Improving Delivery and Use of HIV Pre-Exposure Prophylaxis in the US: A Systematic Review of Implementation Strategies and Adjunctive Interventions.

Implementation of pre-exposure prophylaxis (PrEP) to prevent HIV transmission is suboptimal in the United States. To date, the literature has focused on identifying determinants of PrEP use, with a lesser focus on developing and testing change methods to improve PrEP implementation. Moreover, the change methods available for improving the uptake and sustained use of PrEP have not been systematically categorized. To summarize the state of the literature, we conducted a systematic review of the implementation strategies used to improve PrEP implementation among delivery systems and providers, as well as the adjunctive interventions used to improve the uptake and persistent adherence to PrEP among patients. Between November 2020 and January 2021, we searched Ovid MEDLINE, PsycINFO, and Web of Science for peer reviewed articles. We identified 44 change methods (18 implementation strategies and 26 adjunctive interventions) across a variety of clinical and community-based service settings. We coded implementation strategies and adjunctive interventions in accordance with established taxonomies and reporting guidelines. Most studies focused on improving patient adherence to PrEP and most conducted pilot trials. Just over one-third of included studies demonstrated a positive effect on outcomes. In order to end the human immunodeficiency virus (HIV) epidemic in the U.S., future, large scale HIV prevention research is needed that develops and evaluates implementation strategies and adjunctive interventions for target populations disproportionately affected by HIV.

Effects of Substance Use on Condomless Anal Sex in a Large Sample of Adolescent Men Who Have Sex with Men: A Within and Between Relationship Design.

Substance use is a significant risk factor for HIV infection among adolescent men who have sex with men (AMSM). Substance use may reduce the use of HIV prevention measures or increase the likelihood of engaging in activities with a higher risk of HIV transmission, but there is a lack of studies dedicated to analyzing these mechanisms in adolescents and young MSM. This study aimed to explore the impact of substance use on condomless anal sex (CAS) in a large, racially diverse sample of AMSM. Additionally, we investigated how an individual's general level of substance use moderated the association between substance use before sex and CAS at the partnership level. Baseline data for an HIV prevention intervention were collected through online surveys from April 2018 to June 2020. The sample consisted of 1624 AMSM (M age, 16.69 years) who reported at least one sexual partner in the previous 3 months. Participants provided information about their three most recent sexual partners, including their relationship to the partner, PrEP use, frequency of alcohol, marijuana, and non-prescription drug use before sex, and the number of CAS acts. Participants also completed measures of their substance use frequency. Multilevel modeling in Mplus was used for data analysis, accounting for sexual partnerships nested within participants. All models controlled for PrEP use and relationship status. Results revealed a significant positive association between the frequency of non-prescription drug use before sex and CAS at the partnership level. This indicates that higher non-prescription drug use frequency before sex was associated with a greater number of CAS acts with partners. Moreover, the cross-level interaction between alcohol frequency and non-prescription drug use before sex was statistically significant. Specifically, for participants with high alcohol frequency scores, there was a significant positive association between non-prescription drug use before sex and CAS at the partnership level. AMSM with higher average alcohol consumption were more likely to engage in CAS when using non-prescription drugs prior to sex with a partner, compared to those with lower alcohol consumption. This study's use of multilevel data analysis contributes innovatively to the field by shedding light on how substance use operates within sexual relationships and different partnership dynamics. Tailored interventions targeting substance use should be developed to reduce HIV risk among AMSM.

Machine learning algorithms using national registry data to predict loss to follow-up during tuberculosis treatment.

BACKGROUND: Identifying patients at increased risk of loss to follow-up (LTFU) is key to developing strategies to optimize the clinical management of tuberculosis (TB). The use of national registry data in prediction models may be a useful tool to inform healthcare workers about risk of LTFU. Here we developed a score to predict the risk of LTFU during anti-TB treatment (ATT) in a nationwide cohort of cases using clinical data reported to the Brazilian Notifiable Disease Information System (SINAN). METHODS: We performed a retrospective study of all TB cases reported to SINAN between 2015 and 2022; excluding children (< 18 years-old), vulnerable groups or drug-resistant TB. For the score, data before treatment initiation were used. We trained and internally validated three different prediction scoring systems, based on Logistic Regression, Random Forest, and Light Gradient Boosting. Before applying our models we splitted our data into training (~ 80% data) and test (~ 20%) sets, and then compared the model metrics using the test data set. RESULTS: Of the 243,726 cases included, 41,373 experienced LTFU whereas 202,353 were successfully treated. The groups were different with regards to several clinical and sociodemographic characteristics. The directly observed treatment (DOT) was unbalanced between the groups with lower prevalence in those who were LTFU. Three models were developed to predict LTFU using 8 features (prior TB, drug use, age, sex, HIV infection and schooling level) with different score composition approaches. Those prediction scoring systems exhibited an area under the curve (AUC) ranging between 0.71 and 0.72. The Light Gradient Boosting technique resulted in the best prediction performance, weighting specificity and sensitivity. A user-friendly web calculator app was developed ( https://tbprediction.herokuapp.com/ ) to facilitate implementation. CONCLUSIONS: Our nationwide risk score predicts the risk of LTFU during ATT in Brazilian adults prior to treatment commencement utilizing schooling level, sex, age, prior TB status, and substance use (drug, alcohol, and/or tobacco). This is a potential tool to assist in decision-making strategies to guide resource allocation, DOT indications, and improve TB treatment adherence.

