Resumo Os benefícios do brinquedo terapêutico (BT) em pediatria são amplamente divulgados na literatura, entretanto, seu uso pelos profissionais de saúde ainda é limitado. Objetivou-se compreender como os profissionais que pertencem ao grupo BrinquEinstein e avaliam o processo de implementação sistemática do BT em unidades pediátricas hospitalares. Realizou-se estudo exploratório, de abordagem qualitativa, nas unidades pediátrica e de terapia intensiva de um hospital geral de extraporte, na cidade de São Paulo. Participaram 13 profissionais de diferentes categorias pertencentes ao BrinquEinstein. Os dados foram coletados por meio de entrevista semiestruturada individual e audiogravada, sendo analisados a partir da Análise Temática Indutiva proposta por Braun e Clark. Da análise das entrevistas, emergiram cinco temas: vivenciando um processo transformador; os benefícios que fortalecem o caminho; as facilidades que impulsionam a caminhada; as barreiras que desafiam o processo; e as perspectivas futuras. Para os profissionais entrevistados, é imprescindível que o uso do BT se torne uma prática rotineira nos diferentes contextos de atendimento à saúde da criança, sendo que gestores e instituições têm papel fundamental na sua implementação. (BT literatura entretanto limitado Objetivouse Objetivou hospitalares Realizouse Realizou exploratório qualitativa extraporte Paulo 1 audiogravada Clark entrevistas temas transformador caminho caminhada futuras entrevistados criança

Abstract The benefits of therapeutic play (TP) in pediatrics are widely reported in the literature, however its use by health professionals is still limited. The objective was to understand how professionals belonging to the BrinquEinstein group evaluate the process of systematic implementation of TP in hospital pediatric units. Exploratory study, with a qualitative approach, developed in the pediatric and intensive care units of extra-large general hospital in São Paulo. The sample consisted of 13 professionals from different categories belonging to BrinquEinstein. Data was collected through individual semi-structured and audio-recorded interviews, being analyzed based on the Inductive Thematic Analysis proposed by Braun and Clark. From the analysis of the interviews, five themes emerged: experiencing a transforming process; the benefits that strengthen the path; the facilities that encourage the walk; the barriers that challenge the process; the future prospects. For the interviewed professionals, it is essential that the use of TP becomes a routine practice in different contexts of the child´s healthcare, in which managers and institutions play a fundamental role in its implementation. (TP literature limited study approach extralarge extra large Paulo 1 semistructured semi structured audiorecorded audio recorded interviews Clark emerged path walk prospects childs child s healthcare

Resumo Os benefícios do brinquedo terapêutico (BT) em pediatria são amplamente divulgados na literatura, entretanto, seu uso pelos profissionais de saúde ainda é limitado. Objetivou-se compreender como os profissionais que pertencem ao grupo BrinquEinstein e avaliam o processo de implementação sistemática do BT em unidades pediátricas hospitalares. Realizou-se estudo exploratório, de abordagem qualitativa, nas unidades pediátrica e de terapia intensiva de um hospital geral de extraporte, na cidade de São Paulo. Participaram 13 profissionais de diferentes categorias pertencentes ao BrinquEinstein. Os dados foram coletados por meio de entrevista semiestruturada individual e audiogravada, sendo analisados a partir da Análise Temática Indutiva proposta por Braun e Clark. Da análise das entrevistas, emergiram cinco temas: vivenciando um processo transformador; os benefícios que fortalecem o caminho; as facilidades que impulsionam a caminhada; as barreiras que desafiam o processo; e as perspectivas futuras. Para os profissionais entrevistados, é imprescindível que o uso do BT se torne uma prática rotineira nos diferentes contextos de atendimento à saúde da criança, sendo que gestores e instituições têm papel fundamental na sua implementação.

Abstract The benefits of therapeutic play (TP) in pediatrics are widely reported in the literature, however its use by health professionals is still limited. The objective was to understand how professionals belonging to the BrinquEinstein group evaluate the process of systematic implementation of TP in hospital pediatric units. Exploratory study, with a qualitative approach, developed in the pediatric and intensive care units of extra-large general hospital in São Paulo. The sample consisted of 13 professionals from different categories belonging to BrinquEinstein. Data was collected through individual semi-structured and audio-recorded interviews, being analyzed based on the Inductive Thematic Analysis proposed by Braun and Clark. From the analysis of the interviews, five themes emerged: experiencing a transforming process; the benefits that strengthen the path; the facilities that encourage the walk; the barriers that challenge the process; the future prospects. For the interviewed professionals, it is essential that the use of TP becomes a routine practice in different contexts of the child´s healthcare, in which managers and institutions play a fundamental role in its implementation.

ABSTRACT OBJECTIVE: To identify the factors associated with HIV self-testing (HIVST) uptake among adolescent men who have sex with men (AMSM) and adolescent transgender women (ATGW) before and during the COVID-19 pandemic. METHODS: A cross-sectional HIVST uptake study was conducted among AMSM and ATGW. Peer educators and health professionals began providing HIVST in February 2019. The outcome was the HIVST uptake before and during the COVID-19 pandemic. The association between each predictor and outcome in each period was analyzed using simple and multiple logistic regressions, estimating odds ratios, and their respective 95% confidence intervals. RESULTS: The uptake was 229/510 (44.9%) and 382/1,075 (35.5%) before and during the pandemic. During the pre-pandemic period, HIVST uptake was higher in participants who reported receptive anal sex. During the pandemic, uptake was lower in participants with a steady sexual partner and higher in those with frequent oral sex with a steady partner in the previous three months. Before and during the pandemic, HIVST uptake was lower in ATGW and higher in those aged 18–19 years and in participants who lived alone. CONCLUSIONS: Uptake decreased during the pandemic. Sexual behavioral factors associated with HIVST uptake changed during the COVID-19 pandemic, showing the fluid dynamics of sexuality in AMSM and ATGW during this period. HIV programs can optimize the implementation of HIVST among adolescents and young people by incorporating effective and differentiated service delivery models to increase HIV testing uptake and to reach undiagnosed individuals effectively.

ABSTRACT OBJECTIVE: To identify recent HIV-1 infection and estimate HIV incidence among adolescent men who have sex with men (AMSM) and transgender women (ATGW) in Brazil. METHODS: From January to December 2020, a cross-sectional analysis was conducted with baseline data from the PrEP1519 study, an HIV pre-exposure prophylaxis (PrEP) demonstration cohort in Brazil among sexually active AMSM/ATGW aged 15-19. For enrollment, participants were screened with a fourth-generation HIV rapid test. The recent infection testing algorithm (RITA) included a recency assay in blood specimens, viral load, and CD4 cell count prior to antiretroviral treatment use. Among these participants, RITA-based HIV incidence was estimated using a mean duration of recency infection of 214 days and a false-recent rate of 0.02. RESULTS: Out of the 494 participants screened, 21 tested positive for HIV. Following RITA, five adolescents had a recent HIV infection, 14 had long-term infections, and two did not have blood specimens available. We classified these two participants as long-term infection cases due to CD4 cell counts and previous use of antiretroviral treatment. Among those who tested positive, all but one were AMSM (94.7%), 73.6% were aged 18-19, and 76.2% were non-White. The HIV prevalence was 4.2%, and the estimated HIV incidence was 1.7%. CONCLUSIONS: The estimated incidence highlights the need for targeted HIV prevention interventions, such as PrEP, for sexual minority adolescents. Integrating RITA into routine HIV testing services for this population provides valuable information on the current HIV epidemic. This strategy can aid in monitoring the effectiveness of prevention efforts and improving early entry to HIV care.

