Physical examination for the detection of sexually transmitted infections among transgender women and travestis in Brazil: acceptability and associated factors

OBJECTIVE: This study aimed to determine the acceptability and factors associated with uptake of a physical examination for the detection of symptomatic sexually transmitted infections (STIs) by transgender women and travestis in Brazil. METHODS: TransOdara was a multi-centric, cross-sectional STI prevalence study conducted among transgender women and travestis in five capital cities (Campo Grande, Manaus, Porto Alegre, Salvador and São Paulo) representing all Brazilian regions, between December 2019 and July 2021. A total of 1,317 self-identified transgender women and travestis aged ≥18 years were recruited using respondent-driven sampling and responded to a standard questionnaire. A medical consultation was offered including a physical examination and collection of samples from multiple sites to detect various STIs. Factors associated with uptake were investigated by reviewing demographic characteristics of participants who gave permission for physical examination (general, genital, and anorectal). RESULTS: Most participants (65.4%, 95% confidence interval - 95%CI 62.7-68.0) gave permission for a general examination (including oropharyngeal), with fewer permitting genital (42.3%, 95%CI 39.6-46.0) or anorectal (42.1%, 95%CI 39.4-44.9) examinations. Overall, 34.4% (95%CI 31.8-37.0) of participants refused all examinations. Participants with STI symptoms were significantly more likely to give permission for full examination than asymptomatic participants (64.3 vs. 37.4%, adjusted odds ratio - AOR=3.6, 95%CI 2.4-5.5). Other factors significantly associated with uptake of a full examination in multivariate analysis included age (AOR=1.5 for ≥25 years), religion (AOR=1.7 for Afro-Brazilian, AOR=1.9 for other religions compared to no religion), and education (AOR=2.0 for higher-level). CONCLUSION: In the context of STI management, this study found limited acceptance of anogenital examinations among transgender women and travestis, with higher acceptance among those with STI symptoms

Reducing intersectional stigma among transgender women in Brazil to promote uptake of HIV testing and PrEP: study protocol for a randomised controlled trial of Manas por Manas

IntroductionGlobally, transgender ('trans') women experience extreme social and economic marginalisation due to intersectional stigma, defined as the confluence of stigma that results from the intersection of social identities and positions among those who are oppressed multiple times. Among trans women, gender-based stigma intersects with social positions such as engagement in sex work and substance use, as well as race-based stigma to generate a social context of vulnerability and increased risk of HIV acquisition. In Brazil, trans women are the 'most at-risk' group for HIV, with 55 times higher estimated odds of HIV infection than the general population; further, uptake of HIV testing and pre-exposure prophylaxis (PrEP) among trans women is significantly lower than other at-risk groups. Through extensive formative work, we developed Manas por Manas, a multilevel intervention using HIV prevention strategies with demonstrated feasibility and acceptability by trans women in Brazil, to address intersectional stigma and increase engagement in the HIV prevention continuum.Methods and analysisWe are conducting a two-arm randomised wait-list controlled trial of the intervention's efficacy in São Paulo, Brazil, to improve uptake of HIV testing and PrEP among transgender women (N=400). The primary outcomes are changes in HIV testing (self-testing and clinic based), changes in PrEP uptake and changes in PrEP persistence at baseline and follow-up assessment for 12 months at 3-month intervals.Ethics and disseminationThis study was approved by University of California, San Francisco Institutional Review Board (15-17910) and Comissão Nacional de Ética em Pesquisa (Research Ethics National Commission, CAAE: 25215219.8.0000.5479) in Brazil. Participants provided informed consent before enrolment. We are committed to collaboration with National Institutes of Health officials, other researchers, and health and social services communities for rapid dissemination of data and sharing of materials. The results will be published in peer-reviewed academic journals and scientific presentations.Trial registration numberNCT03081559

Model-based estimation of transmissibility and reinfection of SARS-CoV-2 P.1 variant

Acknowledgements We are grateful for the collaborative work of the reviewers and the entire group of the Observatório COVID-19 BR. In particular, we thank Verônica Coelho for critical inputs. We also thank the research funding agencies: the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brazil (Finance Code 001 to F.M.D.M., L.S.F. and T.P.P.), Conselho Nacional de Desenvolvimento Científico e Tecnológico—Brazil (grant number: 315854/2020-0 to M.E.B., 141698/2018-7 to R.L.P.S., 313055/2020-3 to P.I.P., 312559/2020-8 to M.A.S.M.V., 311832/2017-2 to R.A.K., 305703/2019-6 to A.A.M.S.) and Fundação de Amparo à Pesquisa do Estado de São Paulo—Brazil (grant number: 2019/26310-2 and 2017/26770-8 to C.F., 2018/26512-1 to O.C., 2018/24037-4 to S.P. and contract number: 2016/01343-7 to R.A.K.). The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers of Disease Control and Prevention.Peer reviewe

Assessing the best time interval between doses in a two-dose vaccination regimen to reduce the number of deaths in an ongoing epidemic of SARS-CoV-2

