LEVERAGING RESPONDENT DRIVEN SAMPLING AND MAPPING DATA TO CHARACTERIZE THE EPIDEMIOLOGY OF HIV, SEXUALLY TRANSMITTED INFECTIONS, AND VIRAL HEPATITIS B AND C AMONG MEN WHO HAVE SEX WITH MEN AND TRANSGENDER WOMEN IN RWANDA

Background. Globally, gay men and other men who have sex with men (MSM) and transgender women (TGW) have a disproportionate burden of HIV, sexually transmitted infections (STI), and viral hepatitis B (HBV) and C (HCV) infections. However, the particular needs and vulnerabilities of MSM and TGW (MSM/TGW) have been largely overlooked in the design of health prevention and treatment strategies across Africa. The goal of this dissertation was to address the dearth of epidemiological data of these infections among MSM/TGW to inform programming in Rwanda. Methods. We used data from a behavioral and biological survey that recruited 738 MSM/TGW using respondent driven sampling between March – August 2018 in Kigali. The study also mapped physical social venues and assessed virtual platforms used by MSM/TGW to meet male sexual partners. These data were used to estimate the prevalence and care cascade of HIV, prevalence of genital and extragenital curable STI and prevalence of HBV and HCV infections. Finally, we characterized the structure of venue-based affiliation networks in Kigali of MSM/TGW and the physical and online venues that they use to meet male sexual partners. Results. One in ten MSM/TGW was living with HIV, and 40% of participants living with HIV had unsuppressed viral load. One in five participants had a prevalent curable STI. Half of gonorrhea infections and a third infections of chlamydia infections were rectal. The prevalence of HBV and HCV were comparable to those seen in the general population. Majority of participants with detectable HBV surface antigen had detectable HBV viral load and a 30% of HCV antibodies carriers had chronic HCV infection. The majority of MSM/TGW in Kigali reported both physical and online venues for male partner seeking. The venue-based affiliation networks showed a core-periphery structure that can facilitate provision of health services to a large number of MSM/TGW just by targeting a few most central venues. Conclusions. MSM/TGW in Kigali showed substantial gaps in HIV, STI and viral hepatitis programs. Moving forward, community-based interventions leveraging venue-based and digital health interventions will be necessary to optimize health outcomes among MSM/TGW in Rwanda