The impact of ZIKV infection on gene expression in neural cells over time.

Zika virus (ZIKV) outbreak caused one of the most significant medical emergencies in the Americas due to associated microcephaly in newborns. To evaluate the impact of ZIKV infection on neuronal cells over time, we retrieved gene expression data from several ZIKV-infected samples obtained at different time point post-infection (pi). Differential gene expression analysis was applied at each time point, with more differentially expressed genes (DEG) identified at 72h pi. There were 5 DEGs (PLA2G2F, TMEM71, PKD1L2, UBD, and TNFAIP3 genes) across all timepoints, which clearly distinguished between infected and healthy samples. The highest expression levels of all five genes were identified at 72h pi. Taken together, our results indicate that ZIKV infection greatly impacts human neural cells at early times of infection, with peak perturbation observed at 72h pi. Our analysis revealed that all five DEGs, in samples of ZIKV-infected human neural stem cells, remained highly upregulated across the timepoints evaluated. Moreover, despite the pronounced inflammatory host response observed throughout infection, the impact of ZIKV is variable over time. Finally, the five DEGs identified herein play prominent roles in infection, and could serve to guide future investigations into virus-host interaction, as well as constitute targets for therapeutic drug development.

Improved Treatment Outcome Following the Use of a Wound Dressings in Cutaneous Leishmaniasis Lesions.

Leishmaniasis, caused by Leishmania parasites, is a neglected tropical disease and Cutaneous Leishmaniasis (CL) is the most common form. Despite the associated toxicity and adverse effects, Meglumine antimoniate (MA) remains the first-choice treatment for CL in Brazil, pressing the need for the development of better alternatives. Bacterial NanoCellulose (BNC), a biocompatible nanomaterial, has unique properties regarding wound healing. In a previous study, we showed that use of topical BNC + systemic MA significantly increased the cure rate of CL patients, compared to treatment with MA alone. Herein, we performed a study comparing the combination of a wound dressing (BNC or placebo) plus systemic MA versus systemic MA alone, in CL caused by Leishmania braziliensis. We show that patients treated with the combination treatment (BNC or placebo) + MA showed improved cure rates and decreased need for rescue treatment, although differences compared to controls (systemic MA alone) were not significant. However, the overall time-to-cure was significantly lower in groups treated with the combination treatment (BNC+ systemic MA or placebo + systemic MA) in comparison to controls (MA alone), indicating that the use of a wound dressing improves CL treatment outcome. Assessment of the immune response in peripheral blood showed an overall downmodulation in the inflammatory landscape and a significant decrease in the production of IL-1a (p < 0.05) in patients treated with topical BNC + systemic MA. Our results show that the application of wound dressings to CL lesions can improve chemotherapy outcome in CL caused by L. braziliensis.

Inflammatory profiles in sputum and blood of people with TB with and without HIV coinfection.

Although tuberculosis (TB) remains a major killer among infectious diseases and the leading cause of death for people with HIV, drivers of immunopathology, particularly at the site of infection in the lungs remain incompletely understood. To fill this gap, we compared cytokine profiles in paired plasma and sputum samples collected from adults with pulmonary TB with and without HIV. We found that people with pulmonary TB with HIV had significantly higher markers of inflammation in both plasma and sputum than those without HIV; these differences were present despite a similar extent of radiographic involvement. We also found that the strength and direction of correlations between biomarkers in the blood and lung compartments differed by HIV status and people with HIV had more positive correlations than those without HIV. Future studies can further explore these differences in inflammation by HIV status across the blood and lung compartments and seek to establish how these profiles may be associated with long-term outcomes and lung health after completion of TB treatment.

Examining biopsychosocial predictors of risk for cognitive impairment among a racially diverse sample of men who have sex with men living with HIV.

Background: Cognitive decline among people living with HIV (PLWH) is growing concern as world populations become increasing older including higher proportions of PLWH. It is vitally important to understand psychosocial predictors of age-related cognitive decline men who have sex with men (MSM) living with HIV. Objectives: The current study seeks to examine psychosocial risk factors the contribute to the risk of age-related cognitive impairment as measured by Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) score in a racially diverse sample of MSM living with HIV. Design: The present analysis utilizes data from the baseline (n = 196) and 6-month follow-up (n = 135) time points of a longitudinal cohort study of PLWH. Methods: Using a self-report survey, we examine the associations between psychosocial predictors (e.g. trauma, mental health, chronic pain, sleep disturbance, etc.) and risk of dementia using the CAIDE risk score. Analyses include linear and logistic regression. Results: In adjusted model stress, chronic pain, Black racial identity, and having a sexual identity that is bisexual or another category are all positively associated with CAIDE scores. Childhood sexual abuse history was negatively associated with CAIDE scores indicating a protective effect. Sleep disorder has a positive association with CAIDE scores after adjusting for the baseline CAIDE scores. Conclusion: These results indicate modifiable correlates of cognitive risk (stress and chronic pain). Interventions should seek to address these comorbid factors including the consideration of minority stress and stigma. Interventions should seek to reach Black and bisexual men living with HIV, including possible cultural tailoring to interventions and messaging. Lastly, future research should examine the impact of variation within childhood sexual abuse histories to better understand their association with cognitive impairment later in life. This may include considering the nature, severity, and potential treatment of trauma symptoms.

