Background
Mental health plays an important role in the effectiveness of HIV prevention strategies, as poor mental health can lead to decreased adherence and increased vulnerability to HIV infection. Long-acting PrEP modalities can help overcome barriers related to PrEP persistence and adherence, and should be considered for those with mental health challenges. We explored the association between sociodemographic factors, depression and suicide risk among young sexual and gender minorities (SGMs) participating in the ImPrEP CAB study. This is the first study to evaluate CAB-LA PrEP implementation in Latin America, a region where scaling up PrEP is urgently needed.
Methods
ImPrEP CAB Brasil is an implementation study to assess PrEP choice, feasibility, acceptability, and effectiveness of CAB-LA for SGMs (18-30 years) in public health PrEP services in 6 Brazilian cities. Depression and suicide risk were assessed at baseline, prior to the first CAB-LA injection, using the PHQ-9 (no/mild [0-9] vs. moderate/severe [10-27]) and C-SSRS (no risk vs. suicide risk), respectively, with ongoing monitoring during the study. Participants with positive screenings were referred for on-site psychiatric evaluation. Sociodemographic factors were analyzed using Chi-square or Fisher’s exact tests, with Bonferroni adjustments for multiple comparisons.
Results
Between Oct 2023 and Sep 2024, 1200 participants were enrolled and received the first CAB-LA injection. Most were cisgender men who have sex with men (MSM) (91%), aged 25-30 (62%), non-White (61%), and had >12 years of education (72%). Overall, 11% had moderate/severe depression and 9.6% suicide risk. Transgender women/travestis had higher rates of depression (24.2%) and suicide risk (16.7%) compared to cisgender MSM (9.9%; 8.9%, respectively). Transgender men had the highest rates of both outcomes (30.8%), while non-binary/queer participants had 13.3% for each. Depression and suicide risk were greater in those with ≤12 years of education (16.1% and 12.5%, respectively) compared to >12 years (9% and 8.4%, respectively). Suicide risk was highest among ages 18-20 (21.8%), compared to 21-24 (10.5%) and 25-30 (7.5%) (Table).
Conclusions
Our findings reveal high rates of moderate to severe depression and suicide risk among young SGMs enrolled in ImPrEP CAB-LA, especially among transgender persons, younger participants, and those with lower education levels. These results underscore the critical need to integrate mental health interventions into PrEP programs.