ABSTRACT OBJECTIVE: To identify recent HIV-1 infection and estimate HIV incidence among adolescent men who have sex with men (AMSM) and transgender women (ATGW) in Brazil. METHODS: From January to December 2020, a cross-sectional analysis was conducted with baseline data from the PrEP1519 study, an HIV pre-exposure prophylaxis (PrEP) demonstration cohort in Brazil among sexually active AMSM/ATGW aged 15-19. For enrollment, participants were screened with a fourth-generation HIV rapid test. The recent infection testing algorithm (RITA) included a recency assay in blood specimens, viral load, and CD4 cell count prior to antiretroviral treatment use. Among these participants, RITA-based HIV incidence was estimated using a mean duration of recency infection of 214 days and a false-recent rate of 0.02. RESULTS: Out of the 494 participants screened, 21 tested positive for HIV. Following RITA, five adolescents had a recent HIV infection, 14 had long-term infections, and two did not have blood specimens available. We classified these two participants as long-term infection cases due to CD4 cell counts and previous use of antiretroviral treatment. Among those who tested positive, all but one were AMSM (94.7%), 73.6% were aged 18-19, and 76.2% were non-White. The HIV prevalence was 4.2%, and the estimated HIV incidence was 1.7%. CONCLUSIONS: The estimated incidence highlights the need for targeted HIV prevention interventions, such as PrEP, for sexual minority adolescents. Integrating RITA into routine HIV testing services for this population provides valuable information on the current HIV epidemic. This strategy can aid in monitoring the effectiveness of prevention efforts and improving early entry to HIV care. OBJECTIVE HIV1 1 HIV- (AMSM ATGW (ATGW METHODS 2020 crosssectional cross sectional PrEP PrEP151 study preexposure pre exposure (PrEP AMSMATGW 1519. 1519 15 19. 19 15-19 enrollment fourthgeneration fourth generation test (RITA load CD RITAbased based falserecent false 002 0 02 0.02 RESULTS 49 2 longterm long term infections available 94.7%, 947 94.7% , 94 7 (94.7%) 736 73 6 73.6 1819, 1819 18 19, 18-19 762 76 76.2 nonWhite. nonWhite non White. White non-White 42 4 4.2% 17 1.7% CONCLUSIONS interventions epidemic care 202 PrEP15 151 15-1 00 0.0 94.7 9 (94.7% 73. 181 18-1 76. 4.2 1.7 20 PrEP1 15- 0. 94. (94.7 18- 4. 1. (94. (94 (9 (

ABSTRACT OBJECTIVE: To identify the factors associated with HIV self-testing (HIVST) uptake among adolescent men who have sex with men (AMSM) and adolescent transgender women (ATGW) before and during the COVID-19 pandemic. METHODS: A cross-sectional HIVST uptake study was conducted among AMSM and ATGW. Peer educators and health professionals began providing HIVST in February 2019. The outcome was the HIVST uptake before and during the COVID-19 pandemic. The association between each predictor and outcome in each period was analyzed using simple and multiple logistic regressions, estimating odds ratios, and their respective 95% confidence intervals. RESULTS: The uptake was 229/510 (44.9%) and 382/1,075 (35.5%) before and during the pandemic. During the pre-pandemic period, HIVST uptake was higher in participants who reported receptive anal sex. During the pandemic, uptake was lower in participants with a steady sexual partner and higher in those with frequent oral sex with a steady partner in the previous three months. Before and during the pandemic, HIVST uptake was lower in ATGW and higher in those aged 18–19 years and in participants who lived alone. CONCLUSIONS: Uptake decreased during the pandemic. Sexual behavioral factors associated with HIVST uptake changed during the COVID-19 pandemic, showing the fluid dynamics of sexuality in AMSM and ATGW during this period. HIV programs can optimize the implementation of HIVST among adolescents and young people by incorporating effective and differentiated service delivery models to increase HIV testing uptake and to reach undiagnosed individuals effectively. OBJECTIVE selftesting self (HIVST (AMSM (ATGW COVID19 COVID 19 COVID-1 pandemic METHODS crosssectional cross sectional 2019 regressions ratios 95 intervals RESULTS 229510 229 510 229/51 44.9% 449 44 9 (44.9% 3821075 382 1 075 382/1,07 35.5% 355 35 5 (35.5% prepandemic pre months 1819 18 18–1 alone CONCLUSIONS effectively COVID1 COVID- 201 22951 22 51 229/5 44.9 4 (44.9 382107 38 07 382/1,0 35.5 3 (35.5 181 18– 20 2295 2 229/ 44. (44. 38210 0 382/1, 35. (35. (44 3821 382/1 (35 (4 382/ (3 (

Resumo Objetivo Identificar e mapear as principais estratégias educativas para prevenção de infecções do trato reprodutor feminino no sistema prisional. Métodos Revisão de escopo, realizada conforme a recomendações do Joanna Briggs Institute, com pesquisa nas bases de dados MEDLINE (PubMed), Cochrane Library, LILACS, SCOPUS, Science Direct, Embase; Google Scholar e Proquest, durante o período de 23 a 29 de maio de 2023. Utilizou-se o instrumento Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) para o fluxograma de busca e seleção dos artigos da revisão. Foram incluídos todos os títulos que seguiram a estratégia PCC: População mulheres com idade a partir dos 18 anos. Conceito uso de estratégias educativas para prevenção de ITR feminino. Contexto sistema prisional, com cumprimento de pena em regime fechado. Foram excluídos aqueles que contemplaram estratégia educativa realizada para homens cisgênero ou com mulheres que já possuíam o diagnóstico de ITR. Resultados Foram selecionados 13 estudos publicados entre 1995 e 2023, com predomínio de estratégias educativas voltadas para prevenção de infecções sexualmente transmissíveis, principalmente causadas pelo Vírus da Imunodeficiência Humana. As estratégias educativas priorizaram ações educativas grupais, estratégia de dramatização e técnica da abordagem comportamental, utilizando os seguintes recursos educativos: panfletos, cartilhas, cartazes, livro de desenhos animados, simuladores de órgãos genitais, vídeos e jogos. Conclusão As sessões educativas coletivas foram as mais evidenciadas na literatura para prevenção de infecções, predominantemente, sexualmente transmissíveis, com escassos estudos de prevenção de vaginites ou vaginoses. prisional escopo Institute PubMed, PubMed , (PubMed) Library LILACS SCOPUS Direct Embase Proquest 2 2023 Utilizouse Utilizou se MetaAnalyses Meta Analyses PRISMAScR PRISMA ScR (PRISMA-ScR revisão PCC 1 anos fechado 199 transmissíveis Humana grupais comportamental educativos panfletos cartilhas cartazes animados genitais jogos predominantemente vaginoses (PubMed 202 19 20

