INTRODUCTION:Women with systemic lupus erythematosus (SLE) have increased prevalence of precancer cervical squamous intraepithelial lesions (SIL). This study aimed to compare human papillomavirus (HPV) seroprevalence, cervical HPV-DNA detection and HPV-related cervical lesions between SLE and immunocompetent women. METHODS:In this cross-sectional study, women aged 18-45 years with SLE receiving immunosuppressive or disease-modifying antirheumatic drugs were compared with immunocompetent women, selected from the same hospital in Sao Paulo, Brazil. Eligible participants had no self-reported history of genital warts or any other HPV-related cervical, vaginal or vulvar lesions, nor received prior HPV vaccination. Cervical samples were tested for HPV-DNA using PapilloCheck and for SIL lesions by liquid-based cytology. A multiplex pseudovirion-based serology assay (PsV-Luminex) measured serum antibodies against eight of the HPV types targeted by non-valent (9vHPV) HPV vaccine. RESULTS:A total of 122 women with SLE and 132 immunocompetent women (mean age 34.3 and 32.5 years, respectively) were enrolled. Compared with immunocompetent women, SLE participants had higher prevalence of HPV-related cervical lesions (low-grade and high-grade SIL combined, 11.3% vs 2.4%, p=0.009), higher prevalence of at least one cervical HPV type (38.8% vs 20.2%, p=0.003), non-significantly higher prevalence of cervical high-risk HPV types (23.5% vs 14.9% p=0.286) and higher HPV seroprevalence to eight HPV types included in the 9vHPV vaccine (80.4% vs 59.7%, p=0.001). CONCLUSION:Our findings underscore the importance of tailored cervical cancer screening and HPV vaccination of SLE women at young age.

OBJECTIVES:International migrants are disproportionately affected by HIV and blood-borne viruses compared with non-migrants in high-income countries, but data on prevalence and risk of other sexually transmitted infections (STIs) are scarce. We aimed to synthesize evidence on STI prevalence among migrants and summarize risk compared with non-migrants. METHODS:We conducted a systematic review and meta-analysis of peer-reviewed literature using MEDLINE, Embase, and Global Health from January 1, 2014 to June 9, 2025 (PROSPERO: CRD42024560384) and assessed the risk of bias using the Newcastle-Ottawa scale. We used a random-effects meta-analysis to calculate pooled prevalence and prevalence ratio (PR) of STIs, among migrants compared with non-migrants overall and by infection and specific population sub-groups. RESULTS:We included 85 studies from 31 countries, providing data on 1,384,443 tests on migrants and 1,414,096 on non-migrants. We found high pooled prevalence of chlamydia (53.55 per 1000, 95% confidence interval [CI]: 30.02-82.97), gonorrhea (20.77 per 1000, 95% CI: 3.33-49.84), and probable active syphilis (17.36 per 1000, 95% CI: 9.50-27.34). Compared with non-migrants, migrants had a higher PR for probable active and seropositive syphilis but not gonorrhea. CONCLUSION:Migrants may face an elevated risk of STIs compared with non-migrants in host countries. The studies were heterogeneous, limiting the precision of estimates, and many lacked disaggregated demographic data. Our findings call for greater consideration of migrants in STI prevention and control alongside further research.

BACKGROUND:Female genital schistosomiasis (FGS), a gynecological disease caused by Schistosoma haematobium egg deposition in the female genital tract, is prevalent in sub-Saharan Africa, the region with the highest cervical cancer burden globally. Persistent high-risk human papillomavirus (HR-HPV) infection is necessary for cervical cancer development. We determined the association between FGS and HR-HPV genotypes in Zambian women. METHODS:Sexually active women aged 15-50 years, not menstruating or pregnant, were recruited at home and provided 2 cervicovaginal self-swabs, urine sample, and HIV and Trichomonas vaginalis self-tests, and completed a questionnaire. In clinic, midwives collected cervicovaginal swabs and cervical images with point-of-care colposcopy (EVA System, MobileODT). Swabs were analyzed for 14 HR-HPV types (GeneXpert) and Schistosoma DNA (ITS-2 real-time polymerase chain reaction [qPCR]); urine was analyzed for Schistosoma ova by microscopy and circulating anodic antigen. Visual FGS was defined as colposcopic identification of specific genital lesions, and molecular FGS as Schistosoma-positive cervicovaginal qPCR. RESULTS:Among 2532 women (median age, 28 [interquartile range, 22-36] years) recruited at home, 1694 (67%) completed clinic follow-up. Prevalence of visual FGS, molecular FGS, and HR-HPV was 35.2% (595/1691), 6.5% (165/2532), and 28.7% (690/2401), respectively. Molecular FGS was weakly associated with all HR-HPV (adjusted odds ratio [aOR], 1.3 [95% confidence interval {CI}, .9-1.9]). Women with molecular FGS were more likely to test positive for HR-HPV types 16/18/45 (aOR, 1.7 [95% CI, 1.0-2.8]). No association was observed between visual FGS and HR-HPV infection (95% CI, .7-1.1). CONCLUSIONS:This is the first study to jointly screen for FGS and HR-HPV in Zambia, reporting an association between oncogenic HR-HPV types and molecular FGS.