What makes middle-aged or older people who have HIV more likely to have memory problems later in life? We asked a racially diverse group of gay and bisexual men who have HIV. Why was the study done? Older people are becoming a larger portion of our communities including older people living with HIV. It's important to understand what makes older people more likely to have memory problems as they age including older people living with HIV. What did the researchers do? We asked 196 middle-aged and older adults who have HIV to answer questions about their health including things that we know might make them more likely to have memory problems later in life. What did the researchers find? We found that having more stress or reoccurring pain was related to being more likely to have memory problems later in life. People who have trouble sleeping were more likely to have memory problems later in life. We also found that Black people were more likely to have memory problems later in life. People who had been abused sexually as children were less likely to have memory problems later in life. What do the findings mean? These findings help us understand things that may make someone more likely to have memory problems later in life. These include things that could be changed like reoccurring pain and troubles sleeping. It also highlighted that Black people may need more support to prevent memory problems later in life.

High-throughput prioritization of target proteins for development of new antileishmanial compounds.

Leishmaniasis, a vector-borne disease, is caused by the infection of Leishmania spp., obligate intracellular protozoan parasites. Presently, human vaccines are unavailable, and the primary treatment relies heavily on systemic drugs, often presenting with suboptimal formulations and substantial toxicity, making new drugs a high priority for LMIC countries burdened by the disease, but a low priority in the agenda of most pharmaceutical companies due to unattractive profit margins. New ways to accelerate the discovery of new, or the repositioning of existing drugs, are needed. To address this challenge, our study aimed to identify potential protein targets shared among clinically-relevant Leishmania species. We employed a subtractive proteomics and comparative genomics approach, integrating high-throughput multi-omics data to classify these targets based on different druggability metrics. This effort resulted in the ranking of 6502 ortholog groups of protein targets across 14 pathogenic Leishmania species. Among the top 20 highly ranked groups, metabolic processes known to be attractive drug targets, including the ubiquitination pathway, aminoacyl-tRNA synthetases, and purine synthesis, were rediscovered. Additionally, we unveiled novel promising targets such as the nicotinate phosphoribosyltransferase enzyme and dihydrolipoamide succinyltransferases. These groups exhibited appealing druggability features, including less than 40% sequence identity to the human host proteome, predicted essentiality, structural classification as highly druggable or druggable, and expression levels above the 50th percentile in the amastigote form. The resources presented in this work also represent a comprehensive collection of integrated data regarding trypanosomatid biology.

Impact of Xpert MTB/RIF implementation in tuberculosis case detection and control in Brazil: a nationwide intervention time-series analysis (2011-2022).

Background: Since 2014, Brazil has gradually implemented the Xpert MTB/RIF (Xpert) test to enhance early tuberculosis (TB) and drug-resistant (DR-TB) detection and control, yet its nationwide impact remains underexplored. Our study conducts an intervention time-series analysis (ITSA) to evaluate how the Xpert's implementation has improved TB and DR-TB detection nationwide. Methods: 1,061,776 cases from Brazil's National TB Registry (2011-2022) were reviewed and ITSA (2011-2019) was used to gauge the impact of the Xpert's adoption on TB and DR-TB notification. Granger Causality and dynamic regression modelling determined if incorporating Xpert testing as an external regressor enhanced forecasting accuracy for Brazil's future TB trends. Findings: Xpert implementation resulted in a 9.7% increase in TB notification and substantial improvements in DR-TB (63.6%) and drug-susceptible TB (92.1%) detection compared to expected notifications if it had not been implemented. Xpert testing counts also presented a time-dependent relationship with DR-TB detection post-implementation, and improved predictions in forecasting models, which depicted a potential increase in TB and DR-TB detection in the next six years. Interpretation: This study underscores the critical role of Xpert's adoption in boosting TB and DR-TB detection in Brazil, reinforcing the case for its widespread use in disease control. Improvements in prediction accuracy resulting from integrating Xpert data are crucial for allocating resources and reducing the incidence of TB. By acknowledging Xpert's role in both disease control and improving predictions, we advocate for its expanded use and further research into advanced molecular diagnostics for effective TB and DR-TB control. Funding: FIOCRUZ.

The inflammatory microenvironment of the lung at the time of infection governs innate control of SARS-CoV-2 replication.

SARS-CoV-2 infection leads to vastly divergent clinical outcomes ranging from asymptomatic infection to fatal disease. Co-morbidities, sex, age, host genetics and vaccine status are known to affect disease severity. Yet, how the inflammatory milieu of the lung at the time of SARS-CoV-2 exposure impacts the control of viral replication remains poorly understood. We demonstrate here that immune events in the mouse lung closely preceding SARS-CoV-2 infection significantly impact viral control and we identify key innate immune pathways required to limit viral replication. A diverse set of pulmonary inflammatory stimuli, including resolved antecedent respiratory infections with S. aureus or influenza, ongoing pulmonary M. tuberculosis infection, ovalbumin/alum-induced asthma or airway administration of defined TLR ligands and recombinant cytokines, all establish an antiviral state in the lung that restricts SARS-CoV-2 replication upon infection. In addition to antiviral type I interferons, the broadly inducible inflammatory cytokines TNFα and IL-1 precondition the lung for enhanced viral control. Collectively, our work shows that SARS-CoV-2 may benefit from an immunologically quiescent lung microenvironment and suggests that heterogeneity in pulmonary inflammation that precedes or accompanies SARS-CoV-2 exposure may be a significant factor contributing to the population-wide variability in COVID-19 disease outcomes.

