Efficacy of a short message service brief contact intervention (SMS-SOS) in reducing repetition of hospital-treated self-harm: randomised controlled trial.

BACKGROUND: Hospital-treated self-harm is common and costly, and is associated with repeated self-harm and suicide. AIMS: To investigate the effectiveness of a brief contact intervention delivered via short message service (SMS) text messages in reducing hospital-treated self-harm re-presentations in three hospitals in Sydney (2017-2019), Australia. Trial registration number: ACTRN12617000607370. METHOD: A randomised controlled trial with parallel arms allocated 804 participants presenting with self-harm, stratified by previous self-harm, to a control condition of treatment as usual (TAU) (n = 431) or an intervention condition of nine automated SMS contacts (plus TAU) (n = 373), over 12 months following the index self-harm episode. The primary outcomes were (a) repeat self-harm event rate (number of self-harm events per person per year) at 6-, 12- and 24-month follow-up and (b) the time to first repeat at 24-month follow-up. RESULTS: The event rate for self-harm repetition was lower for the SMS compared with TAU group at 6 months (IRR = 0.79, 95% CI 0.61-1.01), 12 months (IRR = 0.78, 95% CI 0.64-0.95) and 24 months (IRR = 0.78, 95% CI 0.66-0.91). There was no difference between the SMS and TAU groups in the time to first repeat self-harm event over 24 months (HR = 0.96, 95% CI 0.72-1.26). There were four suicides in the TAU group and none in the SMS group. CONCLUSIONS: The 22% reduction in repetition of hospital-treated self-harm was clinically meaningful. SMS text messages are an inexpensive, scalable and universal intervention that can be used in hospital-treated self-harm populations but further work is needed to establish efficacy and cost-effectiveness across settings.

Low education and mental health among older adults: the mediating role of employment and income.

PURPOSE: Transition from work to retirement may be associated with poor mental health outcomes in older-age groups, especially among those of lower socio-economic position (SEP). This study investigates the association between low educational achievement and mental health status, and the mediating role of employment status and income level among older-age Australians. METHODS: This study was based on the '45 and Up Study', a prospective cohort study of participants from New South Wales (Australia) aged 45 years and older (N = 267,153), followed-up over the period 2006-2018. A causal mediation analysis was used to assess the total causal effect (TCE) of educational achievement level on psychological distress, and the extent of mediation by employment status and income level. RESULTS: Lower educational achievement was associated with subsequent psychological distress, with a stronger TCE among those with low educational achievement (OR = 1.46, 95% CI 1.25-1.72), followed by those with intermediate educational achievement (OR = 1.26, 95% CI 1.07-1.48), compared to those with high educational achievement. In models investigating mediation by employment status and income level, 44.7%, (95% CI 34.2-55.3) of the association was mediated by employment status and income level, with a stronger mediating effect evident for income level. CONCLUSION: Findings suggest that employment status and income level changes at older age are more strongly associated with poorer mental health among those of lower SEP. Poor mental health associated with lower SEP may be ameliorated particularly by changes to income level, but also how people transition from employment to retirement.

The impact of the COVID-19 pandemic on hospital-treated self-harm in Sydney (Australia).

OBJECTIVES: This study investigated trends in hospital-treated self-harm and hospital presenting suicidal ideation in the period before and after COVID-19 public health responses by key socio-demographic groups among those presenting to hospitals in the Western Sydney (Australia) population catchment. METHODS: Emergency department presentations for the period January 2016 to June 2021 were used to specify a series of interrupted time-series models to compare the observed and expected event rates of (1) hospital-treated self-harm and (2) hospital presenting suicidal ideation in the period following the onset of COVID-19 public health measures in March 2020. Rate differences between observed and expected rates in the post-implementation period were also estimated in models stratified by sex, age group, country of birth and socio-economic status. RESULTS: There was no significant increase in hospital-treated self-harm in the period post-implementation of public health orders (March 2020) compared to the previous period, although there were lower than expected rates of emergency department presentations among non-Australian-born males, males aged 0-14 years and 25-44 years, and females aged 45-64 years. In contrast, there was a significant increase in hospital presenting suicidal ideation, particularly among women (rate difference per 100,000 = 3.91, 95% confidence interval = [1.35, 6.48]) and those aged 15-24 years (both males and females, rate differences ranging from 8.91 to 19.04), and among those residing in lower socio-economic status areas (both males and females, rate differences ranging from 0.90 to 2.33). CONCLUSION: There was no increase in hospital-treated self-harm rates in the 15 months post-implementation of COVID-19 public health orders in Western Sydney; however, there was a significant increase in hospital presenting suicidal ideation. The limited change in suicidal behaviour may reflect the success of social and economic supports during this period, the benefits of which may have been different for young people, and those of lower socio-economic status.

