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Effects of the COVID-19 pandemic on the sexual and mental health of adolescent and adult men who have sex with men and transgender women participating in two PrEP cohort studies in Brazil: COBra study protocol
  1. Dulce Ferraz1,2,
  2. Inês Dourado3,
  3. Eliana Miura Zucchi4,
  4. Xavier Mabire2,
  5. Laio Magno5,
  6. Alexandre D Grangeiro6,
  7. Márcia Thereza Couto6,
  8. Laura Ferguson7,
  9. Mateus Westin8,
  10. Lorruan Alves dos Santos6,
  11. Marie Préau2
  1. 1 Escola FIOCRUZ de Governo, FIOCRUZ Brasília, Fundação Oswaldo Cruz, Brasília, DF, Brazil
  2. 2 Groupe de Recherche en Psychologie Sociale (EA 4163), Université Lumière Lyon 2 - Campus Porte des Alpes, Bron, France
  3. 3 Instituto de Saúde Coletiva (ISC), Universidade Federal da Bahia, Salvador, BA, Brazil
  4. 4 Programa de Pós-Graduação em Saúde Coletiva, Universidade Catolica de Santos, Santos, SP, Brazil
  5. 5 Departamento de Ciências da Vida, Universidade do Estado da Bahia, Salvador, BA, Brazil
  6. 6 Departamento de Medicina Preventiva, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, São Paulo, Brazil
  7. 7 Institute on Inequalities in Global Health, University of Southern California, Los Angeles, California, USA
  8. 8 Departamento de Doenças Infecciosas e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
  1. Correspondence to Dr Dulce Ferraz; dulcefer{at}


Introduction The COVID-19 pandemic and its control measures have impacted health and healthcare provision in various levels. Physical distancing measures, for instance, may affect sexual health, impacting access to HIV prevention supplies and changing sexual behaviour, as well as mental health, increasing feelings of unsafety and weakening community support ties. These effects can be worsened among socially marginalised groups, such as men who have sex with men (MSM) and transgender women (TGW). Brazil is among the countries most affected by COVID-19 in the world, where control measures have been inconsistently implemented. We aim to investigate the effects of the COVID-19 pandemic on the sexual and mental health of adolescent and adult MSM and TGW in Brazil.

Methods Convergent mixed-method prospective cohort study, nested in two ongoing HIV pre-exposure prophylaxis (PrEP) cohorts in Brazil, named PrEP1519 and Combina. Participants will be invited to answer, at baseline and after 6 months, a questionnaire about the effects of the COVID-19 pandemic on sexual behaviour, HIV prevention and mental health. Data on HIV infection and sexually transmitted infections (STI) will be collected as part of routine follow-up from the cohorts. Main outcome measures (HIV infection, STI and depression symptoms) will be observed within 12 months after baseline. Sample size is estimated at 426 participants. Complementarily, 50 participants will be invited to in-depth interviews through video calls or interactive voice response, and 20 will be invited to chronicle their lives during the pandemic through digital diaries. Triangulation will be done across qualitative methods and with the quantitative data.

Ethics and dissemination The study was approved by Research Ethics Committees from the Brazilian Universities coordinating the study. Findings will be published in scientific journals and presented at meetings. Informative flyers will be elaborated to communicate study findings to participants and key stakeholders.

  • COVID-19
  • sexual medicine
  • mental health
  • HIV & AIDS

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  • Contributors DF, ID, EMZ, XM, LM, ADG and MP conceived and designed the COBra Study protocol. MTC and LF participated in the design of the study, particularly in the development of the qualitative investigation. MW and LAdS collaborated on the design of the quantitative investigation. All authors worked on the drafting of this manuscript with relevant intellectual contributions.

  • Funding COBra is supported by the ANRS - Maladies infectieuses émergentes, grant number ANRS COV 31 COBra. PrEP1519 is funded by UNITAID (grant number 2017–15-FIOTECPrEP), SVS-MS/CNPq (404055/2018–4) and the Brazilian Ministry of Health. Combina is funded by the Brazilian Ministry of Health and the Pan American Health Organization (PAHO).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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