An integrative multi-omics approach to characterize interactions between tuberculosis and diabetes mellitus.

Tuberculosis-diabetes mellitus (TB-DM) is linked to a distinct inflammatory profile, which can be assessed using multi-omics analyses. Here, a machine learning algorithm was applied to multi-platform data, including cytokines and gene expression in peripheral blood and eicosanoids in urine, in a Brazilian multi-center TB cohort. There were four clinical groups: TB-DM(n = 24), TB only(n = 28), DM(HbA1c ≥ 6.5%) only(n = 11), and a control group of close TB contacts who did not have TB or DM(n = 13). After cross-validation, baseline expression or abundance of MMP-28, LTE-4, 11-dTxB2, PGDM, FBXO6, SECTM1, and LINCO2009 differentiated the four patient groups. A distinct multi-omic-derived, dimensionally reduced, signature was associated with TB, regardless of glycemic status. SECTM1 and FBXO6 mRNA levels were positively correlated with sputum acid-fast bacilli grade in TB-DM. Values of the biomarkers decreased during the course of anti-TB therapy. Our study identified several markers associated with the pathophysiology of TB-DM that could be evaluated in future mechanistic investigations.

The sound of silent RNA in tuberculosis and the lncRNA role on infection.

Tuberculosis (TB) is one of the leading causes of death worldwide, and Diabetes Mellitus is one of the major comorbidities (TB/DM) associated with the disease. A total of 103 differentially expressed ncRNAs have been identified in the TB and TB/DM comparisons. A machine learning algorithm was employed to identify the most informative lncRNAs: ADM-DT, LINC02009, LINC02471, SOX2-OT, and GK-AS1. These lncRNAs presented substantial accuracy in classifying TB from HC (AUCs >0.85) and TB/DM from HC (AUCs >0.90) in the other three countries. Genes with significant correlations with the five lncRNAs enriched common pathways in Brazil and India for both TB and TB/DM. This suggests that lncRNAs play an important role in the regulation of genes related to the TB immune response.

Retreatment and Anti-tuberculosis Therapy Outcomes in Brazil Between 2015 and 2022: A Nationwide Study.

Background: Adherence to anti-tuberculosis treatment (ATT) in Brazil remains a challenge in achieving the goals set by the World Health Organization (WHO). Patients who are lost to follow-up during treatment pose a significant public health problem. This study aimed to investigate the factors associated with unfavorable ATT outcomes among those undergoing retreatment in Brazil. Methods: We conducted an observational study of patients aged ≥18 years with tuberculosis (TB) reported to the Brazilian National Notifiable Disease Information System between 2015 and 2022. Clinical and epidemiologic variables were compared between the study groups (new cases and retreatment). Regression models identified variables associated with unfavorable outcomes. Results: Among 743 823 reported TB cases in the study period, 555 632 cases were eligible, consisting of 462 061 new cases and 93 571 undergoing retreatments (44 642 recurrent and 48 929 retreatments after loss to follow-up [RLTFU]). RLTFU (odds ratio [OR], 3.96 [95% confidence interval {CI}, 3.83-4.1]) was a significant risk factor for any type of unfavorable ATT. Furthermore, RLTFU (OR, 4.93 [95% CI, 4.76-5.11]) was the main risk factor for subsequent LTFU. For death, aside from advanced age, living with HIV (OR, 6.28 [95% CI, 6.03-6.54]) was the top risk factor. Conclusions: Retreatment is a substantial risk factor for unfavorable ATT outcomes, especially after LTFU. The rates of treatment success in RLTFU are distant from the WHO End TB Strategy targets throughout Brazil. These findings underscore the need for targeted interventions to improve treatment adherence and outcomes in persons who experience RLTFU.

Machine learning algorithms using national registry data to predict loss to follow- up during tuberculosis treatment.