BACKGROUND:Human papillomavirus (HPV) vaccination is a key component of the World Health Organization's global strategy for cervical cancer elimination. The effect of malaria, a known immunomodulator, on HPV vaccine immunogenicity is poorly understood. This study assessed the effect of malaria parasitaemia at the time of vaccination on HPV vaccine immune responses among participants in a dose-reduction immunogenicity trial (DoRIS). METHODS AND FINDINGS:930 HIV-negative Tanzanian schoolgirls aged 9-14 years were randomised to receive one, two or three doses of Cervarix® or Gardasil®9 (155 per arm) and followed to month (M)36. One-dose and two-dose arms participants were enrolled in a long-term extension and are included in this malaria sub-study. Dried blood spots at each vaccination visit were tested for malaria parasitaemia by quantitative polymerase chain reaction. HPV16/18 antibody responses were measured at M12, 24, 36 and 60. In the one-dose arms, there was no evidence of a difference in antibody geometric mean concentrations (GMC) or avidity index (AI) between participants with and without malaria at the time of vaccination. In the two-dose Cervarix® arm, M36 HPV16 antibody GMCs and AI results were lower in participants with malaria at either vaccination visit (HPV16 GMC ratio = 0.74, 95%CI = 0.55-0.99; AI ratio = 0.95, 95%CI = 0.91-0.99). In the two-dose Gardasil®9 arm, M36 HPV18 antibody GMCs and AI results were lower in participants with malaria at the first vaccine dose than those without malaria (HPV18 GMC ratio = 0.58, 95%CI = 0.37-0.92; AI ratio = 0.93, 95%CI = 0.87-0.99). These trends were also observed at M60. CONCLUSIONS:Whilst some effect of malaria on antibody responses was observed in the two-dose arms, these were mostly small in magnitude and unlikely to have clinical significance. Single-dose arms results are reassuring but further evaluations in larger populations would be valuable to confirm the findings. The potential for an effect of moderate or severe infection with greater parasite burden remains unclear. (NCT02834637).

Background Pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV, but not other sexually transmitted infections (STIs) in men who have sex with men (MSM) and transgender women (TGW). PrEP users are offered periodic STI testing for early detection of STIs, including Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and syphilis. However, the optimal and most cost-effective frequency for separate and combined STI testing in PrEP users has yet to be established. Methods We constructed dynamic transmission models and simulated the epidemic trajectories of three STIs (CT, NG and syphilis) among MSM/TGW using PrEP in Australia, Brazil and Thailand. Two testing scenarios were considered: single pathogen testing for CT, NG or syphilis, and combined testing for all three STIs simultaneously (syphilis testing alone plus dual testing for CT/NG). From a healthcare system perspective, cost-effectiveness analysis and incremental cost-effectiveness ratio (ICER) was used to explore the optimal testing strategy for STIs across three countries over a 5-year time horizon. Findings For the single CT/NG testing scenario, either maintaining status quo, or every 6 or 12 months was more cost-effective for Australian MSM, Brazilian MSM and Thai MSM/TGW, while 3-monthly CT/NG testing was optimal for Brazilian TGW. For the single syphilis testing scenario, 3-monthly testing was more cost-effective for Australian, Brazilian MSM/TGW and Thai TGW, while 6-monthly testing was optimal for Thai MSM. For the combined testing strategy, 3-monthly dual testing for CT/NG, along with 3-monthly syphilis testing for Australian MSM and Brazilian TGW, was a cost-saving and optimal strategy, but exceeded the willingness-to-pay threshold for Brazilian MSM (ICER = $23,187/QALY gained), Thai MSM (ICER = $477,442/QALY gained) and Thai TGW (ICER = $37,697/QALY gained). Interpretation Our study suggests that more frequent (3-monthly) syphilis testing for PrEP users provides enhanced economic value among both MSM and TGW. However, less frequent CT and NG testing may only be required, depending on the background disease burden and the costs associated with testing and management in each country. Funding Supported by the World Health Organization (Grant Number: INV-035239).