The Impact of Mental Health Literacy Training Programs on the Mental Health Literacy of University Students: a Systematic Review.

Student mental health is of growing concern for the university education sector. Supporting opportunities to increase mental health literacy of students is one strategy in which universities and colleges are actively investing to support students build their capacity to be well. This study is a systematic review of mental health literacy training (MHLT) programs, other than Mental Health First Aid training, to examine their impact on the mental health literacy of university students. The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) (Online Resource 1) and A Measurement Tool to Assess Systematic Reviews (AMSTAR2) guidelines. Search terms related to mental health literacy concepts, mental health literacy training and university students were used in four major databases (i.e. EBSCOhost, Ovid, ProQuest and Web of Science), retrieving a total of 1219 articles, with 44 studies selected for full-text review, and a final number of 24 studies included for review based on pre-determined eligibility criteria. Results were reported against three main themes: types of MHLT offered; common practices, processes and implementation elements; and effectiveness of intervention. Results indicate a high level of variability in approaches to mental health literacy interventions and measures of assessment and reporting. Additionally, reported benefits to mental health literacy failed to report on comparable units of improvement or the sustainability of benefits. Although it is in the best interest of universities to prioritise early intervention programs to address mental health and improve wellbeing, more robust data is required to establish the effectiveness of MHLT programs in achieving this aim.

Students as leaders in supporting campus well-being: Peer-to-peer health promotion in higher education.

ISSUE ADDRESSED: This study aimed to analyse the relationship between peer-delivered health promotion programmes and student well-being and to expand the limited body of research examining peer-to-peer mental health promotion as experienced by student leaders. METHODS: The study was cross-sectional and focused on the experience of participants of a Sydney-based University Mental Health Day event, including student leaders, student participants, university staff and industry partners. It adopted a mixed-method approach to data collection, including a quantitative and a qualitative phase. RESULTS: Results from the quantitative phase demonstrate the benefits of peer-delivered health promotion programmes to students who receive the event. Results from the qualitative phase of the study provide a deeper insight into the delivery of the event, from both a student leader perspective, and also from the perspective of other stakeholders, who worked closely with student leaders. Two main themes emerged from the qualitative material and are explored in detail: enabling leadership and creating a sense of purpose. CONCLUSION: The study concludes that, while there is mounting evidence of the benefits of student-led mental health programmes for both leaders and their peers, more research needs to be carried out to better understand how to optimise these experiences and unlock their full potential with reference to student mental health. SO WHAT?: With the ongoing pressure on university student services to support student well-being not being met with appropriate resourcing, peer-to-peer programmes, like the Mental Health and Well-being Student Ambassador Programme, have a real opportunity to make strides in supporting and promoting student mental health.

A cross-sectional study of mental health and suicidality among trans women in São Paulo, Brazil.