Background: Identifying patients at increased risk of loss to follow-up (LTFU) is key to developing strategies to optimize the clinical management of tuberculosis (TB). The use of national registry data in prediction models may be a useful tool to inform healthcare workers about risk of LTFU. Here we developed a score to predict the risk of LTFU during anti-TB treatment (ATT) in a nationwide cohort of cases using clinical data reported to the Brazilian Notifiable Disease Information System (SINAN). Methods: We performed a retrospective study of all TB cases reported to SINAN between 2015-2022; excluding children (<18 years-old), vulnerable groups or drug-resistant TB. For the score, data before treatment initiation were used. We trained and internally validated three different prediction scoring systems, based on Logistic Regression, Random Forest, and Light Gradient Boosting. Before applying our models we split our data into train (~80% data) and test (~20%), and then we compare model metrics using a test data set. Results: Of the 243,726 cases included, 41,373 experienced LTFU whereas 202,353 were successfully treated and cured. The groups were different with regards to several clinical and sociodemographic characteristics. The directly observed treatment (DOT) was unbalanced between the groups with lower prevalence in those who were LTFU. Three models were developed to predict LTFU using 8 features (prior TB, drug use, age, sex, HIV infection and schooling level) with different score composition approaches. Those prediction scoring system exhibited an area under the curve (AUC) ranging between 0.71 and 0.72. The Light Gradient Boosting technique resulted in the best prediction performance, weighting specificity, and sensibility. A user-friendly web calculator app was created (https://tbprediction.herokuapp.com/) to facilitate implementation. Conclusions: Our nationwide risk score predicts the risk of LTFU during ATT in Brazilian adults prior to treatment commencement. This is a potential tool to assist in decision-making strategies to guide resource allocation, DOT indications, and improve TB treatment adherence.

Influence of dietary pattern on anti-tuberculosis treatment outcomes in persons with dysglycemia: a Peruvian prospective cohort study.

Introduction: Dietary patterns (DPs) are associated with overall nutritional status and may alter the clinical prognosis of tuberculosis. This interaction can be further intricated by dysglycemia (i.e., diabetes or prediabetes). Here, we identified DPs that are more common with tuberculosis-dysglycemia and depicted their association with tuberculosis treatment outcomes. Methods: A prospective cohort study of persons with tuberculosis and their contacts was conducted in Peru. A food frequency questionnaire and a multidimensional systems biology-based analytical approach were employed to identify DPs associated with these clinical groups. Potential independent associations between clinical features and DPs were analyzed. Results: Three major DPs were identified. TB-dysglycemia cases more often had a high intake of carbohydrates (DP1). Furthermore, DP1 was found to be associated with an increased risk of unfavorable TB outcomes independent of other factors, including dysglycemia. Conclusion: Our findings suggest that the evaluation of nutritional status through DPs in comorbidities such as dysglycemia is a fundamental action to predict TB treatment outcomes. The mechanisms underlying the association between high intake of carbohydrates, dysglycemia, and unfavorable tuberculosis treatment outcomes warrant further investigation.

Barreiras de acesso à profilaxia pós-exposição ao HIV: estudo de caso / Barreras de acceso a la profilaxis post exposición al VIH: estudio de caso / Barriers to access HIV post-exposure prophylaxis: a case study

Resumo Objetivo Explorar as barreiras de acesso à Profilaxia Pós-Exposição ao HIV percebidas por usuários e profissionais. Métodos Pesquisa exploratória com abordagem qualitativa. Os participantes da pesquisa foram profissionais médicos e enfermeiros envolvidos no protocolo da profilaxia em Centros de Referência e usuários da prevenção, totalizando 10 participantes, amostragem definida por saturação de dados. As entrevistas gravadas foram transcritas e posteriormente processadas pela Classificação Hierárquica Descendente e por análise de Similitude. Resultados Foram obtidas cinco classes: Informação; Centralização de acesso; Fluxo de atendimento; Relações interpessoais nos serviços de saúde e Dificuldades e Barreiras. Existem diversos fatores dificultadores no acesso à prevenção, que perpassam conhecimento, acolhimento e divulgação de informações. Diante do advento da Pandemia de COVID-19 muitos desses problemas se agravam e aumentam a vulnerabilidade de possiveis utilizadores da profilaxia. Conclusão O acesso à profilaxia pós-exposição ao HIV encontra desafios e barreiras, que vão desde o desconhecimento sobre a profilaxia, o que impossibilita sua busca, à centralização dos serviços de saúde e estigmas que permeiam as estruturas dos serviços de saúde.

Resumen Objetivo Explorar las barreras de acceso a la Profilaxis Post Exposición al VIH percibidas por usuarios y profesionales. Métodos Investigación exploratoria con abordaje cualitativo. Los participantes de la investigación fueron profesionales médicos y enfermeros involucrados en el protocolo de profilaxis en Centros de Referencia y usuarios de la prevención, totalizando 10 participantes, muestreo definido por saturación de datos. Se transcribieron las entrevistas grabadas y posteriormente procesadas por la Clasificación Jerárquica Descendente y por medio de análisis de Similitud. Resultados Se obtuvieron cinco clases: Información; Centralización de acceso; Flujo de atención; Relaciones interpersonales en los servicios de salud y Dificultades y Barreras. Hay diversos factores que dificultan el acceso a la prevención, que sobrepasan conocimiento, acogida y divulgación de informaciones. Ante el surgimiento de la Pandemia de COVID-19, muchos de esos problemas se agravan y aumentan la vulnerabilidad de posibles utilizadores de la profilaxis. Conclusión El acceso a la profilaxis post exposición al VIH encuentra desafíos y barreras, que van desde el desconocimiento sobre la profilaxis, lo que imposibilita su búsqueda, a la centralización de los servicios de salud y estigmas que permean las estructuras de los servicios de salud.