Background: Despite widespread Plasmodium falciparum resistance, intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine–pyrimethamine is more protective against adverse pregnancy and birth outcomes compared to IPTp with dihydroartemisinin–piperaquine, even though dihydroartemisinin–piperaquine is superior against malaria-related outcomes. We assessed whether adding metronidazole to sulfadoxine–pyrimethamine is more protective against adverse pregnancy and birth outcomes compared to IPTp with dihydroartemisinin–piperaquine in an area of high malaria transmission and parasite resistance to sulfadoxine–pyrimethamine, and where curable sexually transmitted infections (STIs) in pregnancy, including bacterial vaginosis, are common. Methods: From December 2019 to March 2022, we enrolled pregnant women without HIV into ASPIRE, an individually randomised, double-blinded, three-arm, partly placebo-controlled trial in Zambia. Participants received monthly IPTp with standard sulfadoxine–pyrimethamine (3 tablets 500mg sulfadoxine and 25mg pyrimethamine) plus placebo metronidazole in Arm 1, or standard sulfadoxine–pyrimethamine plus metronidazole (4 tablets 500mg) in Arm 2, or dihydroartemisinin-piperaquine plus metronidazole (3 tablets 40mg dihydroartemisinin and 320mg piperaquine once daily for 3 consecutive days) plus metronidazole (4 tablets 500mg) in Arm 3. The primary outcome was any adverse pregnancy or birth outcome (spontaneous abortion, stillbirth, low birthweight, preterm birth, or neonatal death). Secondary outcomes included components of the primary outcome, small-for-gestational age, and day 28 treatment efficacy of IPTp regimens against asymptomatic Plasmodium falciparum malaria infection and asymptomatic curable STIs. We used a modified intention-to-treat analysis for the primary outcome. ClinicalTrials.gov: NCT04189744. Findings: 5436 pregnant women were allocated to three treatment-arms. Overall, 16·3% (288/1763) of women in Arm 1 (reference) had adverse pregnancy and birth outcomes compared to 16·6% (290/1745) in Arm 2 (p=0·82), and 16·0% (281/1755) in Arm 3 (p=0·79). Of individual components of adverse pregnancy and birth outcomes in the primary outcome, none differed across arms. However, women in Arm 3 were at greater risk of delivering small-for-gestational age newborns relative to Arm 1, 28·4% (476/1678) vs 24·5% (408/1663) (p=0·01). In Arms 1, 2, and 3, the day 28 clearance of asymptomatic peripheral malaria detected by PCR was 72·1% (555/770), 71·8% (541/754), and 93·5% (722/772), respectively. In Arm 1, day 28 clearance of asymptomatic STIs by PCR, and bacterial vaginosis by microscopy using the Nugent score, were: Chlamydia trachomatis 98·4% (60/61), Neisseria gonorrhoea 84·1% (95/113), Trichomonas vaginalis 75·0% (96/128), and bacterial vaginosis 34·3% (193/563). In Arm 2, day 28 clearance rates were: C. trachomatis 89·5% (51/57), N. gonorrhoea 84·2% (96/114), T. vaginalis 87·5% (105/120), and bacterial vaginosis 53·9% (289/536). In Arm 3, day 28 clearance rates were: C. trachomatis 80·8% (42/52), N. gonorrhoea 84·9% (84/99), T. vaginalis 89·8% (115/128), and bacterial vaginosis 62·2% (335/536). Interpretation: Neither Arm 2 nor 3 were superior to Arm 1 for protection against adverse pregnancy and birth outcomes. Arm 3 was superior to Arms 1 and 2 against malaria infection, whereas all IPTp regimens reduced curable STIs, including bacterial vaginosis. Sulfadoxine-pyrimethamine may serve as an important tool fo