Abstract Objective To identify and map the main educational strategies for preventing infections of the female reproductive tract in the prison system. Methods This is a scoping review, carried out in accordance with JBI recommendations, with research in the databases MEDLINE (PubMed), Cochrane Library, LILACS, Scopus, Science Direct, Embase, Google Scholar and Proquest, from May 23 to 29, 2023. The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) for the search and selection flowchart of review articles was used. All titles that followed the PCC strategy were included: Population Women aged 18 and older. Concept Use of educational strategies to prevent female RTI. Context Prison system, with sentences served in a closed regime. Those who included an educational strategy carried out for cisgender men or women who already had an RTI diagnosis were excluded. Results A total of 13 studies published between 1995 and 2023 were selected, with a predominance of educational strategies aimed at preventing sexually transmitted infections, mainly caused by the Human Immunodeficiency Virus. Educational strategies prioritized group educational actions, dramatization strategy and behavioral approach technique, using pamphlets, booklets, posters, cartoon books, genital organ simulators, videos and games. Conclusion Collective educational sessions were the most evidenced in the literature for infection prevention, predominantly sexually transmitted, with few studies on vaginitis or vaginosis prevention. system recommendations PubMed, PubMed , (PubMed) Library LILACS Scopus Direct Embase Proquest 2 29 MetaAnalyses Meta Analyses PRISMAScR PRISMA ScR (PRISMA-ScR used 1 older regime excluded 199 202 selected Virus actions technique pamphlets booklets posters books simulators games prevention (PubMed 19 20

Resumen Objetivo Identificar y mapear las principales estrategias educativas para la prevención de infecciones del tracto reproductor (ITR) femenino en el sistema penitenciario. Métodos Revisión de alcance, realizada de acuerdo con las recomendaciones del Joanna Briggs Institute, con búsqueda en las bases de datos: MEDLINE (PubMed), Cochrane Library, LILACS, SCOPUS, Science Direct, Embase; Google Scholar y Proquest, durante el período del 23 al 29 de mayo de 2023. Se utilizó el instrumento Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) para el diagrama de flujo de búsqueda y selección de los artículos de la revisión. Se incluyeron todos los títulos que siguieron la estrategia PCC. Población mujeres a partir de 18 años. Concepto uso de estrategias educativas para la prevención de ITR femenino. Contexto sistema penitenciario, con cumplimiento de condena en régimen cerrado. Se excluyeron aquellos que contemplaron estrategias educativas para hombres cisgénero o con mujeres que ya tenían el diagnóstico de ITR. Resultados Se seleccionaron 13 estudios publicados entre 1995 y 2023, con un predominio de estrategias educativas orientadas a la prevención de infecciones de transmisión sexual, principalmente causadas por el Virus de la Inmunodeficiencia Humana. Las estrategias educativas priorizaron acciones educativas grupales, estrategias de dramatización y técnicas de enfoque conductual, mediante la utilización de los siguientes recursos educativos: folletos, cartillas, carteles, libros de historietas, simuladores de órganos genitales, videos y juegos. Conclusión Las sesiones educativas colectivas fueron las más destacadas en la literatura para la prevención de infecciones, predominantemente de transmisión sexual, con escasos estudios de prevención de vaginitis o vaginosis. (ITR penitenciario alcance Institute datos PubMed, PubMed , (PubMed) Library LILACS SCOPUS Direct Embase Proquest 2 2023 MetaAnalyses Meta Analyses PRISMAScR PRISMA ScR (PRISMA-ScR revisión PCC 1 años cerrado 199 sexual Humana grupales conductual educativos folletos cartillas carteles historietas genitales juegos vaginosis (PubMed 202 19 20

ABSTRACT Alternative materials can be used to reduce reliance on mining for P-based fertilizers. In this sense, the pyrolysis process of bovine bones produces the “bone char”, which can be used as a source of P. This study aimed to characterize bone char and conduct a comparative analysis with both soluble (triple superphosphate) and non-soluble (Bayóvar phosphate rock) phosphate fertilizers, specifically examining its behavior in soil and uptake by plants. Bone char characterization was performed by X-ray diffraction (XRD), attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR), and scanning electron microscopy coupled with energy-dispersive (SEM-EDS). The XRD analyses have shown the presence of hydroxyapatite in the bone char, bands assigned to P-O stretching from phosphate have been observed in ATR-FTIR, and Ca, P, C, and O elements were identified in the materials by EDS analyses. Solubility from fertilizer extractants was higher for bone char compared to Bayóvar, and both sources showed lower solubility compared to triple superphosphate. Cumulative amount of P released from bone char was higher than Bayóvar and lower than triple superphosphate. Amount of total dry matter, total shoot P uptake, and total shoot Ca uptake were higher for triple superphosphate compared to bone char and Bayóvar. Release profile of P from bone char strongly suggests this material can be used as a slow-release P source, with intermediate solubility between soluble and non-soluble commercialized sources. Pbased based fertilizers sense , char” nonsoluble non rock plants Xray X ray XRD, (XRD) ATRFTIR, ATRFTIR ATR FTIR (ATR-FTIR) energydispersive energy dispersive SEMEDS. SEMEDS SEM . (SEM-EDS) PO FTIR, ATR-FTIR C matter slowrelease slow release (XRD (ATR-FTIR (SEM-EDS

Resumo Este estudo avaliou a resistência de união (RU) de sistemas de pinos de fibra de vidro convencionais, anatomizados, ajustáveis e CAD/CAM. Quarenta raízes de caninos superiores foram enfraquecidas, tratadas endodonticamente e divididas em quatro grupos (n=10). Um slice de cada terço do canal radicular (cervical, média e apical) foi submetido ao teste de push-out e o padrão de falha foi analisado posteriormente. O slice mais apical foi submetido à análise da espessura da linha de cimentação por microscopia eletrônica de varredura (MEV). Os dados referentes à RU e espessura da linha de cimentação foram submetidos ao teste de normalidade de Shapiro-Wilk seguido dos testes de variância e Tukey. O padrão de falha foi expresso em porcentagem e submetido ao teste qui-quadrado. O pino convencional apresentou menor RU em comparação aos demais pinos de fibra de vidro (p<0,05). Todos os pinos de fibra de vidro apresentaram maior percentual de falhas adesivas à dentina. A MEV evidenciou linha de cimentação mais espessa para o pino convencional em relação aos demais grupos (p<0,05), além de lacunas e espaços vazios no material restaurador. Os pinos de fibra de vidro anatomizados, ajustáveis e fresados em CAD/CAM demonstraram RU superior e melhor adaptação à dentina radicular em comparação com o pino de fibra de vidro convencional. (RU convencionais anatomizados CADCAM CAD CAM enfraquecidas n=10. n10 n n=10 . 10 (n=10) cervical, cervical (cervical pushout push out posteriormente MEV. (MEV) ShapiroWilk Shapiro Wilk Tukey quiquadrado. quiquadrado qui quadrado. quadrado qui-quadrado p<0,05. p005 p p<0,05 0 05 (p<0,05) p<0,05, , restaurador n1 n=1 1 (n=10 (MEV p00 p<0,0 (p<0,05 n= (n=1 p0 p<0, (p<0,0 (n= p<0 (p<0, (n p< (p<0 (p< (p