BACKGROUND: Trans women have been shown to experience disproportionately poor outcomes in physical and mental health. Although it is common to talk about the violence against trans people, little is still known about mental health outcomes and experiences of suicidality among trans women, particularly in developing countries. This study aims to investigate risk factors and associations with mental health, suicide ideation and suicide attempts among trans women in the largest metropolitan area in Brazil. METHODS: Trans women living in São Paulo were recruited between May 2017 and July 2019 using the long-chain peer referral method Respondent-Driven Sampling. Multivariate regression models were used to investigate the associations with K10 score classification (logistic) and suicidal ideation/suicide attempt (ordinal logistic). RESULTS: A total of 763 trans women were included in the study. Over one quarter (26.5%) of trans women had been diagnosed with anxiety in the past, and close to one in five (19.1%) trans women had received a diagnosis of depression. More than two in five (41.9%) trans women had moderate to severe psychological distress. More than half of all participating trans women reported having previously either experienced suicidal ideation or attempted to take their own lives (25.0 and 31.2% respectively). In multivariate regression, moderate to severe psychological distress was associated with homelessness, income, current sex work, use of stimulant drugs, history of physical abuse, depression diagnosis and access to mental health treatment. Suicidal ideation and suicide attempts were associated with race/skin color, living arrangements, marital status, current sex work, history of sexual violence, depression and PTSD diagnoses, access to mental health treatment and psychological distress. CONCLUSIONS: This study showed that there is a significant association between mental health conditions, lack of treatment for these conditions and suicidality among trans gender women. Findings point to the need for a structural transformation in Brazil that enables a reduction in the social inequality and violence that impact the mental health of trans women. A number of recommendations to achieve this are provided.

The impact of transitions from employment to retirement on suicidal behaviour among older aged Australians.

PURPOSE: Transition from employment to retirement may be detrimental to mental health, and associated with suicidal behaviour. This study investigated the association between employment and retirement status and suicidal behaviour among older aged Australians. METHODS: This study was based on the '45 and Up Study', a large prospective cohort study of participants from New South Wales (Australia) aged 45 years and older (N = 267,153), followed up over the period 2006-2018. The risk of attempted suicide and suicide was compared between categories of employment and retirement status in a series of recurrent event survival analysis models adjusting for identified time variant and invariant confounders. RESULTS: Compared to those who were employed, the risk of attempted suicide was higher among those who were not in the labour force and not retired (predominantly those who were sick or disabled, or carers) (HR = 1.97-95% CI 1.49-2.62), those who retired involuntarily (HR = 1.35-95% CI 1.03-1.77), and to a lesser extent those unemployed (HR = 1.31-95% CI 0.89-1.92). Risk of attempted suicide among those who retired voluntarily was similar to those who remained employed (HR = 1.09-95% CI 0.82-1.45). A similar pattern was evident for suicide, with a higher risk of suicide among those who were not in the labour force or retired, and those who retired involuntarily, compared to those who remained employed; however, these differences were not statistically significant. CONCLUSION: Transition from employment to retirement may be an important precipitating factor for suicidal behaviour, affected by current and previous mental health status. Services and programs facilitating continued or re-employment in older age, and adjustment to the transition from employment to retirement may prevent suicidal behaviour.

Creating Healthy Universities: The role of campus-based health promotion events in supporting student well-being.

ISSUE ADDRESSED: University students have been increasingly recognised as a population with a high prevalence of mental ill health, with research suggesting that psychological distress is higher among tertiary education students than nonstudents. The purpose of this study was to assess students' perceptions of the effectiveness of student-led, campus-based mental health promotion events on their well-being. METHODS: The cross-sectional study included six campus-based events, and collected data from 700 university students using a survey tool that included quantitative and qualitative measures. A multivariate logistic regression model was developed to investigate the association among explanatory variables and the response variable. A log-likelihood ratio test was used to assess the goodness of fitness of the final model. Qualitative data were thematically analysed. RESULTS: Results showed that the majority of students (84%) agreed the event promoted and supported student well-being, with three variables being statistically related to this agreement: (a) respondents' decision to spend more time on campus due to the event; (b) how respondents felt about receiving health information from student peers; and (c) the number of activities in which they took part. CONCLUSIONS: Our findings suggest that campus-based mental health promotion events need to be designed with emphasis on activities that attract, retain and educate students about mental health, and are delivered with the benefits of peer-to-peer health promotion in mind, in order to reach their full potential in supporting improved student mental health. SO WHAT?: The findings highlight the opportunities that can be created by university events to promote and support student mental health by building peer relationships and creating a sense of community.