Abstract Objective To explore barriers to access HIV post-exposure prophylaxis perceived by users and professionals. Methods This is an exploratory, qualitative study. The research participants were medical professionals and nurses involved in the prophylaxis protocol in Reference Centers and prevention users, totaling 10 participants, a sample defined by data saturation. The recorded interviews were transcribed and later processed by the Descending Hierarchical Classification and by similitude analysis. Results Five classes were obtained: Information; Access centralization; Service flow; Interpersonal relationships in healthcare services; Difficulties and barriers. There are several factors that hinder access to prevention, which permeate knowledge, reception and dissemination of information. With the advent of the COVID-19 pandemic, many of these problems are aggravated and increase the vulnerability of possible users of prophylaxis. Conclusion Access to HIV post-exposure prophylaxis faces challenges and barriers, ranging from lack of knowledge about prophylaxis, which makes it impossible to pursue it, to the centralization of healthcare services and stigmas that permeate the structures of healthcare services.

Comparação da propriedade antimicrobiana da clorexidina e do hipoclorito de sódio como irrigantes endodônticos: revisão integrativa / Comparison between the antimicrobial properties of chlorhexidine and sodium hypochlorite as endodontic irrigants: an integrative review / Comparación de la propiedad antimicrobiana de la clorhexidina y el hipoclorito de sodio como irrigantes endodónticos: revisión integradora

Introdução:Durante o tratamento endodôntico, devido às complexidades anatômicas dos canais radiculares, a ação mecânica dos instrumentos não é suficiente para a completa desinfecção dos condutos. Dessa forma, se faz necessário o uso de soluções irrigadoras que possampotencializar a desinfecção do sistema de canais radiculares. Objetivo:Realizar uma revisão integrativa da literatura para comparar as propriedades antimicrobianas da clorexidina com o hipoclorito de sódio.Metodologia:A busca na literatura foi realizada no período de setembro de 2019 a agosto de 2021, nas seguintes bases de dados: PUBMED/MEDLINE, LILACS e SCIELO. Utilizando os descritores: clorexidina, hipoclorito de sódio, irrigante do canal radicular e limpeza. Utilizou-se como critérios de busca, trabalhos experimentais laboratoriais in vitro, publicados entre os anos de 2017 e 2021.Resultados:Foram encontrados 165 artigos, dos quais 15 foram selecionados ao final do processo. 8 trabalhos não encontraram diferença estatisticamente significativa entre a clorexidina e o hipoclorito,5 artigos apresentaram resultados superiores dohipoclorito de sódioem 2 a clorexidina foi superior. Conclusões:Após análise da literatura, observamos semelhança entre a ação antimicrobiana do hipoclorito de sódioe da clorexidina, e podemos concluir que ambas apresentam boa ação antimicrobiana, justificando seu uso clinicamente (AU).

Introduction:During endodontic treatment, due to the anatomical complexities of the root canals, the mechanical action of the instruments is not sufficient for the complete disinfection of the canals. Thus, it is necessary to use irrigating solutions that can makethe disinfection of the root canal system.Objective:Conduct an integrative literature review to compare the antimicrobial properties of chlorhexidine with sodium hypochlorite.Methodology:The literature search was carried out from September 2019 to August 2021, in the following databases: PUBMED/MEDLINE, LILACS and SCIELO. Using the descriptors: chlorhexidine, sodium hypochlorite, root canal irrigant and cleaning. As search criteria, in vitro laboratory experimental works published between 2017 and 2021 were used.Results:A total of 165 articles were found, of which 15 were selected at the end of the process. 8 studies did not find a statistically significant difference between chlorhexidine and hypochlorite, 5 articles showed superior results for NaOCl and in 2 chlorhexidine was superior.Conclusions:After analyzing the literature, we observed a similarity between the antimicrobial action of sodium hypochlorite and chlorhexidine, and we can conclude that both have good antimicrobial action, justifying their clinical use (AU).

Introducción:Durante el tratamiento endodóntico, debido a las complexidades anatómicas de los conductos radiculares, la acción mecánica de los instrumentos no es suficiente para la desinfección completa de los conductos. Por lo tanto, es necesario utilizar soluciones de irrigación que puedan mejorar la desinfección del sistema de conductos radiculares.Objetivo: Realice una revisión integradora de la literatura para comparar las propiedades antimicrobianas de la clorhexidina con el hipoclorito de sodio.Metodología: La búsqueda bibliográfica se realizó desde septiembre de 2019 hasta agosto de 2021, en las siguientes bases de datos: PUBMED/MEDLINE, LILACS y SCIELO. Usando los descriptores: chlorhexidine, sodium hypochlorite, root canal irrigant and cleaning. Como criterio de búsqueda se utilizaron trabajos experimentales de laboratorio in vitro publicados entre 2017 y 2021.Resultados: Se encontraron un total de 165 artículos, de los cuales 15 fueron seleccionados al final del proceso. 8 estudios no encontraron diferencia estadísticamente significativa entre clorhexidinae hipoclorito, 5 artículos mostraron resultados superiores para NaOCl y en 2 la clorhexidina fue superior.Conclusiones: Después de analizar la literatura, observamos una similitud entre la acción antimicrobiana del hipoclorito de sodio y la clorhexidina,y podemos concluir que ambos tienen una buena acción antimicrobiana, lo que justifica su uso clínico (AU).