Abstract This study evaluated the bond strength (BS) of conventional, anatomized, adjustable, and CAD/CAM fiberglass post systems. Forty maxillary canine roots were weakened, endodontically treated, and divided into four groups (n=10). A slice from each of the three sections (cervical, middle, apical) of the root canal was subjected to the push-out test and the failure pattern was subsequently analyzed. The most apical slice was subjected to analysis of the cementation line thickness by scanning electron microscopy (SEM). Data regarding the BS and cementation line thickness were subjected to the Shapiro-Wilk normality test followed by the variance and Tukey tests. Data failure patterns were expressed as a percentage and submitted to the chi-square test. Conventional fiberglass posts had the lowest BD compared to the other fiberglass posts (p<0.05). All fiberglass posts exhibited a higher percentage of adhesive failures to dentin. The SEM demonstrated a thicker cementation line for the conventional post compared to the other groups (p<0.05), as well as gaps and voids in the cementing material. The anatomized, adjustable, and CAD/CAM milled fiberglass post systems demonstrated a superior BS and adaptation to the root dentin compared to the conventional fiberglass post. (BS anatomized adjustable CADCAM CAD CAM weakened treated n=10. n10 n n=10 . 10 (n=10) cervical, cervical (cervical middle pushout push out analyzed SEM. (SEM) ShapiroWilk Shapiro Wilk tests chisquare chi square p<0.05. p005 p p<0.05 0 05 (p<0.05) p<0.05, , material n1 n=1 1 (n=10 (SEM p00 p<0.0 (p<0.05 n= (n=1 p0 p<0. (p<0.0 (n= p<0 (p<0. (n p< (p<0 (p< (p

Resumen: Los efectos adversos de la profilaxis preexposición (PrEP) oral con fumarato de disoproxilo de tenofovir son barreras para el inicio y la continuación de la PrEP. Aunque los efectos graves son raros y predecibles, la evidencia de esta evaluación entre hombres que tienen sexo con hombres (HSH) y mujeres transgénero (MTG) sigue siendo limitada. Este estudio evalúa los efectos adversos de la PrEP oral diaria en HSH y MTG. Se trata de una revisión sistemática y un metaanálisis de ensayos clínicos y cohortes que demuestran el uso de la PrEP oral diaria seleccionada de las bases de datos PubMed/MEDLINE, Embase, LILACS y Cochrane CENTRAL. La recolección de datos incluyó efectos adversos y cambios en los marcadores renales y hepáticos. Se utilizaron modelos de efectos aleatorios para resumir el riesgo de efectos adversos a lo largo del estudio. La heterogeneidad se evaluó mediante la prueba Q de Cochran y la inconsistencia (I2). El riesgo de sesgo y la certeza de la evidencia se evaluaron utilizando las recomendaciones de la Colaboración Cochrane. Se identificaron 653 referencias. De estas, se seleccionaron diez. Todos los estudios evaluaron los marcadores renales de elegibilidad y los marcadores hepáticos. El uso diario de la PrEP oral no se asoció con eventos de grado 3 o 4 (RR = 0,99; IC95%: 0,83-1,18; I2 = 26,1%), con ningún evento adverso grave (RR = 1,04; IC95%: 0,58-1,87; I2 = 88,4%), con creatinina de grado 3 o 4 (RR = 0,66; IC95%: 0,24-1,84; I2 = 79,9%) y con hipofosfatemia de grado 3 o 4 (RR = 0,56, IC95%: 0,15-2,10). La certeza de la evidencia varió de alta a moderada para los resultados analizados. La PrEP oral diaria es segura y bien tolerada por HSH y MTG. Los efectos adversos fueron mínimos y se distribuyeron uniformemente entre la intervención y el control. Resumen (PrEP predecibles (HSH MTG (MTG limitada PubMedMEDLINE PubMed MEDLINE PubMed/MEDLINE Embase CENTRAL hepáticos I2. I . (I2) 65 referencias estas diez RR 0,99 099 0 99 IC95% IC95 IC 0,831,18 083118 0,83 1,18 83 1 18 0,83-1,18 26,1%, 261 26,1% , 26 26,1%) 1,04 104 04 0,581,87 058187 0,58 1,87 58 87 0,58-1,87 88,4%, 884 88,4% 88 88,4%) 0,66 066 66 0,241,84 024184 0,24 1,84 24 84 0,24-1,84 79,9% 799 79 9 056 56 0,56 0,152,10. 015210 0,15 2,10 15 2 10 0,15-2,10) analizados control (I2 6 0,9 09 IC9 831 0,831,1 08311 083 0,8 118 1,1 8 0,83-1,1 26,1 1,0 581 0,581,8 05818 058 0,5 187 1,8 5 0,58-1,8 88,4 0,6 06 241 0,241,8 02418 024 0,2 184 0,24-1,8 79,9 7 05 152 0,152,10 01521 015 0,1 210 2,1 0,15-2,10 (I 0, 0,831, 0831 08 11 1, 0,83-1, 26, 0,581, 0581 0,58-1, 88, 0,241, 0241 02 0,24-1, 79, 0,152,1 0152 01 21 2, 0,15-2,1 0,831 0,83-1 0,581 0,58-1 0,241 0,24-1 0,152, 0,15-2, 0,83- 0,58- 0,24- 0,152 0,15-2 0,15-