Funding: This work was supported by the Coordination of Superior Level Staff Improvement (CAPES), Brazil (Finance Code 001 to LSF and FMDM), National Council for Scientific and Technological Development (CNPq), Brazil (grant number: 315854/2020-0 to MEB, 141698/2018-7 to RLPS, 312559/2020-8 to MASMV and 311832/2017-2 to RAK), São Paulo Research Foundation (FAPESP), Brazil (grant #2019/26310-2 and #2017/26770-8 to CF, #2018/26512-1 to OC, #2018/24037-4 to SP, #2018/23984-0 to VS and contract #2016/01343-7 to RAK) and Swiss National Science Foundation (grant PCEFP3_181243 to VS). The Sound Foundation (Massachusetts, USA) provided financial support for the open-source publication of this work via a grant to The University of Oxford (UK) to support the work of members of the COVID-19 International Modeling (CoMo) Consortium. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Peer reviewedPublisher PD

O potencial de propagação da Covid-19 e a tomada de decisão governamental: uma análise retrospectiva em Florianópolis, Brasil

Objective: to analyze the association between the spreading potential of SARS-CoV-2 and the decision-making of the municipal government of Florianópolis (Brazil) regarding social distance. Methods: We analyzed new cases of COVID-19 with nowcasting treatment identified in Florianópolis residents between February 1 and July 14, 2020. Decrees related to COVID-19 published in the Official Gazette of the Municipality between February 1 and July 14, 2020 were also analyzed. Based on the actions proposed in the decrees, it was analyzed whether they relaxed social isolation, increased or maintained existing restrictions, thus creating the Social Distancing Index. Time-dependent reproduction numbers (Rt) for the period of 14 days prior to each decree were calculated. A matrix was constructed associating the classification of each decree and the Rt values, analyzing the consonance or dissonance between the potential dissemination of SARS-CoV-2 and the actions of the decrees. Results: 5,374 cases of COVID-19 and 26 decrees were analyzed. Nine decrees increased measures of social distance, nine maintained them and eight made them more flexible. Of the 26 actions, 9 were consonant and 17 dissonant with the tendency indicated by the Rt. Dissonances were observed in all the decrees that maintained the distance measures or made them more flexible. In the last two months analyzed there was the fastest expansion in the number of new cases and the greatest amount of dissonant decrees. Conclusion: There was an important divergence between municipal measures of social distance with epidemiological indicators at the time of each political decision.   Key-words: Coronavirus Infections. Epidemiology. Decision Making. Government.Objetivo: analisar a relação entre o potencial de propagação do SARS-CoV-2 e as tomadas de decisão do governo municipal de Florianópolis (Brasil) quanto ao distanciamento social. Métodos: Foram analisados casos novos de COVID-19 com tratamento de nowcasting identificados em residentes de Florianópolis entre 01 de fevereiro e 14 de julho de 2020. Também foram analisados os decretos relacionados à COVID-19 publicadas no Diário Oficial do Município entre 01 de fevereiro e 14 de julho de 2020. Com base nas ações dispostas nos decretos, analisou-se se elas promoviam o relaxamento, o aumento ou a manutenção das restrições vigestes, criando-se o Índice de Distanciamento Social. Para o período de cinco dias anteriores a cada decreto calcularam-se os números de reprodução dependente do tempo (Rt). Construiu-se matriz entre a classificação de cada decreto e os valores de Rt, verificando-se a consonância ou a dissonância entre o potencial de disseminação do SARS-CoV-2 e as ações dos decretos. Resultados: Foram analisados 5.374 casos de COVID-19 e 26 decretos. Nove decretos aumentaram as medidas de distanciamento social, nove mantiveram e oito as flexibilizaram. Das 26 ações, 9 eram consonantes e 17 dissonantes com a tendência indicada pelos Rt. Dissonâncias foram observadas com todos os decretos que mantiveram as medidas de distanciamento e que as flexibilizavam. No segundo bimestre da análise houve a mais rápida expansão do número de casos novos e a maior quantidade de dissonâncias dos decretos. Conclusão: Observou-se importante divergência entre as medidas de distanciamento social com indicadores epidemiológicos no momento da decisão política

Prevalence of chlamydia and gonorreheae among transgender women and travestis in five Brazilian capitals, 2019-2021

