Marcos Jessé Abrahão Silva, Rebecca Lobato Marinho, Daniele Melo Sardinha, Luiza Raquel Tapajós Figueira, Eliete Costa da Cruz, Thiago Pinto Brasil, Iago Sergio de Castro Farias, Natália da Silva Oliveira, Francisco Marto Leal Pinheiro Júnior, Cristiane Cunha Frota, Maria Elias Sarmento da Silveira, Ana Judith Pires Garcia, Ligia Regina Franco Sansigolo Kerr, Carl Kendall, Luana Nepomuceno Gondim Costa Lima
Combination HIV prevention approaches, integrating behavioral, biomedical, and social components, have shown promise but remain under-evaluated in trans-specific contexts. This work aimed to compare the effectiveness of different HIV prevention strategies among transgender populations through a network meta-analysis. A systematic search was conducted through PRISMA-NMA 2020 across PubMed, SciELO, LILACS, and Science Direct (2000-2025) using descriptors related to HIV, combined prevention, and Transgender populations. Only original quantitative studies reporting effect measures of interventions were included, using the condom usage behavior as common comparator: A) Restrictive sexual behavior + Safer sex self-efficacy; B) Restrictive sexual behavior + Safe sex with a condom; C) Restrictive sexual behavior + Safe sex with a condom + Social Support. Mean, SD, SE and 95% CI were estimated, and interventions were ranked using SUCRA radial. Four studies and 9 interventions were included. The most effective strategy was safer receptive sex with transgender people (SUCRA 84.3%), followed by safer sex with non-transgender males (SUCRA 66.11%). Direct and indirect comparisons indicated that interventions promoting safer receptive sex practices among transgender individuals were more effective than those targeting condom use behavior alone. The inclusion of gender-specific content and social support appears to enhance the impact of prevention strategies.