Resumo: Os efeitos adversos da profilaxia pré-exposição (PrEP) oral com fumarato de tenofovir desoproxila são barreiras para o início e a continuidade da PrEP. Embora os efeitos graves sejam raros e previsíveis, as evidências dessa avaliação entre homens que fazem sexo com homens (HSH) e mulheres transgênero (MTG) ainda são limitadas. Este estudo avalia os efeitos adversos da PrEP oral diária em HSH e MTG. Trata-se de uma revisão sistemática e metanálise de ensaios clínicos e coortes que demonstram o uso de PrEP oral diária selecionados nas bases de dados PubMed/MEDLINE, Embase, LILACS e Cochrane CENTRAL. A extração de dados incluiu os efeitos adversos e alterações nos marcadores renais e hepáticos. Modelos de efeitos aleatórios foram usados para resumir o risco de efeitos adversos ao longo do estudo. A heterogeneidade foi avaliada pelo teste Q de Cochran e inconsistência (I2). O risco de viés e a certeza da evidência foram avaliados por meio das recomendações da Colaboração Cochrane. Foram identificadas 653 referências. Destes, dez foram selecionadas. Todos os estudos avaliaram marcadores renais de elegibilidade e marcadores hepáticos. O uso diário de PrEP oral não foi associado a eventos de grau 3 ou 4 (RR = 0,99; IC95%: 0,83-1,18; I2 = 26,1%), a qualquer evento adverso grave (RR = 1,04; IC95%: 0,58-1,87; I2 =88,4%), à creatinina grau 3 ou 4 (RR = 0,66; IC95%: 0,24-1,84; I2 = 79,9%) e à hipofosfatemia grau 3 ou 4 (RR = 0,56; IC95%: 0,15-2,10). A certeza das evidências variou de alta a moderada para os desfechos analisados. A PrEP oral diária é segura e bem tolerada por HSH e MTG. Os efeitos adversos foram mínimos e distribuídos uniformemente entre a intervenção e o controle. Resumo préexposição pré exposição (PrEP previsíveis (HSH MTG (MTG limitadas Tratase Trata se PubMedMEDLINE PubMed MEDLINE PubMed/MEDLINE Embase CENTRAL hepáticos I2. I . (I2) 65 referências Destes selecionadas RR 0,99 099 0 99 IC95% IC95 IC 0,831,18 083118 0,83 1,18 83 1 18 0,83-1,18 26,1%, 261 26,1% , 26 26,1%) 1,04 104 04 0,581,87 058187 0,58 1,87 58 87 0,58-1,87 =88,4%, 884 =88,4% 88 =88,4%) 0,66 066 66 0,241,84 024184 0,24 1,84 24 84 0,24-1,84 79,9% 799 79 9 0,56 056 56 0,152,10. 015210 0,15 2,10 15 2 10 0,15-2,10) analisados controle (I2 6 0,9 09 IC9 831 0,831,1 08311 083 0,8 118 1,1 8 0,83-1,1 26,1 1,0 581 0,581,8 05818 058 0,5 187 1,8 5 0,58-1,8 =88,4 0,6 06 241 0,241,8 02418 024 0,2 184 0,24-1,8 79,9 7 05 152 0,152,10 01521 015 0,1 210 2,1 0,15-2,10 (I 0, 0,831, 0831 08 11 1, 0,83-1, 26, 0,581, 0581 0,58-1, =88, 0,241, 0241 02 0,24-1, 79, 0,152,1 0152 01 21 2, 0,15-2,1 0,831 0,83-1 0,581 0,58-1 =88 0,241 0,24-1 0,152, 0,15-2, 0,83- 0,58- =8 0,24- 0,152 0,15-2 0,15-

Abstract: The adverse effects of oral pre-exposure prophylaxis (PrEP) using tenofovir disoproxil fumarate are barriers to PrEP initiation and continuation. Although serious effects are rare and predictable, evidence for this assessment among men who have sex with men (MSM) and transgender women (TGW) is still limited. This study assesses the adverse effects of daily oral PrEP in MSM and TGW. This is a systematic review and meta-analysis of clinical trials and cohort studies on the use of daily oral PrEP selected from the PubMed/MEDLINE, Embase, LILACS, and Cochrane CENTRAL databases. Data extraction included adverse effects and changes in renal and hepatic markers. Random effects models were used to summarize the risk of adverse effects throughout the study. Heterogeneity was assessed using the Cochran’s Q test and the inconsistency test (I2). The risk of bias and the certainty of the evidence were assessed using the Cochrane Collaboration recommendations. The search identified 653 references. Of these, 10 were selected. All studies assessed the eligibility of renal and hepatic markers. The use of daily oral PrEP was not associated with grade 3 or 4 adverse events (RR = 0.99; 95%CI: 0.83-1.18; I2 = 26.1%), any serious adverse event (RR = 1.04; 95%CI: 0.58-1.87; I2 = 88.4%), grade 3+4 creatinine level (RR = 0.66; 95%CI: 0.24-1.84; I2 = 79.9%), and grade 3 or 4 hypophosphatemia (RR = 0.56; 95%CI: 0.15-2.10). The certainty of the evidence ranged from high to moderate for the outcomes analyzed. Daily oral PrEP is safe and well tolerated by MSM and TGW. Adverse effects were minimal and evenly distributed between intervention and control. Abstract preexposure pre exposure (PrEP continuation predictable (MSM TGW (TGW limited metaanalysis meta analysis PubMedMEDLINE PubMed MEDLINE PubMed/MEDLINE Embase LILACS databases markers Cochrans Cochran s I2. I . (I2) recommendations 65 references these 1 RR 0.99 099 0 99 95%CI 95CI CI 95 0.831.18 083118 0.83 1.18 83 18 0.83-1.18 26.1%, 261 26.1% , 26 26.1%) 1.04 104 04 0.581.87 058187 0.58 1.87 58 87 0.58-1.87 88.4%, 884 88.4% 88 88.4%) 34 3+ 0.66 066 66 0.241.84 024184 0.24 1.84 24 84 0.24-1.84 79.9%, 799 79.9% 79 9 79.9%) 0.56 056 56 0.152.10. 015210 0.15 2.10 15 2 0.15-2.10) analyzed control (I2 6 0.9 09 831 0.831.1 08311 083 0.8 118 1.1 8 0.83-1.1 26.1 1.0 581 0.581.8 05818 058 0.5 187 1.8 5 0.58-1.8 88.4 0.6 06 241 0.241.8 02418 024 0.2 184 0.24-1.8 79.9 7 05 152 0.152.10 01521 015 0.1 210 2.1 0.15-2.10 (I 0. 0.831. 0831 08 11 1. 0.83-1. 26. 0.581. 0581 0.58-1. 88. 0.241. 0241 02 0.24-1. 79. 0.152.1 0152 01 21 2. 0.15-2.1 0.831 0.83-1 0.581 0.58-1 0.241 0.24-1 0.152. 0.15-2. 0.83- 0.58- 0.24- 0.152 0.15-2 0.15-

