Differentiated service delivery and peer-led digital messages to strengthen health outcomes among young men and non-binary persons who have sex with men in Brazil

Abstract

Despite the disproportionate burden of HIV among young men and non-binary persons who have sex with men (YMSM/NB) in Latin America, interventions among this population are scarce. We aimed to evaluate changes in health outcomes associated with a targeted intervention. Conectad@s was a 48-week single-arm study among Brazilian YMSM/NB (18–24 years) using an intervention combining differentiated service delivery (DSD) and peer-led weekly digital messages. We used generalized estimating equations to evaluate changes over time during two periods: (1) DSD plus weekly messages (weeks 0–24) and (2) DSD only (weeks 24–48). All 409 YMSM/NB accepted the intervention; 83.4% were retained to 48 weeks. During the first period, we observed increased odds of current ART use (aOR:1.14[99.7%CI 1.05–1.23]), current oral PrEP use (aOR:1.17[99.7%CI 1.14–1.20]), and good self-rated health (aOR:1.03[99.7%CI 1.02–1.05), and decreased odds of binge drinking (aOR:0.97[99.7%CI 0.95–0.99]), depressive symptoms (aOR:0.97[99.7%CI 0.95–0.98]), and anxiety (aOR:0.97[99.7%CI 0.96–0.99]). During the second period, we observed decreases on moderate/high problematic substance use (aOR:0.96[99.7%CI 0.95–0.98]). Most participants reported they would recommend text messages for supporting HIV prevention and treatment (99.4%) and found the weekly frequency to be adequate (92.1%). Our findings support the potential of integrated, LGBTQIAPN + -affirming DSD with digitally tailored engagement strategies to address persistent gaps in HIV prevention and care among YMSM/NB.