Prevalence of Reactive Rapid Test Results for Sexually Transmitted Infections and Associated Factors Among Transgender People Attending Specialized Health Services in Brazil

Background/Objectives: Transgender (trans) individuals experience a disproportionate burden of HIV and other sexually transmitted infections (STIs), although evidence based on point-of-care testing remains limited in Brazil. This study aimed to estimate the prevalence of reactive STI rapid test results and associated factors among transgender individuals receiving care in specialized health services in São Paulo, Brazil. Methods: A cross-sectional study was conducted between July and December 2025 with 400 participants attending two specialized healthcare services. Sociodemographic, behavioral, substance use, clinical, and HIV prevention-related data were collected. The primary outcome was reactivity to at least one rapid test for HIV, syphilis, hepatitis B, or hepatitis C; reactive results could include previously known infections and therefore were not interpreted as newly diagnosed or active infections. Associations were estimated using Poisson regression with robust variance. Results: Overall, 19.2% of participants had at least one reactive rapid test result, with HIV accounting for the largest proportion of reactive results (14.8%). In the adjusted model, increasing age was associated with a higher prevalence of the outcome (PR = 1.04; 95% CI: 1.02–1.05), whereas transgender men had a lower prevalence than transgender women (PR = 0.38; 95% CI: 0.19–0.73). Reported HIV prevention through PrEP and/or PEP was inversely associated with the outcome (PR = 0.37; 95% CI: 0.17–0.82); however, this association should not be interpreted as a direct protective effect because most reactive HIV results occurred among participants with previously known HIV, who would not be eligible for PrEP. Conclusions: These findings indicate a substantial frequency of reactive STI rapid test results among transgender individuals attending specialized health services and support continued access to testing, prevention, and culturally competent sexual healthcare.