SHS (Humanities and Social Sciences) - COBra :- Effects of COVID-19 outbreak on the sexual and mental health of adolescent and adult men who have sex with men and transgender women participating in two PrEP cohorts studies in Brazil

COVID-19 is a global public health emergency. In contexts where official information about the pandemic is inconsistent, like Brazil, public understanding of COVID-19 may be hindered. Besides being a health emergency initself, the COVID-19 outbreak can have detrimental effects in other health issues, such as sexual and mental health. Limitations on healthcare provision during the outbreak along with displacement restrictions due to quarantine may affect HIV and STIs prevention, impacting access to preventive supplies and leading to changes in sexual and preventive behaviors. Among men who have sex with men (MSM) and transgender women (TGW), in particular, quarantine may affect mental health and increase domestic violence related to homophobia and transphobia. In this study, we aim to investigate the effects of the COVID-19 pandemic on the sexual and mental health of adolescent and adult MSM and TGW participating in two HIV pre-exposure prophylaxis (PrEP) cohorts in Brazil, with an emphasis on HIV and STIs, both during and after the quarantine period. The study uses a mixed-method approach and is nested in two cohort studies ongoing in Brazil: PrEP15-19 and Combina, which offer PrEP and other HIV combination prevention methods to adolescents and adults, respectively. Follow-up procedures include quarterly visits to the healthcare facilities for medical consultations, counseling and HIV and STI testing. During the quarantine period, most consultations and procedures have been adapted to use videoconference and texting, and PrEP and HIV self-testing (HIVST) are mailed to participants. All PrEP 15-19 and Combina participants will be invited to respond to an online questionnaire. Baseline participants will be recruited between the fifth and sixth week of quarantine in each city. Follow-up will occur in twotime points: participant's next visit to the studies' clinics and one year after the baseline. HIV infection at baseline will be evaluated by an HIVST and the following blood tests will be done during regular follow-up procedures. Baseline data collection will cover information on: socioeconomic, COVID-19 quarantine measures, sexual health, and mental health issues. After quarantine, use of HIV/STI prevention methods, use of PrEP, HIV infection, and symptoms of depression will be evaluated, and the ques-COVID-19 baseline will be applied again. Sample size was estimated on the assumption of 6% of change in sexual behavior after the quarantine (condomless sex in last intercourse or sex without use of PrEP/PEP), power of 80% and a significance level of 95%, thus totaling 426 participants. Multivariate logistic regression will be used to estimate associations between outcome variables and predictor variables, with adjusted odds ratio. The qualitative component will investigate participants' social representation of COVID-19 pandemic and understanding of protection measures, their management of self-care during and after quarantine, and the effects of the COVID-19 outbreak on their STI/HIV prevention behaviors. In accordance with ethical research standards, around 50 in-depth interviews through video calls or interactive voice response will be conducted with adolescents and adults. Other data collection strategies include practices integrated into the social lives of participants, namely daily recorded narratives using WhatsApp, and photographs that represent their daily lives during the pandemic. COBra is a collaboration between the coordination teams of PrEP15-19 and Combina cohorts based at public universities in Brazil, and GRePS Laboratory, based at Université Lumière Lyon 2, which currently runs an investigation on the social representations of COVID-19 and its impacts on the adaptation to quarantine.