Factors associated with the completion of syphilis treatment among transgender women and travestis, in five Brazilian capitals, 2019-2021: a multicenter cross-sectional study.

Objective: To assess the previous history of syphilis in transgender women and travestis (TWTs) and identify factors associated with treatment incompleteness.

Methods: : This was a multicenter cross-sectional study conducted between 2019 and 2021, with participants recruited through respondent-driven sampling, in five Brazilian capitals. Dependent variable: "reported syphilis treatment in the last year", "no/incomplete" or "complete". A multivariate-logistic model was used to identify factors associated with completeness.

Results: : Of the 1,317 participants, 16.0% reported previous history of syphilis. Of these, 68.9% were Black, 54.6% earned up to 1 minimum wage and 61.1% completed the treatment. Treatment completion was lower in São Paulo (42.7%) and among those who experienced verbal abuse (53.6%; ORa 0.46; 95%CI 0.25;0.85).

Conclusion: In this sample, both the prevalence of self-reported syphilis and the proportion of participants who reported not having started/completed treatment were high. It is essential to identify the barriers faced by TWTs that hinder healthcare access, and identify their needs in order to ensure adequate diagnosis and treatment.

Main results: Of the 16% of participants who reported a previous diagnosis of syphilis, only one-third completed the treatment. Residents of São Paulo were less likely to complete it compared to those from other cities, and those who had experienced verbal abuse.

Implications for services: There is a need for healthcare professionals to receive training focused on specific needs of TWTs , including respect for their social names, extended opening hours, point-of-care strategy and alternatives for the administration of intramuscular benzathine penicillin injections.

Perspectives: It is crucial to develop new, more effective therapeutic methods for syphilis treatment and deepen research on the impacts of discrimination and stigma on transgender women and travestis' access to healthcare, especially diagnosis and treatment of sexually transmitted infections.