OBJECTIVE: To estimate the prevalence and factors associated with the detection of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in transgender women and travestis in five Brazilian capitals. METHODS: Data were obtained from a cross-sectional study conducted between 2019 and 2021, with participants recruited through Respondent Driven Sampling in São Paulo, Campo Grande, Manaus, Porto Alegre and Salvador. Detection of CT and NG was analyzed at three collection sites (anorectal, oropharyngeal and urethral). Mixed logistic regression models were employed to identify associated factors. RESULTS: A total of 1,297 recruited participants provided biological material to detect these infections. The prevalences of CT, NG and coinfection were 11.5%, 13.3% and 3.6%, respectively. Independent associations with CT infections included past (OR=1.73; 95%CI 1.02-2.95), current (OR=2.13; 95%CI 1.23-3.69), and part-time sex work (OR=2.75; 95%CI 1.60-4.75), as well as lifetime injectable drug use (OR=3.54; 95%CI 1.49-8.40). For NG, associations were observed with lifetime injectable drug use (OR=1.91; 95%CI 1.28-2.84) and sexual orientation, including heterosexual (OR=3.44; 95%CI 1.35-8.82), homosexual (OR=5.49; 95%CI 1.89-15.97), and bisexual (OR=3.21; 95%CI 1.06-9.68). Coinfection was associated with use of illicit drugs in the last 12 months (OR=2.34, 95%CI 1.10-5.00), and younger age was associated with all investigated outcomes. CONCLUSION: Estimated prevalences of CT, NG and co-infection were higher among transgender women and travestis compared to the general population, particularly among younger, individuals engaged in sex work and illicit drug use

Carta à Comunidade Científica: o Brasil frente às novas variantes de SARSCoV- 2

This letter discusses the epidemic situation of Covid-19 in Brazil, in the face of the emergence of a new strain, called P1, more transmissible and with possible associated reinfection.  Given the collapse of hospital care in Manaus in January 2021 and the results of three recent preprints, all of which found increased transmissibility of the P.1 variant, we propose some urgent actions: the establishment of genomic surveillance based on multi-step diagnostics, starting with RT-PCR type tests  to sequencing; an immediate effort to identify reinfections associated with the new variant, updating its definition protocols; and studies on the efficacy of currently available vaccines in Brazil in respect to the new variant.  We also propose the improvement of the Brazilian health surveillance system, which should be articulated with genomic surveillance, in order to respond more timely to future emergencies. We call on the public agents involved in health surveillance to share data and information regarding the epidemic in a clear, fast and transparent way. Finally, we propose a greater engagement in inter-institutional cooperation of all those involved in the response and production of knowledge about the pandemic in our country.Esta carta discute a situação epidêmica da Covid-19 no Brasil frente aoaparecimento de uma nova linhagem, chamada P1, mais transmissível e compossível re-infecção associada. Tendo em vista o colapso do atendimentohospitalar em Manaus em janeiro de 2021 e os resultados de três preprintsrecentes, todos encontrando maior transmissibilidade da variante P.1, propomos algumas ações urgentes: o estabelecimento de uma vigilância genômica baseada em diagnóstico em múltiplos passos, iniciando com os testes do tipo RT-PCR até o sequenciamento; um esforço imediato na identificação de re-infecções associadas à nova variante, atualizando os seus protocolos de definição; e estudos sobre a eficácia das vacinas atualmente disponíveis no Brasil na vigência da nova variante. Propomos, ademais, o aprimoramento do sistema de vigilância em saúde brasileiro, que seja articulado com a vigilância genômica, de forma a responder mais oportunamente a emergências futuras. Chamamos os agentes públicos implicados na vigilância em saúde para que compartilhem dados e informações referentes à epidemia de forma clara, rápida e transparente. Finalmente propomos um maior engajamento na cooperação inter-institucional de todos os envolvidos na resposta e produção de conhecimento sobre a pandemia em nosso país

Brazil in the face of new SARS-CoV-2 variantsemergencies and challenges in public health

Peer reviewedPublisher PD

TransOdara study: the challenge of integrating methods, settings and procedures during the COVID-19 pandemic in Brazil.

OBJECTIVE: Sexually transmitted infections (STIs) disproportionately affect transgender women and travestis (TGW), who often lack access to healthcare due to stigma and discrimination. We describe the approach and methodology of a study investigating the prevalence of syphilis, HIV, hepatitis A, B, and C, Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), and human papillomavirus (HPV) among TGW, as well as their knowledge and perceptions regarding syphilis, to better inform policies to curb STIs among this vulnerable population. METHODS: TransOdara was a multicentric, cross-sectional study conducted among TGW in five capital cities from major Brazilian regions between December 2019 and July 2021. Self-identified transgender women and travestis aged >18 years were recruited using respondent-driven sampling after a qualitative formative phase, completed an interviewer-led questionnaire, were offered a physical examination, and were also asked to provide samples from multiple sites to detect various STIs, starting vaccination and treatment when indicated. RESULTS: A total of 1,317 participants were recruited from the five study locations: Campo Grande (n=181, 13.7%), Manaus (n=340, 25.8%), Porto Alegre (n=192, 14.6%), Salvador (n=201, 15.3%), and São Paulo (n=403, 30.6%). The recruitment period varied at each study location due to logistic constraints imposed by the COVID-19 pandemic. CONCLUSION: Despite the enormous challenges posed by the co-occurrence of the COVID-19 pandemic and field work targeting a vulnerable, elusive, and scattered population, the TransOdara project has been effectively implemented. Caveats did not preclude 1,300 TGW from being interviewed and tested, amid a significant epidemic that disrupted health services and research projects in Brazil and worldwide