BACKGROUND:Syphilis remains a global health challenge, with rising incidence rates worldwide Prevalence surveys conducted in Brazil over extended periods of time are scarce. This study examines the secular trends and risk factors for syphilis seroprevalence among first-time blood donors in Brazil. METHODS:A retrospective analysis was conducted as part of a multicenter, repeated cross-sectional survey of blood donors from four major Brazilian blood centers, covering the period from 2007 to 2020. First-time donors who had undergone valid treponemal screening tests were included in the final dataset. Demographic characteristics and serological results were analyzed to identify risk factors for syphilis seroprevalence using multivariate Poisson models. An interaction term between age group and donation year was added to the final model. Model comparisons were performed using Likelihood Ratio Tests (LRT) and Akaike Information Criterion (AIC). RESULTS:1,424,850 donations from first-time donors were included during the study period. The overall syphilis seroprevalence was 2.19%, with significant heterogeneity across centers. Risk factors for increased seroprevalence included male gender, older age, lower education level, and self-reported black or mixed skin color. Notably, an increasing trend in syphilis seroprevalence was observed among younger donors and those born after 1990. Interaction analyses revealed significant effects between visit period and key demographic variables (age group, gender, education, and ethnicity), with the interaction between age group and donation year indicating higher seroprevalence among younger age groups in recent years. CONCLUSION:The study highlights a high syphilis seroprevalence among first-time blood donors in Brazil, which has significant implications for blood safety and public health. The increasing trend among younger donors suggests a shift towards newer infections, warranting continued surveillance in this demographic.

BACKGROUND:Women living with HIV have an elevated risk for cervical cancer, present earlier, and have more recurrent human papillomavirus (HPV) infections compared with women without HIV. To update WHO recommendations on screening and treatment to prevent cervical cancer, we aimed to identify whether women living with HIV should be screened for cervical cancer at a specific age, the optimal screening interval following a negative cervical screen, and the screening interval following treatment. METHODS:We conducted a systematic literature review on cervical cancer and HIV by searching MEDLINE, Embase, CENTRAL, the Cochrane Library, and clinical trial registries covering Jan 1, 2012, through to Oct 13, 2019, updating a previous systematic review covering database inception to July, 2012. Included articles reported original data and assessed one or more outcomes related to cervical precancer and cancer in women living with HIV; no restrictions on study design or setting were made. Articles were excluded if they did not include any women living with HIV, or if they reported only HPV genotype prevalence without any other relevant data. Two authors extracted data from any study reporting cervical cancer screening tests and histopathologically confirmed disease outcomes, by age. We analysed summary data on optimal age and screening intervals, providing pooled estimates when possible; we then conducted an individual patient data meta-analysis (IPDMA) to analyse age-specific data on cervical cancer and precancer. Authors of studies with 40 or more women living with HIV and cervical intraepithelial neoplasia (CIN) grade 2+ were invited to submit individual patient data for meta-analysis. Random-effects models were used to calculate predicted probabilities for cervical cancer screening results by age, HIV status, and antiretroviral therapy (ART) status. FINDINGS:Of the 304 full-text articles screened, 34 studies from 12 countries, with 128 732 women, including 63 790 women living with HIV, were included in the systematic review. Of 55 studies potentially eligible for the IPDMA, eight studies provided data for 72 350 women, 12 527 of whom were living with HIV, from seven countries (Burkina Faso, Cameroon, India, Kenya, South Africa, Thailand, and the USA). In the IPDMA, the pooled predicted probability of CIN2 or CIN3 among women living with HIV increased from 6·0% (95% CI 0·74-64·1) for ages 15-19 years to 32·4% (8·3-72·7) for ages 20-24 years, 42·1% (16·4-80·2) for ages 25-29 years, 50·3% (16·3-80·0) for ages 30-34 years, 47·0% (16·3-80·0) for ages 35-39 years, 49·0% (16·3-80·2) for ages 40-44 years, 58·1% (17·0-81·5) for ages 45-49 years, and 55·3% (21·0-86·6) for age 50 years and older; invasive cervical cancer was uncommon before 30 years of age. In the systematic review, women living with HIV who had a negative baseline cytology result and negative HPV test had a cumulative incidence of developing CIN2+ that ranged from 0·8% to 5% within 4·2-6·4 years and a cumulative incidence of developing of CIN of any grade up to 10% within 12 years. Also in the systematic review, women living with HIV had high recurrence of CIN2+ following treatment (11-27% by 1 year follow-up, 3-64% by 3 years, and 57% by 10 years). No significant evidence of publication bias was found in the data included in the IPDMA (Egger's test p=0·83). INTERPRETATION:Our data show a clear, age-related increase in CIN2 and CIN3 among women living with HIV, with the highest risk occurring in the 45-49-year age group. Our findings informed WHO recommendations to initiate cervical cancer screening for women living with HIV at age 25 years, with regular screening every 3-5 years. Expanding screening and treatment is necessary to reduce cervical cancer incidence towards its elimination. FUNDING:US Agency for International Development and US President's Emergency Plan for AIDS Relief.

