BACKGROUND: HIV prevention programmes that include pre-exposure prophylaxis (PrEP) for men who have sex with men (MSM) and transgender women (TGW) in South Africa have not been widely implemented OBJECTIVES: The authors examined oral PrEP uptake, adherence, and adverse events among HIV-uninfected MSM and TGW to inform intervention acceptability and feasibility METHOD: In 2015, MSM and TGW in two South African cities were offered a comprehensive package of HIV prevention services, including daily oral PrEP, and were followed for one year. Different models of PrEP delivery were used at each site. Adherence was measured using self-report and pill-count data and tenofovir-diphosphate (TFV-DP) concentrations RESULTS: Among 135 participants who were eligible for PrEP, 82 (61%) initiated PrEP, of whom 67 (82%) were on PrEP at study end. Participants were on PrEP for a median of 294 out of 314.5 possible days (93% protected days). The median time from PrEP initiation to discontinuation or study end was 305 days (interquartile range: 232-325 days). Across the follow-up time points, 57% - 72% of participants self-reported taking protective levels of PrEP and 59% - 74% were adherent to PrEP as indicated by pill counts. Fewer (≤ 18%) achieved protective TFV-DP concentrations of ≥ 700 fmol/punch in dried blood spots. Side effects, while typically mild, were the most commonly cited reason by participants for early PrEP discontinuation CONCLUSION: Many MSM and TGW initiated and maintained PrEP, demonstrating that PrEP can be successfully delivered to South African MSM and TGW in diverse programmatic contexts. Biologic adherence measures suggest MSM and TGW may experience challenges taking PrEP regularly. Counselling for coping with side effects and motivating daily pill taking is recommended to support South African MSM and TGW in achieving protection with PrEP

Increasing access and frequency of human immunodeficiency virus testing are critical to stemming the epidemic. In Brazil's concentrated epidemic, human immunodeficiency virus prevalence in the men who have sex with men/transgender population far exceeds that in the general population, but testing rates fall below what is needed to ensure early detection and treatment. Over-the-counter human immunodeficiency virus self-testing kits, now available in stores in the U.S., have enormous potential to increase testing access and frequency and to facilitate early detection and treatment. With the advent of human immunodeficiency virus self-testing upon us, it is timely to engage the scientific community, government, and civil society in a dialog around how to best utilize this technology in Brazil. We summarize recent research on over-the-counter testing among men who have sex with men, raise potential questions and challenges to using self-tests, suggest implementation strategies, and outline a research agenda moving forward.

A epidemia de HIV/AIDS no Brasil é concentrada em homens que fazem sexo com homens (HSH), mas suas taxas de testagem são incompatíveis com seus riscos. Estratégias para expandir o diagnóstico precoce entre HSH podem incluir kits de autotestagem em ambiente doméstico (AAD), como os disponíveis para compra nos Estados Unidos. Em abril de 2011, realizamos uma pesquisa com HSH brasileiros recrutados em Facebook para conhecer preferências de testagem e aceitabilidade da AAD. Entre 356 HSH HIV(-) testados previamente, 47% preferiam a AAD, 27% testagem em clínicas e 26% sem preferência. HSH com menos testagem ou que consideraram a testagem sem fazê-la tinham maior probabilidade de preferir a AAD (p < 0,05). Quase 90% usariam a AAD, 62 e 54% para decidir sobre ter sexo desprotegido com parceiros regulares e novos, respectivamente. Dificuldade de entender os testes (32%) e receber os resultados sozinhos (23%) foram preocupações referidas. Testes anti-HIV de AAD podem ser atrativos para HSH e resultar em aumento de testagem. Pesquisas com foco na viabilidade e utilização dos kits AAD na prática são necessárias.

The Brazilian HIV/AIDS epidemic is concentrated among men who have sex with men (MSM), however HIV testing rates among MSM are not commensurate with their risk. Strategies to expand early diagnosis may include use of self-conducted home-based testing kits, which are now available for purchase in the US. In April 2011 we conducted a survey with Brazilian MSM using Facebook to assess HIV testing preferences and acceptability of home-based testing. Among 356 previously tested, HIV-negative MSM, 47% reported a preference for home-based testing, 27% preferred clinic-based testing, and 26% had no preference. Less frequent testers and those who had considered testing but failed to test were more likely to prefer home-based testing. Close to 90% reported that they would use self-test kits; 62% and 54% said they would use home-based testing to make choices about unprotected sex with regular and new partners, respectively. Concerns included difficulty to understand the tests (32%) and receiving results alone (23%). Overall, home-based testing may appeal to MSM and result in increased testing frequency. Research on feasibility and utilization of self-tests in practice is needed.

