactive for anti-HBc and reactive for anti-HBs, the latter being a vaccine marker for hepatitis B. CONCLUSIONS: The investigation of viral hepatitis biomarkers among vulnerable populations enables the early identification of infections, the provision of timely treatment, and an opportunity to point out the need to expand vaccination coverage.

Resumo O contexto brasileiro de desigualdades sociais e barreiras no acesso aos serviços de saúde pode agravar a situação da pandemia de COVID-19, que já afeta todos os estados da federação, com a curva crescente de aumento de casos confirmados e mortes. O governo dos países e os agentes do campo científico têm buscado evidências para as melhores práticas de prevenção e controle da transmissão, e cuidado da infecção e doença, incluindo medidas de diagnóstico, tratamento e de atenção à saúde. A estratégia de testagem em larga escala, visando o diagnóstico precoce, quarentena dos casos leves identificados, bem como dos contactantes, e cuidado adequado dos casos graves, tem sido revisada e indicada como uma das medidas eficientes para o controle da pandemia em vários países do mundo. O artigo tem como objetivo discutir os desafios da testagem e do diagnóstico de COVID-19 no Brasil.

Abstract The Brazilian context of social inequalities and barriers in accessing health services may deteriorate the situation of the COVID-19 pandemic, which already affects all Brazilian federative states, with the growing curve of increasing confirmed cases and deaths. National governments and scientific field agents have been looking for evidence for the best practices of prevention and control of transmission, and care of infection and disease, including diagnosis, treatment, and health care measures. The large-scale testing strategy, aimed at early diagnosis, quarantine of the mild cases identified, as well as those of the contacts, and adequate care of severe cases, has been revised and indicated as one of the efficient pandemic control measures in several countries in the world. This paper aims to discuss the challenges of COVID-19 testing and diagnosis in Brazil.