Los hombres adolescentes que tienen sexo con hombres (AHSH) sufren más vulnerabilidad ante el VIH. El objetivo de este estudio fue estimar la prevalencia de VIH y los factores asociados individuales, sociales, y programáticos asociados entre AHSH en Salvador, Bahia, Brasil. Se trata de un estudio transversal, basado en el análisis de los datos de referencia de la cohorte PrEP1519 en Salvador. Se realizaron análisis descriptivos, bivariados, y multivariados usando las dimensiones de vulnerabilidad respecto al VIH, como los niveles jerárquicos de análisis. Los modelos de regresión logística se usaron para estimar las odds ratios (OR) de la asociación entre las variables predictoras y la infección por VIH. La prevalencia de infección por VIH entre los 288 AHSH reclutados para el proyecto fue 5,9% (IC95%: 3,7-9,3). El análisis ajustado reveló una asociación estadísticamente significativa entre autoidentificarse como un trabajador sexual (OR = 3,74, IC95%: 1,03-13,60) y la infección por VIH. Otras asociaciones con una significación estadística marginal fueron: uso de apps para encontrar pareja sexual (OR = 3,30, IC95%: 0,98-11,04), menos años de educación (OR = 3,59, IC95%: 0,96-13,41), no estar contratado o ser despedido de un trabajo debido a la orientación sexual (OR = 2,88, IC95%: 0,89-9,28), y no usar los servicios de salud como recurso habitual de atención sanitaria (OR = 3,14, IC95%: 0,97-10,17). Se identificó una alta prevalencia de VIH entre AHSH en Salvador. Asimismo, nuestro estudio halló que los factores desde una perspectiva individual, dimensión social, y dimensión programática estuvieron asociados con una infección por VIH entre AHSH. Recomendamos que se intensifiquen las actividades combinadas de prevención contra el VIH para AHSH. (AHSH individuales sociales Salvador Bahia Brasil transversal PrEP PrEP151 descriptivos bivariados OR 28 59 5 9 5,9 IC95% IC95 IC (IC95% 3,79,3. 3793 3,7 9,3 . 3 7 3,7-9,3) 374 74 3,74 1,0313,60 1031360 1,03 13,60 1 03 13 60 1,03-13,60 fueron 330 30 3,30 0,9811,04, 0981104 0,98 11,04 , 0 98 11 04 0,98-11,04) 359 3,59 0,9613,41, 0961341 0,96 13,41 96 41 0,96-13,41) 2 88 2,88 0,899,28, 089928 0,89 9,28 89 0,89-9,28) 314 14 3,14 0,9710,17. 0971017 0,97 10,17 97 10 17 0,97-10,17) Asimismo individual social PrEP15 5, IC9 (IC95 79 3,79,3 379 37 3, 93 9, 3,7-9,3 0313 1,0313,6 103136 103 1,0 1360 13,6 6 1,03-13,6 33 3,3 9811 0,9811,04 098110 098 0,9 1104 11,0 0,98-11,04 35 3,5 9613 0,9613,41 096134 096 1341 13,4 4 0,96-13,41 8 2,8 899 0,899,28 08992 089 0,8 928 9,2 0,89-9,28 31 3,1 9710 0,9710,17 097101 097 1017 10,1 0,97-10,17 PrEP1 (IC9 3,79, 3,7-9, 031 1,0313, 10313 1, 136 13, 1,03-13, 981 0,9811,0 09811 09 0, 110 11, 0,98-11,0 961 0,9613,4 09613 134 0,96-13,4 2, 0,899,2 0899 08 92 0,89-9,2 971 0,9710,1 09710 101 10, 0,97-10,1 (IC 3,79 3,7-9 1,0313 1031 1,03-13 0,9811, 0981 0,98-11, 0,9613, 0961 0,96-13, 0,899, 0,89-9, 0,9710, 0971 0,97-10, 3,7- 1,031 1,03-1 0,9811 0,98-11 0,9613 0,96-13 0,899 0,89-9 0,9710 0,97-10 1,03- 0,981 0,98-1 0,961 0,96-1 0,89- 0,971 0,97-1 0,98- 0,96- 0,97-

Homens adolescentes que fazem sexo com homens (AHSH) apresentam vulnerabilidade aumentada ao HIV. O estudo teve como objetivo estimar a prevalência de HIV e fatores individuais, sociais e programáticos entre AHSH em Salvador, Bahia, Brasil. O estudo transversal foi baseado na análise dos dados da linha de base da coorte PrEP1519 em Salvador. Foram realizadas análises descritivas, bivariadas e multivariadas, usando as dimensões de vulnerabilidade ao HIV como níveis analíticos hierárquicos. Foram usados modelos de regressão logística para estimar as razões de chances (OR) da associação entre as variáveis preditoras e a infecção pelo HIV. A prevalência de infecção pelo HIV entre os 288 AHSH recrutados pelo projeto foi de 5,9% (IC95%: 3,7-9,3). A análise ajustada mostrou uma associação estatisticamente significativa entre a autoidentificação como profissional do sexo (OR = 3,74, IC95%: 1,03-13,60) e a infecção pelo HIV. Outras associações com significância estatística limítrofe foram: uso de aplicativos para achar parceiros sexuais (OR = 3,30, IC95%: 0,98-11,04), menor escolaridade (OR = 3,59, IC95%: 0,96-13,41), história de não ter sido contratado ou de ter sido demitido em função da orientação sexual (OR = 2,88, IC95%: 0,89-9,28) e falta de uso de serviços de saúde como fonte usual de cuidados (OR = 3,14, IC95%: 0,97-10,17). Foi encontrada uma alta prevalência de HIV entre AHSH em Salvador. Além disso, o estudo mostrou que fatores encontrados nas dimensões individual, social e programática estiveram associados à infecção pelo HIV entre esses AHSH. Recomendamos a intensificação das atividades de prevenção combinada entre AHSH. (AHSH individuais Salvador Bahia Brasil PrEP PrEP151 descritivas multivariadas hierárquicos OR 28 59 5 9 5,9 IC95% IC95 IC (IC95% 3,79,3. 3793 3,7 9,3 . 3 7 3,7-9,3) 374 74 3,74 1,0313,60 1031360 1,03 13,60 1 03 13 60 1,03-13,60 foram 330 30 3,30 0,9811,04, 0981104 0,98 11,04 , 0 98 11 04 0,98-11,04) 359 3,59 0,9613,41, 0961341 0,96 13,41 96 41 0,96-13,41) 2 88 2,88 0,899,28 089928 0,89 9,28 89 0,89-9,28 314 14 3,14 0,9710,17. 0971017 0,97 10,17 97 10 17 0,97-10,17) disso individual PrEP15 5, IC9 (IC95 79 3,79,3 379 37 3, 93 9, 3,7-9,3 0313 1,0313,6 103136 103 1,0 1360 13,6 6 1,03-13,6 33 3,3 9811 0,9811,04 098110 098 0,9 1104 11,0 0,98-11,04 35 3,5 9613 0,9613,41 096134 096 1341 13,4 4 0,96-13,41 8 2,8 899 0,899,2 08992 089 0,8 928 9,2 0,89-9,2 31 3,1 9710 0,9710,17 097101 097 1017 10,1 0,97-10,17 PrEP1 (IC9 3,79, 3,7-9, 031 1,0313, 10313 1, 136 13, 1,03-13, 981 0,9811,0 09811 09 0, 110 11, 0,98-11,0 961 0,9613,4 09613 134 0,96-13,4 2, 0,899, 0899 08 92 0,89-9, 971 0,9710,1 09710 101 10, 0,97-10,1 (IC 3,79 3,7-9 1,0313 1031 1,03-13 0,9811, 0981 0,98-11, 0,9613, 0961 0,96-13, 0,899 0,89-9 0,9710, 0971 0,97-10, 3,7- 1,031 1,03-1 0,9811 0,98-11 0,9613 0,96-13 0,89- 0,9710 0,97-10 1,03- 0,981 0,98-1 0,961 0,96-1 0,971 0,97-1 0,98- 0,96- 0,97-