Fatores determinantes da exposição sexual ao HIV em adolescentes luso-brasileiros: uma análise de caminhos* / Determinants of sexual exposure to HIV in Portuguese and Brazilian adolescents: a path analysis / Factores determinantes de la exposición sexual al VIH en adolescentes luso-brasileños: un análisis de rutas

Resumo Objetivo: analisar os efeitos diretos e indiretos de fatores determinantes da exposição sexual ao vírus da imunodeficiência humana entre adolescentes homens que fazem sexo com homens e as implicações para o cuidado em enfermagem. Método: estudo transversal, realizado com 578 adolescentes de 18 a 19 anos luso-brasileiros. Avaliaram-se inter-relações de situação conjugal, uso de aplicativos de relacionamento, prática de chemsex, desinformação, credibilidade do parceiro, práticas sexuais desafiadoras e medidas protetivas pouco eficazes sobre a exposição sexual ao vírus da imunodeficiência humana, com a técnica de Análise de Caminhos. Resultados: apresentou efeito direto significante para exposição sexual ao vírus da imunodeficiência humana: situação conjugal (β=-0,16), uso de aplicativos (β=-0,30), práticas sexuais desafiadoras (β=0,48) e medidas protetivas pouco eficazes (β=0,35). Nos caminhos indiretos: credibilidade do parceiro influenciou medidas protetivas pouco eficazes (β=0,77); ter relacionamento fixo/poliamoroso influenciou o uso de aplicativos de relacionamento (β=-0,46); chemsex, mediado por práticas sexuais desafiadoras (β=0,67), determinou maior exposição sexual. Conclusão: comportamentos sexuais dos adolescentes e configurações do relacionamento amoroso/sexual precisam ser considerados no planejamento da assistência em enfermagem para diminuir a exposição sexual ao vírus da imunodeficiência humana.

Abstract Objective: to analyze the direct and indirect effects of determinants of sexual exposure to the human immunodeficiency virus among male adolescents who have sex with men and the implications for nursing care. Method: cross-sectional study carried out with 578 Portuguese and Brazilian adolescents aged 18 and 19. Interrelationships of conjugal status, use of dating apps, practice of chemsex, unawareness, partner credibility, challenging sexual practices and ineffective forms of protection against sexual exposure to the human immunodeficiency virus were evaluated using the Path Analysis technique. Results: significant direct effect on sexual exposure to the human immunodeficiency virus: conjugal status (β=-0.16), use of apps (β=-0.30), challenging sexual practices (β=0.48) and ineffective forms of protection (β=0.35). Indirect paths: partner credibility influenced ineffective forms of protection (β=0.77); having a steady/polyamorous relationship influenced the use of dating apps (β=-0.46); chemsex, mediated by challenging sexual practices (β=0.67), determined greater sexual exposure. Conclusion: adolescent sexual behaviors and forms of amorous/sexual relationship must be considered in nursing care planning to reduce sexual exposure to the human immunodeficiency virus.

Resumen Objetivo: analizar los efectos directos e indirectos de los factores determinantes de la exposición sexual al virus de la inmunodeficiencia humana entre adolescentes hombres que tienen relaciones sexuales con hombres y las implicaciones para el cuidado en enfermería. Método: estudio transversal, realizado con 578 adolescentes luso-brasileños de 18 a 19 años. Se evaluaron las interrelaciones del estado civil, uso de aplicaciones de relación, práctica de chemsex, desinformación, credibilidad de la pareja, prácticas sexuales desafiantes y medidas de protección ineficaces sobre la exposición sexual al virus de la inmunodeficiencia humana, a través de la técnica del Análisis de Rutas. Resultados: presentó un efecto directo significativo para la exposición sexual al virus de la inmunodeficiencia humana: estado civil (β=-0,16), uso de aplicaciones (β=-0,30), prácticas sexuales desafiantes (β=0,48) y medidas de protección ineficaces (β=0,35). En las rutas indirectas: la credibilidad de la pareja influyó en medidas de protección ineficaces (β=0,77); tener una relación fija/poliamorosa influyó en el uso de aplicaciones de relación (β=-0,46); el chemsex, mediado por prácticas sexuales desafiantes (β=0,67), determinó una mayor exposición sexual. Conclusión: se deben tener en cuenta las conductas sexuales de adolescentes y las configuraciones de una relación amorosa/sexual en la planificación de la asistencia de enfermería para reducir la exposición sexual al virus de la inmunodeficiencia humana.

Knowledge of health students about prophylaxis pre and post exposure to HIV / Conocimiento de estudiantes de la salud acerca de la profilaxia pré y post exposición al VIH / Conhecimento de estudantes de saúde acerca da profilaxia pré e pós exposição ao HIV

ABSTRACT Objective To evaluate students' knowledge of nursing and medical courses at a public university on prophylaxis before and after exposure to HIV/AIDS. Method cross-sectional study, carried out with nursing and medical students (n = 167). In order to explain the effect of variables on knowledge, the Multinomial Logistic Regression was used. Results Participants had a mean of 23.03 years, female (56.5%), unmarried (64.3%), and heterosexual (86.3%). The level of knowledge demonstrated was mostly medium (49.4%), and only 28.6% showed a high knowledge about the subject. The multivariate analysis showed that the course (p = 0.03) and age (p = 0.01) were associated with a higher level of knowledge. Conclusions Nursing and medical students possess knowledge considered as average about HIV preventive prophylaxis, thus it is up to the health education institutions to provide subsidies for a better training of students, treating the theme as a transversal subject in their training.