La epidemia de VIH/SIDA en Brasil se concentra en hombres que practican sexo con hombres (HSH), pero los índices de exámenes clínicos para conocer si están infectados son incompatibles con sus riesgos. Las estrategias para expandir el diagnóstico precoz entre HSH pueden incluir kits de autoanálisis para el hogar, como los que están a disposición del público en Estados Unidos. En abril de 2011, realizamos una investigación con HSH brasileños, captados en Facebook, para conocer preferencias de exámenes y la aceptabilidad del autoanálisis en un ambiente doméstico. Entre los 356 HSH VIH(-) analizados previamente, un 47% preferían un autoanálisis en un ambiente doméstico, un 27% pruebas en clínicas y un 26% no tenían preferencias. HSH que menos exámenes se realizaron o quienes los consideraron, pero no se los hicieron, tenían mayor probabilidad de preferir el autoanálisis en un ambiente doméstico. Casi un 90% usarían autoanálisis en su hogar, un 62% y 54% con el fin de decidir sobre tener sexo sin protección con parejas regulares y nuevas, respectivamente. La dificultad de entender los análisis (32%) y recibir los resultados a solas (23%) fueron las preocupaciones a las que se refirieron. Los análisis anti-VIH de autoadministración en el hogar pueden ser atractivos para HSH y resultar en un aumento de exámenes. Las investigaciones centradas en la viabilidad y utilización de los test de autoanálisis en la práctica son necesarias.

A epidemia de HIV/AIDS no Brasil é concentrada em homens que fazem sexo com homens (HSH), mas suas taxas de testagem são incompatíveis com seus riscos. Estratégias para expandir o diagnóstico precoce entre HSH podem incluir kits de autotestagem em ambiente doméstico (AAD), como os disponíveis para compra nos Estados Unidos. Em abril de 2011, realizamos uma pesquisa com HSH brasileiros recrutados em Facebook para conhecer preferências de testagem e aceitabilidade da AAD. Entre 356 HSH HIV(-) testados previamente, 47% preferiam a AAD, 27% testagem em clínicas e 26% sem preferência. HSH com menos testagem ou que consideraram a testagem sem fazê-la tinham maior probabilidade de preferir a AAD (p < 0,05). Quase 90% usariam a AAD, 62 e 54% para decidir sobre ter sexo desprotegido com parceiros regulares e novos, respectivamente. Dificuldade de entender os testes (32%) e receber os resultados sozinhos (23%) foram preocupações referidas. Testes anti-HIV de AAD podem ser atrativos para HSH e resultar em aumento de testagem. Pesquisas com foco na viabilidade e utilização dos kits AAD na prática são necessárias.

The Brazilian HIV/AIDS epidemic is concentrated among men who have sex with men (MSM), however HIV testing rates among MSM are not commensurate with their risk. Strategies to expand early diagnosis may include use of self-conducted home-based testing kits, which are now available for purchase in the US. In April 2011 we conducted a survey with Brazilian MSM using Facebook to assess HIV testing preferences and acceptability of home-based testing. Among 356 previously tested, HIV-negative MSM, 47% reported a preference for home-based testing, 27% preferred clinic-based testing, and 26% had no preference. Less frequent testers and those who had considered testing but failed to test were more likely to prefer home-based testing. Close to 90% reported that they would use self-test kits; 62% and 54% said they would use home-based testing to make choices about unprotected sex with regular and new partners, respectively. Concerns included difficulty to understand the tests (32%) and receiving results alone (23%). Overall, home-based testing may appeal to MSM and result in increased testing frequency. Research on feasibility and utilization of self-tests in practice is needed.

La epidemia de VIH/SIDA en Brasil se concentra en hombres que practican sexo con hombres (HSH), pero los índices de exámenes clínicos para conocer si están infectados son incompatibles con sus riesgos. Las estrategias para expandir el diagnóstico precoz entre HSH pueden incluir kits de autoanálisis para el hogar, como los que están a disposición del público en Estados Unidos. En abril de 2011, realizamos una investigación con HSH brasileños, captados en Facebook, para conocer preferencias de exámenes y la aceptabilidad del autoanálisis en un ambiente doméstico. Entre los 356 HSH VIH(-) analizados previamente, un 47% preferían un autoanálisis en un ambiente doméstico, un 27% pruebas en clínicas y un 26% no tenían preferencias. HSH que menos exámenes se realizaron o quienes los consideraron, pero no se los hicieron, tenían mayor probabilidad de preferir el autoanálisis en un ambiente doméstico. Casi un 90% usarían autoanálisis en su hogar, un 62% y 54% con el fin de decidir sobre tener sexo sin protección con parejas regulares y nuevas, respectivamente. La dificultad de entender los análisis (32%) y recibir los resultados a solas (23%) fueron las preocupaciones a las que se refirieron. Los análisis anti-VIH de autoadministración en el hogar pueden ser atractivos para HSH y resultar en un aumento de exámenes. Las investigaciones centradas en la viabilidad y utilización de los test de autoanálisis en la práctica son necesarias.