Is the Frequency in Somatosensory Electrical Stimulation the Key Parameter in Modulating the Corticospinal Excitability of Healthy Volunteers and Stroke Patients with Spasticity?

Somatosensory electrical stimulation (SES) has been proposed as an approach to treat patients with sensory-motor impairment such as spasticity. However, there is still no consensus regarding which would be the adequate SES parameters to treat those deficits. Therefore, the aim of this study was to evaluate the effects of applying SES over the forearm muscles at four different frequencies of stimulation (3, 30, 150, and 300 Hz) and in two intervals of time (5' and 30') by means of transcranial magnetic stimulation and Hoffmann's reflex (H-reflex) in healthy volunteers (Experiments I and II). A group of stroke patients (Experiment III) was also preliminary evaluated to ascertain SES effects at a low frequency (3 Hz) applied for 30' over the forearm spastic flexors muscles by measuring the wrist joint passive torque. Motor evoked potentials and the H-reflex were collected from different forearm and hand muscles immediately before and after SES and up to 5' (Experiment I) and 10' (Experiments I and II) later. None of the investigated frequencies of SES was able to operate as a key in switching modulatory effects in the central nervous system of healthy volunteers and stroke patients with spasticity.

Physical activity levels of economically disadvantaged women living in the Olympic city of Rio de Janeiro.

The objective of this study was to analyze the physical activity patterns of women living in a low-income community located in close proximity to the 2016 Rio de Janeiro Olympic Park. Data (N = 140) were collected in June and July 2012 using the International Physical Activity Questionnaire. Findings indicated that the majority (54.8%) of participants reported high levels of physical activity. The domains that contributed the most to this pattern were occupational and household physical activity. Significantly, 88.1% of participants reported low physical activity levels during their leisure-time. In the transport-related domain, participants were relatively more active, but more than half of them (57%) spent less than 600 MET-minutes/week in this domain. The results highlighted the discrepancies between different physical activity domains. In addition, the findings also suggested that low-income women in our study engaged little in physical activity during their leisure time. Therefore, the proposed commitments found in the Rio de Janeiro Candidature File to host the 2016 Olympic Games to increase sport/physical activity participation within low-income communities in Rio de Janeiro need to be implemented effectively if this physical activity behavior during self-directed time is to be changed.

Multiple substance use and associated factors in transgender women and travestis: findings from the TransOdara Study, Brazil.

OBJECTIVE: To estimate the prevalence of concomitant substance consumption and analyze associated risk factors in a non-probabilistic sample of the Brazilian population of transgender women and travestis. METHODS: A cross-sectional study was conducted with recruitment via respondent-driven sampling. The sample included transgender women and travestis residing in São Paulo, Porto Alegre, Salvador, Manaus, and Campo Grande, aged 18 years or older, between 2019 and 2021. The outcome was the concomitant use of licit and illicit substances. The association between sociodemographic/behavioral factors and the outcome was analyzed through Poisson regression with mixed effects. Adjusted prevalence ratios (confidence interval of 95% - 95%CI) were estimated. RESULTS: The prevalence in the last 12 months of multiple substance use was 49.3%, of which 65.5% were alcohol, 52.9% tobacco, and 40.1% marijuana. Transgender women and travestis who use multiple substances face more violence (1.71; 95%CI 1.14-2.55), unemployment (1.58; 95%CI 1.05-2.37) and pervasive unstable work status (1.52; 95%CI 1.08-2.14), transactional sex (1.51; 95%CI 1.21-1.88) which can be their sole option to make a living, and are aged 18 to 24 years (1.37; 95%CI 1.14-1.65). CONCLUSION: The use of multiple substances may be an attempt to cope with distress and marginalization. Substance use has been associated with multiple harms and medical conditions. Comprehensive management and care should be provided, as defined by the key principles of the Brazilian Unified Health System. Health care should be integrated into structural interventions.

Discrimination based on gender identity against transgender women and travestis in Brazil: a latent class analysis and associated factors.

