The variant of concern (VOC) P.1 emerged in the Amazonas state (Brazil) and was sequenced for the 1st time on 6-Jan-2021 by the Japanese National Institute of Infectious Diseases. It contains a constellation of mutations, ten of them in the spike protein. Consequences of these mutations at the populational level have been poorly studied so far. From December-2020 to February-2021, Manaus was devastated by four times more cases compared to the previous peak (April-2020). Here, data from the national health surveillance of hospitalized individuals were analysed using a model-based approach to estimate P.1 parameters of transmissibility and reinfection by maximum likelihood. Sensitivity analysis was performed changing pathogenicity and the period analysed (including/excluding the health system collapse period). In all analysed cases, the new variant transmissibility was found to be about 2.5 times higher compared to the previous variant in Manaus. A low probability of reinfection by the new variant (6.4%) was estimated, even under initial high prevalence (68%) by the time P.1 emerged. Consequences of a higher transmissibility were already observed with VOC B.1.1.7 in the UK and Europe. Urgent measures must be taken to control the spread of P.1.

Background Brazil has many people living with HIV (PLWH) who are unaware of their serostatus. The public health system has recently added HIV self-testing (HIVST) for key populations such as men who have sex with men (MSM). This study estimates HIVST acceptability among Brazilian MSM and explores factors associated with acceptability among MSM who have never tested for HIV or who had a previous negative result. Methods Respondent-driven sampling (RDS) was used to recruit 4176 MSM in 12 Brazilian cities in 2016 to this biological and behavioral surveillance study. We excluded from this analysis all MSM who were aware of their positive HIV serostatus. Descriptive, bivariate and multivariate analyses were conducted. Overall proportions were weighted with Gile’s estimator in RDS Analyst software and 95% confidence intervals were calculated. The analyses of HIVST acceptability were stratified by prior HIV testing (never or one or more times). Results For this analysis, 3605 MSM were included. The acceptability of HIVST was 49.1%, lower among those who had never tested for HIV (42.7%) compared to those who had a previous HIV negative test (50.1%). In the subgroup of MSM who had never tested for HIV, those who reported discrimination or who had a medical appointment in the last 12 months reported higher HIVST acceptability. Among MSM who had a previous negative HIV test, only those reporting condomless receptive anal sex reported higher HIVST acceptability. In addition, we observed that high levels of knowledge of HIV/AIDS, taking part in lesbian, gay, bisexual, and transgender nongovernmental organizations (LGBT-NGO), or complete secondary or incomplete higher undergraduate education reported higher acceptability. Conclusions The acceptability of HIVST was low among MSM, especially among those who never tested for HIV. Given access to HIVST in Brazil, we point to the need for programs that enhance promotion of testing addressed to MSM.

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