BACKGROUND:Most longitudinal studies of COVID-19 incidence have used unlinked samples. The city of Manaus, Brazil, has a blood donation program which allows sample linkage, and was struck by two large COVID-19 epidemic waves between mid-2020 and early 2021. METHODS:We estimated the changing force of infection, i.e. incidence in susceptible individuals. Seroconversion was inferred by a mixture model for serial values from the Abbott Architect SARS-CoV-2 nucleocapsid (N) IgG assay. We estimated the number of suspected COVID-19 hospitalizations arising from each infection over calendar time. RESULTS:Whole blood donations between April 2020 and March 2021 were included from 6734 people, 2747 with two or more donations. The inferred criterion for seroconversion, and thus an incident infection, was a 6.07 fold increase in N IgG reactivity. The overall force of infection was 1.19 per person year (95% confidence interval 1.14-1.24) during the two main waves. The estimated number of suspected hospitalizations per infection, was approximately 4.1 times higher in the second wave than in the first. CONCLUSIONS:Serial values from this assay can be used to infer seroconversion over time, and in Manaus show a higher number of suspected COVID-19 hospitalizations per infection in the second wave relative to the first.

Prophylactic human papillomavirus vaccines such as Cervarix® and Gardasil®9 induce robust and sustained antibody responses over time. One driver of such responses is memory B-cells (MBCs), primed during initial HPV-vaccine exposure. As part of the Dose Reduction Immunobridging and Safety Study (DoRIS), MBCs were evaluated in peripheral blood mononuclear cells by enzyme-linked immunosorbent spot assay at baseline and at 5 visits post-first vaccine dose to Month 36 in 930 Tanzanian girls randomly allocated to 3, 2, or 1 doses of either vaccine. Most ( > 90%) participants had detectable MBCs at all time points, with maximum responses by Month 7. Geometric mean frequency HPV-specific MBCs and the proportion responding declined thereafter for both vaccines in the 2 and 3-dose arms. MBC frequencies were lower in single-dose than in 2- and 3-doses recipients at all time points subsequent to Month 1. By Month 36, MBC responses to both vaccines for both HPV16 and 18 were similar across all dosing arms. The clinical significance of the dose response remains to be evaluated; however, the presence of MBCs in the circulation after 3 years with a single vaccine dose is encouraging in terms of generating long-lasting protection with a one-dose vaccination strategy.