OBJECTIVE: To identify groups of transgender women and travestis (TGW) with specific patterns of gender-based discrimination (GBD) and analyze the factors associated with GBD. METHODS: A cross-sectional study was conducted with TGW recruited through respondent-driven sampling in five Brazilian cities (2019-2021). Latent class analysis was used to characterize GBD (low, medium, and high) using 14 observable variables. Descriptive analysis was performed, and associations between predictor variables and GBD were estimated by adjusted odds ratios (aOR) using ordinal logistic regression. RESULTS: Out of a total of 1,317 TGW, 906 (68.8%) answered questions about GBD. Most were under 34 years old, single, and had a Brown race/skin color. GBD was classified as "low," "medium," and "high," with estimates of 41.7, 44.5, and 13.8%, respectively. Variables positively associated with higher intensity of GBD included living in Manaus compared to São Paulo, being ≤34 years old compared to >34, being homeless compared to living in one's own house or rented apartment, not having legally changed one's name compared to those who had, and reporting physical or sexual violence compared to those who did not report. Variables negatively associated with higher intensity of GBD included having a Brown or Asian race/skin color compared to White and a monthly income ≥1 minimum wage compared to ³1. CONCLUSION: A high proportion of GBD was observed in Brazilian TGW, with this outcome associated with more vulnerable sociodemographic characteristics and a history of violence.

Factors associated with prior testing for HIV, Syphilis, and Hepatitis B and C among transgender women and travestis in Brazil.

OBJECTIVE: To investigate the prior testing for HIV, syphilis, hepatitis B (HBV), and hepatitis C (HCV) among transgender women and travestis (TGW) in five Brazilian cities and identify factors associated with each of these previous tests. METHODS: This is a cross-sectional study with the recruitment of TGW through respondent-driven sampling (TransOdara Study). The investigated outcome variable was prior testing for HIV, syphilis, HBV, and HCV in the last 12 months. The association between sociodemographic and behavioral factors with the outcome was analyzed using a binomial logistic regression with mixed effects. Adjusted odds ratios (aOR) and 95% confidence intervals (CI95%) were estimated. RESULTS: The proportions of individuals with prior testing in the past year were as follows: 56.3% for HIV, 58.0% for syphilis, 42.1% for HBV, and 44.7% for HCV. Negative associations with prior testing were observed for individuals aged 35 years or older, whereas positive associations were found for those with high school education, those who experienced verbal or psychological violence in the last 12 months, and those who had commercial or casual partners in the last 6 months. CONCLUSION: There was low frequency of testing in the 12 months preceding the study for HIV, syphilis, HBV, and HCV compared to the guidelines established by the Ministry of Health. Expanding access to and engagement with healthcare and prevention services for TGW is an essential strategy in reducing the transmission chain of HIV and other sexually transmitted infections (STIs).

Bodies of desire: use of nonprescribed hormones among transgender women and travestis in five Brazilian capitals (2019-2021).

OBJECTIVE: To analyze the experiences of transgender women and travestis regarding the use of hormones for body changes without a medical prescription. METHODS: This is a cross-sectional, quantitative and qualitative study, using data from "TransOdara", which estimated the prevalence of Sexually Transmitted Infections in transgender women and travestis recruited through Respondent-Driven Sampling, between December 2019 and July 2021, in São Paulo, Campo Grande, Manaus, Porto Alegre, and Salvador, Brazil. The main outcome was: use of hormones without medical prescription and associated risk factors. Descriptive analysis, mixed univariate logistic regression models, and semi-structured interviews were carried out. RESULTS: Of the 1,317 recruited participants, 85.9% had already used hormones. The current use of hormones was reported by 40.7% (536) of them. Of those who were able to inform the place where they obtained them, 72.6% (381/525) used them without a medical prescription. The variables associated with the outcome were: current full-time sex work (OR 4.59; 95%CI 1.90-11.06) or in the past (OR 1.92; 95%CI 1.10-3.34), not having changed their name (OR 3.59; 95%CI 2.23-5.76), not currently studying (OR 1.83; 95%CI 1.07-3.13), being younger (OR 2.16; 95%CI 1.31-3.56), and having suffered discrimination at some point in life for being a transgender women and travestis (OR 0.40; 95%CI 0.20-0.81). CONCLUSION: The use of nonprescribed hormones is high among transgender women and travestis, especially among those who are younger, did not study, have not changed their name, and with a history of sex work. This use is related to the urgency for gender transition, with excessive use and damage to health.