Adolescent men who have sex with men (AMSM) are at a heightened vulnerability for human immunodeficiency virus (HIV). This study aimed to estimate the prevalence of HIV and associated individual, social, and programmatic factors among AMSM in Salvador, Bahia State, Brazil. This is a cross-sectional study which analyzed baseline data from the PrEP1519 cohort in Salvador. Descriptive, bivariate, and multivariate analyses were conducted using the dimensions of vulnerability to HIV as hierarchical levels of analysis. Logistic regression models were used to estimate the odds ratios (OR) of the association between predictor variables and HIV infection. The prevalence of HIV infection among the 288 AMSM recruited to the project was 5.9% (95%CI: 3.7-9.3). Adjusted analysis showed a statistically significant association between self-identifying as a sex worker (OR = 3.74, 95%CI: 1.03-13.60) and HIV infection. Other associations with borderline statistical significance were the use of application programs to find sexual partners (OR = 3.30, 95%CI: 0.98-11.04), low schooling level (OR = 3.59, 95%CI: 0.96-13.41), failing to be hired or being dismissed from a job because of sexual orientation (OR = 2.88, 95%CI: 0.89-9.28), and not using health services as a usual source of care (OR = 3.14, 95%CI: 0.97-10.17). We found a high HIV prevalence among AMSM in Salvador. Furthermore, our study found that individual, social, and programmatic factors were associated with HIV infection among these AMSM. We recommend intensifying HIV combined-prevention activities for AMSM. (AMSM HIV. . (HIV) individual social Salvador State Brazil crosssectional cross sectional PrEP PrEP151 Descriptive bivariate OR 28 59 5 9 5.9 95%CI 95CI CI 95 (95%CI 3.79.3. 3793 3.7 9.3 3 7 3.7-9.3) selfidentifying self identifying 374 74 3.74 1.0313.60 1031360 1.03 13.60 1 03 13 60 1.03-13.60 330 30 3.30 0.9811.04, 0981104 0.98 11.04 , 0 98 11 04 0.98-11.04) 359 3.59 0.9613.41, 0961341 0.96 13.41 96 41 0.96-13.41) 2 88 2.88 0.899.28, 089928 0.89 9.28 89 0.89-9.28) 314 14 3.14 0.9710.17. 0971017 0.97 10.17 97 10 17 0.97-10.17) Furthermore combinedprevention combined prevention (HIV PrEP15 5. 79 3.79.3 379 37 3. 93 9. 3.7-9.3 0313 1.0313.6 103136 103 1.0 1360 13.6 6 1.03-13.6 33 3.3 9811 0.9811.04 098110 098 0.9 1104 11.0 0.98-11.04 35 3.5 9613 0.9613.41 096134 096 1341 13.4 4 0.96-13.41 8 2.8 899 0.899.28 08992 089 0.8 928 9.2 0.89-9.28 31 3.1 9710 0.9710.17 097101 097 1017 10.1 0.97-10.17 PrEP1 3.79. 3.7-9. 031 1.0313. 10313 1. 136 13. 1.03-13. 981 0.9811.0 09811 09 0. 110 11. 0.98-11.0 961 0.9613.4 09613 134 0.96-13.4 2. 0.899.2 0899 08 92 0.89-9.2 971 0.9710.1 09710 101 10. 0.97-10.1 3.79 3.7-9 1.0313 1031 1.03-13 0.9811. 0981 0.98-11. 0.9613. 0961 0.96-13. 0.899. 0.89-9. 0.9710. 0971 0.97-10. 3.7- 1.031 1.03-1 0.9811 0.98-11 0.9613 0.96-13 0.899 0.89-9 0.9710 0.97-10 1.03- 0.981 0.98-1 0.961 0.96-1 0.89- 0.971 0.97-1 0.98- 0.96- 0.97-

Homens adolescentes que fazem sexo com homens (AHSH) apresentam vulnerabilidade aumentada ao HIV. O estudo teve como objetivo estimar a prevalência de HIV e fatores individuais, sociais e programáticos entre AHSH em Salvador, Bahia, Brasil. O estudo transversal foi baseado na análise dos dados da linha de base da coorte PrEP1519 em Salvador. Foram realizadas análises descritivas, bivariadas e multivariadas, usando as dimensões de vulnerabilidade ao HIV como níveis analíticos hierárquicos. Foram usados modelos de regressão logística para estimar as razões de chances (OR) da associação entre as variáveis preditoras e a infecção pelo HIV. A prevalência de infecção pelo HIV entre os 288 AHSH recrutados pelo projeto foi de 5,9% (IC95%: 3,7-9,3). A análise ajustada mostrou uma associação estatisticamente significativa entre a autoidentificação como profissional do sexo (OR = 3,74, IC95%: 1,03-13,60) e a infecção pelo HIV. Outras associações com significância estatística limítrofe foram: uso de aplicativos para achar parceiros sexuais (OR = 3,30, IC95%: 0,98-11,04), menor escolaridade (OR = 3,59, IC95%: 0,96-13,41), história de não ter sido contratado ou de ter sido demitido em função da orientação sexual (OR = 2,88, IC95%: 0,89-9,28) e falta de uso de serviços de saúde como fonte usual de cuidados (OR = 3,14, IC95%: 0,97-10,17). Foi encontrada uma alta prevalência de HIV entre AHSH em Salvador. Além disso, o estudo mostrou que fatores encontrados nas dimensões individual, social e programática estiveram associados à infecção pelo HIV entre esses AHSH. Recomendamos a intensificação das atividades de prevenção combinada entre AHSH.

Los hombres adolescentes que tienen sexo con hombres (AHSH) sufren más vulnerabilidad ante el VIH. El objetivo de este estudio fue estimar la prevalencia de VIH y los factores asociados individuales, sociales, y programáticos asociados entre AHSH en Salvador, Bahia, Brasil. Se trata de un estudio transversal, basado en el análisis de los datos de referencia de la cohorte PrEP1519 en Salvador. Se realizaron análisis descriptivos, bivariados, y multivariados usando las dimensiones de vulnerabilidad respecto al VIH, como los niveles jerárquicos de análisis. Los modelos de regresión logística se usaron para estimar las odds ratios (OR) de la asociación entre las variables predictoras y la infección por VIH. La prevalencia de infección por VIH entre los 288 AHSH reclutados para el proyecto fue 5,9% (IC95%: 3,7-9,3). El análisis ajustado reveló una asociación estadísticamente significativa entre autoidentificarse como un trabajador sexual (OR = 3,74, IC95%: 1,03-13,60) y la infección por VIH. Otras asociaciones con una significación estadística marginal fueron: uso de apps para encontrar pareja sexual (OR = 3,30, IC95%: 0,98-11,04), menos años de educación (OR = 3,59, IC95%: 0,96-13,41), no estar contratado o ser despedido de un trabajo debido a la orientación sexual (OR = 2,88, IC95%: 0,89-9,28), y no usar los servicios de salud como recurso habitual de atención sanitaria (OR = 3,14, IC95%: 0,97-10,17). Se identificó una alta prevalencia de VIH entre AHSH en Salvador. Asimismo, nuestro estudio halló que los factores desde una perspectiva individual, dimensión social, y dimensión programática estuvieron asociados con una infección por VIH entre AHSH. Recomendamos que se intensifiquen las actividades combinadas de prevención contra el VIH para AHSH.