BACKGROUND:WHO has recommended that one dose of human papillomavirus (HPV) vaccine can be given to individuals aged 9-20 years to prevent HPV infection. Estimating durability of immune responses after a single dose in the target age for vaccination is important. We report immunogenicity results in Tanzanian girls up to 5 years after receiving a dose. METHODS:In this open-label, randomised controlled trial (the Dose Reduction Immunobridging and Safety Study of Two HPV Vaccines in Tanzanian Girls [DoRIS] trial), 930 Tanzanian schoolgirls aged 9-14 years were enrolled and randomly allocated to receive one, two, or three doses of either the two-valent vaccine (Cervarix; GSK, Wavre, Belgium) or nine-valent vaccine (Gardasil-9; Merck Sharp & Dohme, Haarlem, Netherlands). Seropositivity specific to HPV16 or HPV18, antibody geometric mean concentrations (GMCs), and antibody avidity were measured annually up to month 36. Participants in the one-dose and two-dose groups were followed annually in a long-term extension of the DoRIS trial to month 60; the primary outcome was seropositivity specific to HPV16 or HPV18 comparing one dose with two doses. FINDINGS:Single-dose seropositivity for HPV16 IgG antibodies at month 60 with either vaccine was more than 99% and non-inferior to two doses. 98% of girls in the one-dose two-valent vaccine group and 93% in the one-dose nine-valent group were seropositive for HPV18 at month 60; however, the non-inferiority criteria for HPV18 seropositivity comparing one dose with two doses were not met. Although HPV16 and HPV18 antibody GMCs after one dose were lower than those observed after two doses, antibody GMCs in the one-dose groups remained stable from month 12 to month 60. There was no evidence of a difference between the one-dose and two-dose groups in HPV16 or HPV18 antibody avidity at month 36 for either vaccine. INTERPRETATION:A single dose of HPV vaccine in girls aged 9-14 years continues to provide stable immune responses 5 years after vaccination, although ongoing surveillance for potential waning immunity after a single dose is needed. Participants are being followed up to 9 years after vaccination. FUNDING:UK Department of Health and Social Care, UK Foreign, Commonwealth & Development Office, Global Challenges Research Fund, UK Medical Research Council, and the Wellcome Trust through the Joint Global Health Trials Scheme; Bill & Melinda Gates Foundation.

Objectives: Systematic testing of antenatal clinic attendees using dual HIV and syphilis rapid diagnostic tests (RDT) can improve syphilis screening and reduce mother-to-child transmission. We assessed the effect of the dual HIV/syphilis RDT on syphilis care and adverse birth outcomes (ABOs), including congenital syphilis (CS) in Central Uganda. Methods: Eleven antenatal clinics were selected from Kalungu and Masaka districts. First-visit records were extracted on syphilis testing, positivity and treatment over two 9-month periods, pre- and post-introduction, with a 3-month buffer. Syphilis cascade indicators were calculated for the two periods. The World Health Organization CS Estimation Tool evaluated impact on CS cases and ABOs. Results: A total of 6011 records were extracted, 2660 pre-test introduction and 3351 post-introduction. Syphilis testing increased from 49.1% pre-test to 84.0% post-introduction, an increased testing rate ratio of 1.71 (95% confidence interval 1.64-1.78). Treatment coverage modestly increased post-introduction (rate ratio = 1.19, 0.94-1.50), resulting in an absolute rate difference of 31.4% (20.5-41.6%, P <0.001). This resulted in a modeled 41% decline in CS cases and 39% decline in ABOs. Conclusions: This is the first demonstration of the impact of dual HIV/syphilis RDT in routine antenatal clinics in Uganda, which could reduce CS and ABOs.

ABSTRACT 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.

ABSTRACT 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.

ABSTRACT 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.

RESUMO Objetivo: Estimar as prevalências e os fatores associados à detecção de Chlamydia trachomatis (CT) e Neisseria gonorrhoeae (NG) em mulheres trans e travestis em cinco capitais brasileiras. Métodos: Os dados vieram de um estudo transversal, realizado entre 2019 e 2021, com pessoas recrutadas por RDS (respondent driven sampling) em São Paulo, Campo Grande, Manaus, Porto Alegre e Salvador. Analisou-se a detecção de CT e NG, em três sítios de coleta (anorretal, orofaríngeo e uretral). Para identificação dos fatores associados empregaram-se modelos logísticos com efeitos mistos. Resultados: Forneceram material biológico para detecção dessas infecções 1.297 participantes recrutadas. As prevalências de CT, NG e coinfecção foram, respectivamente, 11,5, 13,3 e 3,6%. Foram independentemente associados à detecção para CT: trabalho sexual no passado (odds ratio — OR=1,73; intervalos de confiança para 95% — IC95% 1,02–2,95), no momento atual (OR=2,13; IC95% 1,23–3,69) e como atividade parcial (OR=2,75; IC95% 1,60–4,75) e uso de drogas injetáveis na vida (OR=3,54; IC95% 1,49–8,40). Para NG: uso de drogas injetáveis na vida (OR=1,91; IC95% 1,28–2,84) e orientação sexual – heterossexuais (OR=3,44; IC95% 1,35–8,82), homossexuais (OR=5,49; IC95% 1,89–15,97) e bissexuais (OR=3,21; IC95% 1,06–9,68). Para coinfecção: uso de drogas nos últimos 12 meses (OR=2,34; IC95% 1,10–5,00). Ser mais jovem foi associada a todos os desfechos investigados. Conclusão: As prevalências estimadas de CT, NG e de coinfecção foram desproporcionalmente mais elevadas entre as mulheres trans e travestis se comparadas à população geral, especialmente entre as mais jovens, que exerciam trabalho sexual e faziam uso de drogas.

