P409 Testing and treating syphilis in transgender women – a point-of-care approach in Brazil

Introduction Sexually Transmitted Infections (STIs) disproportionately affect transgender women (TGW). This group faces barriers to accessing health care, especially due to stigma and discrimination. The literature is scarce on data of STIs among TGW in Brazil. We aimed to estimate the prevalence of syphilis and to analyze the completeness of treatment among TGW in two Brazilian cities. Methods A cross-sectional study was conducted in Sao Paulo (SP) and Salvador (SSA) from December 2019 to January 2021, as part of the TransOdara study. Participants aged 18 to 65 years old were recruited using Respondent Driven Sampling (RDS), completed a standard questionnaire and samples were collected for rapid syphilis testing. After laboratory and clinical evaluation by a doctor/nurse, a prescription for antibiotic treatment (oral or injectable) was given, if necessary. Results Of the 562 participants recruited, 71.7% (n=403) were from SP and 28.3% (n=159) from SSA. Most were 20–29 years old (45.1%), with brown skin color (47.5%), were living alone (76.2%), in rented residence (51.1%), had maximum level of high school education (47.9%), and have not legally changed their names (69.5%). The following data related to syphilis is presented for SP and SSA, respectively. Positive rapid test was 57.8% (233/403) (95% CI: 53.0–62.6) and 59.1% (88/159) (95% CI: 47.6–63.0). Of these, 24.9% (58/233) and 47.7% (42/88) received prescription (oral or injectable). Injectable treatment (benzathine penicillin G) was prescribed for 60.3% (35/58) and 97.6% (41/42). The completeness of treatment was assessed only for those who received injectable treatment, occurring for 51.4% (18/35) and 78.0% (32/41). Conclusions Active syphilis is highly prevalent among TGW in both cities. Even in a point-of-care program with active surveillance participants giving up treatment was observed. Our findings reinforce the need for a diversified and creative approach even with a point of care protocol.