Adolescent men who have sex with men (AMSM) are at a heightened vulnerability for human immunodeficiency virus (HIV). This study aimed to estimate the prevalence of HIV and associated individual, social, and programmatic factors among AMSM in Salvador, Bahia State, Brazil. This is a cross-sectional study which analyzed baseline data from the PrEP1519 cohort in Salvador. Descriptive, bivariate, and multivariate analyses were conducted using the dimensions of vulnerability to HIV as hierarchical levels of analysis. Logistic regression models were used to estimate the odds ratios (OR) of the association between predictor variables and HIV infection. The prevalence of HIV infection among the 288 AMSM recruited to the project was 5.9% (95%CI: 3.7-9.3). Adjusted analysis showed a statistically significant association between self-identifying as a sex worker (OR = 3.74, 95%CI: 1.03-13.60) and HIV infection. Other associations with borderline statistical significance were the use of application programs to find sexual partners (OR = 3.30, 95%CI: 0.98-11.04), low schooling level (OR = 3.59, 95%CI: 0.96-13.41), failing to be hired or being dismissed from a job because of sexual orientation (OR = 2.88, 95%CI: 0.89-9.28), and not using health services as a usual source of care (OR = 3.14, 95%CI: 0.97-10.17). We found a high HIV prevalence among AMSM in Salvador. Furthermore, our study found that individual, social, and programmatic factors were associated with HIV infection among these AMSM. We recommend intensifying HIV combined-prevention activities for AMSM.

Resumen: Los efectos adversos de la profilaxis preexposición (PrEP) oral con fumarato de disoproxilo de tenofovir son barreras para el inicio y la continuación de la PrEP. Aunque los efectos graves son raros y predecibles, la evidencia de esta evaluación entre hombres que tienen sexo con hombres (HSH) y mujeres transgénero (MTG) sigue siendo limitada. Este estudio evalúa los efectos adversos de la PrEP oral diaria en HSH y MTG. Se trata de una revisión sistemática y un metaanálisis de ensayos clínicos y cohortes que demuestran el uso de la PrEP oral diaria seleccionada de las bases de datos PubMed/MEDLINE, Embase, LILACS y Cochrane CENTRAL. La recolección de datos incluyó efectos adversos y cambios en los marcadores renales y hepáticos. Se utilizaron modelos de efectos aleatorios para resumir el riesgo de efectos adversos a lo largo del estudio. La heterogeneidad se evaluó mediante la prueba Q de Cochran y la inconsistencia (I2). El riesgo de sesgo y la certeza de la evidencia se evaluaron utilizando las recomendaciones de la Colaboración Cochrane. Se identificaron 653 referencias. De estas, se seleccionaron diez. Todos los estudios evaluaron los marcadores renales de elegibilidad y los marcadores hepáticos. El uso diario de la PrEP oral no se asoció con eventos de grado 3 o 4 (RR = 0,99; IC95%: 0,83-1,18; I2 = 26,1%), con ningún evento adverso grave (RR = 1,04; IC95%: 0,58-1,87; I2 = 88,4%), con creatinina de grado 3 o 4 (RR = 0,66; IC95%: 0,24-1,84; I2 = 79,9%) y con hipofosfatemia de grado 3 o 4 (RR = 0,56, IC95%: 0,15-2,10). La certeza de la evidencia varió de alta a moderada para los resultados analizados. La PrEP oral diaria es segura y bien tolerada por HSH y MTG. Los efectos adversos fueron mínimos y se distribuyeron uniformemente entre la intervención y el control.

Abstract: The adverse effects of oral pre-exposure prophylaxis (PrEP) using tenofovir disoproxil fumarate are barriers to PrEP initiation and continuation. Although serious effects are rare and predictable, evidence for this assessment among men who have sex with men (MSM) and transgender women (TGW) is still limited. This study assesses the adverse effects of daily oral PrEP in MSM and TGW. This is a systematic review and meta-analysis of clinical trials and cohort studies on the use of daily oral PrEP selected from the PubMed/MEDLINE, Embase, LILACS, and Cochrane CENTRAL databases. Data extraction included adverse effects and changes in renal and hepatic markers. Random effects models were used to summarize the risk of adverse effects throughout the study. Heterogeneity was assessed using the Cochran’s Q test and the inconsistency test (I2). The risk of bias and the certainty of the evidence were assessed using the Cochrane Collaboration recommendations. The search identified 653 references. Of these, 10 were selected. All studies assessed the eligibility of renal and hepatic markers. The use of daily oral PrEP was not associated with grade 3 or 4 adverse events (RR = 0.99; 95%CI: 0.83-1.18; I2 = 26.1%), any serious adverse event (RR = 1.04; 95%CI: 0.58-1.87; I2 = 88.4%), grade 3+4 creatinine level (RR = 0.66; 95%CI: 0.24-1.84; I2 = 79.9%), and grade 3 or 4 hypophosphatemia (RR = 0.56; 95%CI: 0.15-2.10). The certainty of the evidence ranged from high to moderate for the outcomes analyzed. Daily oral PrEP is safe and well tolerated by MSM and TGW. Adverse effects were minimal and evenly distributed between intervention and control.

Resumo: Os efeitos adversos da profilaxia pré-exposição (PrEP) oral com fumarato de tenofovir desoproxila são barreiras para o início e a continuidade da PrEP. Embora os efeitos graves sejam raros e previsíveis, as evidências dessa avaliação entre homens que fazem sexo com homens (HSH) e mulheres transgênero (MTG) ainda são limitadas. Este estudo avalia os efeitos adversos da PrEP oral diária em HSH e MTG. Trata-se de uma revisão sistemática e metanálise de ensaios clínicos e coortes que demonstram o uso de PrEP oral diária selecionados nas bases de dados PubMed/MEDLINE, Embase, LILACS e Cochrane CENTRAL. A extração de dados incluiu os efeitos adversos e alterações nos marcadores renais e hepáticos. Modelos de efeitos aleatórios foram usados para resumir o risco de efeitos adversos ao longo do estudo. A heterogeneidade foi avaliada pelo teste Q de Cochran e inconsistência (I2). O risco de viés e a certeza da evidência foram avaliados por meio das recomendações da Colaboração Cochrane. Foram identificadas 653 referências. Destes, dez foram selecionadas. Todos os estudos avaliaram marcadores renais de elegibilidade e marcadores hepáticos. O uso diário de PrEP oral não foi associado a eventos de grau 3 ou 4 (RR = 0,99; IC95%: 0,83-1,18; I2 = 26,1%), a qualquer evento adverso grave (RR = 1,04; IC95%: 0,58-1,87; I2 =88,4%), à creatinina grau 3 ou 4 (RR = 0,66; IC95%: 0,24-1,84; I2 = 79,9%) e à hipofosfatemia grau 3 ou 4 (RR = 0,56; IC95%: 0,15-2,10). A certeza das evidências variou de alta a moderada para os desfechos analisados. A PrEP oral diária é segura e bem tolerada por HSH e MTG. Os efeitos adversos foram mínimos e distribuídos uniformemente entre a intervenção e o controle.