Background The effective testing of sexually transmitted infections (STIs) requires sampling from potential infection sites. This study aimed to assess the choice, satisfaction, and performance of self-collected samples (SCS) from potential infection sites for STI testing among transgender women in Brazil. Methods TransOdara was a multicentric, cross-sectional STI prevalence study conducted in 5 Brazilian cities. Using respondent-driven sampling, 1317 transgender women 18 years or older were recruited. Participants completed interviewer-led questionnaires and provided swab samples from multiple sites (anorectal, oropharyngeal, genital) for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and human papillomavirus (HPV) testing. Participants were given a choice of SCS or provider-collected samples (PCS) at each site. Results Most participants selected SCS for anorectal (74.9%; 95% confidence interval [CI], 72.4–77.3) and genital (72.7%; 95% CI, 70.2–75.1) sites, whereas fewer chose for oropharyngeal samples (49.8%; 95% CI, 47.0–52.6). For future testing, most participants expressed a preference for SCS for genital (72.2%; 95% CI, 69.5–74.7) and anorectal (70.2%; 95% CI, 67.6–72.7) sites. There was no significant difference in the positive test results for CT and NG between SCS and PCS at anorectal and oropharyngeal sites, or for HPV at anorectal and genital (penile or neovaginal) sites. Conclusions This study demonstrated a high level of acceptability and usability of self-sampling for STI testing among transgender women. A preference for SCS was evident at the anorectal and genital sites, and the results of SCS were comparable to those of PCS. The findings suggest that multisite STI testing utilizing self-collection methods as a provided option can be effectively integrated into sexual health services for transgender women.

RESUMO Objetivo: Estimar as prevalências e fatores associados com as hepatites A, B e C em mulheres trans e travestis em cinco regiões do Brasil. Métodos: Estudo transversal com mulheres trans e travestis em cinco capitais brasileiras (Campo Grande, Manaus, Porto Alegre, Salvador e São Paulo), entre dezembro/2019 e julho/2021. As amostras foram submetidas à detecção de marcadores das infecções pelos vírus das hepatites A (HAV), B (HBV) e C (HCV), utilizando-se testes rápidos e quimioluminescência. Amostras positivas foram submetidas à detecção de HBV-DNA e HCV-RNA por PCR em tempo real e genotipadas por sequenciamento de Sanger. Resultados: As análises de 1.317 amostras indicaram taxas de prevalências nas mulheres trans e travestis recrutadas de 69,1%, 24,4% e 1,5% para exposição ao HAV, HBV e HCV, respectivamente. Elevada taxa de suscetibilidade ao HBV (35,7%) e baixa prevalência do marcador vacinal (40,0%) foram observadas. Mostraram-se associadas à presença de anti-HAV: idade maior que 26 anos, autodeclarar-se preta-parda, ter apenas educação básica, história de encarceramento e uso de preservativo na última relação sexual com parceiro casual. Quanto à exposição ao HBV, foi associada a idade maior que 26 anos, cor da pele preto-parda, ter sido profissional do sexo e história de encarceramento. Idade maior de 37 anos, história de abuso sexual e consumo frequente de álcool foram associadas ao HCV. Conclusão: As maiores prevalências de HAV nessa população encontram-se nas regiões Norte e Nordeste. Com relação ao HBV, a prevalência encontrada foi superior à encontrada na população geral, sugerindo maior vulnerabilidade. A prevalência do HCV foi semelhante à encontrada na população geral.