RESUMEN Objetivo Evaluar el conocimiento de alumnos de los cursos de enfermería y medicina de una universidad pública sobre la profilaxis pre y post exposición al VIH / SIDA. Método estudio transversal, realizado con estudiantes de enfermería y medicina (n = 167). Para explicar el efecto de las variables sobre el conocimiento, se utilizó la Regresión Logística Multinomial. Resultados Los participantes tenían en promedio 23,03 años, sexo femenino (56,5%), solteros (64,3%), y eran heterosexuales (86,3%). El nivel de conocimiento demostrado fue mayoritariamente medio (49,4%), y sólo el 28,6% demostró un alto conocimiento acerca de la temática. El análisis multivariado mostró que el curso (p = 0,03) y la edad (p = 0,01) se asociaron a un mayor nivel de conocimiento. Conclusiones Estudiantes de enfermería y medicina poseen conocimiento considerado como medio sobre las profilaxis preventivas al VIH, por lo tanto, corresponde a las instituciones de educación sanitaria proporcionar subsidios para una mejor capacitación de los estudiantes, tratando el tema como un tema transversal en su capacitación.

RESUMO Objetivo Avaliar o conhecimento de alunos dos cursos de enfermagem e medicina de uma universidade pública sobre a profilaxia pré e pós exposição ao HIV/Aids. Método estudo transversal, realizado com estudantes de enfermagem e medicina (n=167). Para explicar o efeito das variáveis sobre o conhecimento, utilizou-se a Regressão Logística Multinomial. Resultados Os participantes tinham em média 23,03 anos, sexo feminino (56,5%), solteiros (64,3%), heterossexuais (86,3%). O nível de conhecimento demonstrado foi majoritariamente médio (49,4%), e apenas 28,6% demonstraram um alto conhecimento acerca da temática. A análise multivariada mostrou que o curso (p=0,03) e a idade maior que 24 anos (p=0,01) foram associados a um maior nível de conhecimento. Conclusões Estudantes de enfermagem e medicina possuem conhecimento considerado como médio sobre as profilaxias preventivas ao HIV, cabendo assim às instituições de ensino em saúde fornecer subsídios para uma melhor formação dos estudantes, tratando o tema como assunto transversal em sua formação.

Consumo de mídias sexualmente explícitas e sexo anal desprotegido em homens que fazem sexo com homens / Consumption of sexually explicit media and unprotected anal sex in men who have sex with men

Resumo O objetivo deste estudo foi avaliar a influência do consumo de mídia sexualmente explícita (MSE) de modalidade bareback na prática de sexo anal sem preservativo por homens que fazem sexo com homens (HSH). Para tanto, foi criada uma página na rede social Facebook® com um link que direcionava os interessados para um questionário. Foram incluídos homens cisgênero, com 18 anos ou mais e que praticaram sexo com outro(s) homem(ns) nos últimos 12 meses. Os dados foram coletados em 2017 e analisados por meio de estatística inferencial (uni)bivariada e regressão logística multivariada. Participaram da pesquisa 2.248 HSH, com média de idade de 24,4 anos e média de 3,9 parceiros nos últimos 30 dias. Possuir múltiplos parceiros sexuais (ORa:9,4; IC95% 3,9-22,4), preferir filmes com cenas bareback (ORa:2,6; IC95% 1,5-4,6), julgar essa prática um fetiche e realizá-lo (ORa:3,52; IC95% 2,3-5,4), ter parceria casual (ORa:1,8; IC95% 1,5-1,9) e ciência do status sorológico negativo do parceiro para o HIV (ORa:1,4; IC95% 1,1-2,3) foram fatores que aumentaram as chances de envolvimento em sexo anal sem preservativo. Dessa forma, verificamos associação entre o consumo de MSE bareback e a prática de sexo sem preservativo entre HSH.

Abstract This study aimed to evaluate the influence of bareback sexually explicit media (SEM) consumption on anal sex without a condom by men who have sex with men (MSM). To this end, a page was created on the Facebook® social network with a link that directed interested parties to a questionnaire. Cisgender men, aged 18 years and over, who had sex with other men in the last 12 months, were included. Data were collected in 2017 and analyzed using univariate and bivariate inferential statistics and multivariate logistic regression. A total of 2,248 MSM participated in the research, with a mean age of 24.4 years and a mean number of 3.9 partners in the last 30 days. Having multiple sexual partners (ORa: 9.4; 95% CI 3.9-22.4), preferring movies with bareback scenes (ORa: 2.6; 95% CI 1.5-4.6), considering this practice a fetish and realizing it (ORa: 3.52; 95% CI 2.3-5.4), having casual partnerships (ORa: 1.8; 95% CI 1.5-1.9) and being aware of the partner's negative serological status for HIV (ORa: 1.4; 95% CI 1.1-2.3) were factors that increased the likelihood of engaging in anal sex without a condom. Thus, we found an association between the consumption of bareback SEM and sex without a condom among MSM.