Prevalence of syphilis in transgender women and travestis in Brazil: results from a national cross-sectional study.

OBJECTIVE: The study aimed to estimate the prevalence of acquired syphilis and associated factors in a national survey. METHODS: TransOdara was a cross-sectional study comprising transgender women and travestis (TGW) in five major cities in Brazil during December of 2019 and July of 2021. The sample was recruited using the respondent-driven sampling (RDS) method. The outcome "active syphilis" was defined as a positive treponemal test and Venereal-Disease-Research-Laboratory (VDRL) title greater than∕ equal to ⅛. Sociodemographic variables were described. Bivariate and multiple logistic regression were performed, and odds ratios (OR) and 95% confidence intervals (95%CI) were estimated. All analyses were performed in R, 4.3.1. RESULTS: A total of 1,317 TGW were recruited, with 1,291 being tested for syphilis, and 294 (22.8%) meeting the criteria for active syphilis. In bivariate analysis, black/mixed race (OR=1.41, 95%CI 1.01-1.97), basic level of education (OR=2.44, 95%CI 1.17-5.06), no name change in documents (OR=1.39, 95%CI 1.00-1.91) and sex work (past only OR= 2.22, 95%CI 1.47-3.32; partial OR=2.75, 95%CI 1.78-4.25; full time OR=3.62, 95%CI 2.36-5.53) were associated with active syphilis. In the multivariate analysis, sex work was the only associated factor, 2.07 (95%CI 1.37-3.13) past sex work, 2.59 (95%CI 1.66-4.05) part-time sex work and 3.16 (95%CI 2.04-4.92) sex work as the main source of income. CONCLUSION: The prevalence of active syphilis in this study was elevated compared with other countries in Latin America. Sex work was an important associated factor with active syphilis, highlighting the impact that this condition of vulnerability may have in the health of TGW, as members of a key, marginalized population.

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.

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.

Hepatitis A, B and C prevalence among transgender women and travestis in five Brazilian capitals between 2019-2021.

OBJECTIVE: To estimate the prevalence and factors associated with hepatitis A, B, and C in transgender women and travestis's networks, in 5 regions of Brazil. METHODS: This cross-sectional study includedtransgender women and travestis in five Brazilian capitals (Campo Grande, Manaus, Porto Alegre, Salvador, and São Paulo), between December/2019 and July/2021. All samples were subjected to detection of serological markers of hepatitis virus A (HAV), B (HBV), and C (HCV) infections through rapid tests and chemiluminescent microparticle immunoassays. Positive samples in the screening tests were submitted to detect HBV DNA and HCV-RNA by real-time PCR and genotyped by Sanger sequencing. RESULTS: Analysis of 1,317 samples showed network prevalence rates of 69.1%, 25.1%, and 1.5% for HAV, HBV, and HCV exposure, respectively. A high susceptibility rate to HBV infection (35.7%) and low prevalence of vaccine response markers (40%) were also observed. Age greater than 26 years, self-declared black/brown skin color, having only primary education, history of incarceration, and use of a condom in the last sexual intercourse with a casual partner were associated with total anti-HAV. Exposure to HBV was associated with age greater than 26 years, self-declared black/brown, history of being a sex worker, and incarceration. Age > 37 years, history of sexual abuse, and frequent alcohol consumption were associated with hepatitis C infection. CONCLUSION: The highest prevalence of HAV in this population was found in the North and Northeast regions, and the prevalence found was higher than that in the general population, suggesting greater vulnerability. The prevalence of HCV infection in our study was similar to that observed in the general population.