A formação interprofissional na saúde indígena: a experiência do projeto "Huka Katu"­a FORP-USPno Xingu / Interprofessional education in indigenous health: the experience of the "Huka Katu" Project -FORP-USPin Xingu

Para o alcance dos princípios do Sistema Único de Saúde é necessária a formação de profissionais de saúde integrados à rede de saúde e que reconheçam a necessidade das diferentes realidades brasileiras, como a atenção aos povos indígenas. O objetivo é apresentar um relato de experiência para a reorientação do modelo formador priorizando a integração ensino-serviço-comunidade e a contribuição da Faculdade de Odontologia de Ribeirão Preto da Universidade de São Paulo para a efetivação das Políticas Públicas de Educação e Saúde, explorando sua interface com a Política Nacional de Atenção à Saúde dos Povos Indígenas e a Política Nacional de Saúde Bucal. As ações formativas propostas no Projeto "Huka Katu" envolvem a reorientação do modelo formador e assistencialjunto à comunidade. As etapas preparatória e operacional são desenvolvidas nas disciplinas optativas livres -Atenção à Saúde Bucal em Populações Indígenas I e II. No período da pandemia da COVID-19, a disciplina I tem se desenvolvido em ambiente virtual com uso de metodologias ativas de ensino-aprendizagem e abordagem do cuidado intercultural. A disciplina II é desenvolvida no contexto da atenção primária nas aldeias do Parque Indígena do Xingu, com ênfase na integralidade da atenção em saúde e aprendizagem pela vivência do trabalho em saúde indígena, junto a equipes multiprofissionais. O Projeto tem contribuído na formação de profissionais de saúde para o trabalho em equipe colaborativo, com egressos envolvidos diretamente na assistência ou na gestão de saúde no subsistema de saúde indígena (AU).

To achieve the principles of the Sistema Único de Saúde, it is necessary to improve health professionals' education who are integrated into the health network and who recognize the need for different Brazilian realities, such as indigenous peoples' health care. The objective is to present an experience report for the reorientation of the educational model prioritizing the teaching-service-community integration and the contribution of the Ribeirão Preto School of Dentistry, University of São Paulo, to the implementation of Public Education and Health Policies, exploring its interface with the National Health Care Policy for Indigenous Peoples and the National Oral Health Policy. The education actions proposed in the "Huka Katu" Project involve the reorientation of the training and assistance model to the community. The preparatory and operational stages are developed in the open elective courses -Oral Health Care in Indigenous Populations I andII. During COVID-19 pandemic, Course I was carried out in a virtual environment using active teaching-learning methodologies and an approach to intercultural care. Course II is developed in the context of primary care in the villages of the Xingu Indigenous Park, with emphasis on comprehensive health care and learning through the experience of working in indigenous health, together with multidisciplinary teams. The Project has contributed to the training of health professionals for collaborative teamwork, with graduates directly involved in health care or management in the indigenous health subsystem (AU).

Promoção da saúde e efetivação da Reforma Sanitária no contexto dos povos originários / Health promotion and accomplishment of Health Care Reform in the context of indigenous populations

RESUMO O Brasil teve atos e políticas excludentes que levaram à quase dizimação dos variados povos indígenas. Buscando voz e inclusão, o movimento dos povos originários contou com a presença de representantes das próprias comunidades para a consolidação da Reforma Sanitária nesse contexto. Conselheiros indígenas de saúde e agentes indígenas de saúde fomentam a resiliência para reivindicar, proteger e curar relações, lidando com a perspectiva biomédica, e atuação de profissionais não indígenas. Este trabalho objetiva evidenciar as aprendizagens colaborativas e práticas interdisciplinares no atual sistema de saúde brasileiro, para a promoção da saúde dos povos originários. Em uma revisão integrativa, propôs-se discorrer sobre o impacto da formação profissional com ênfase na questão étnica, possibilidades de atuação não colonizadora e inclusiva, e a contribuição dos diversos atores, indígenas ou não, que possibilitam a consolidação desse subsistema de atenção, considerando suas especificidades e sua maneira própria do fazer da saúde. A autonomia, com foco no empoderamento, fortalecida por meio do reconhecimento do papel fundamental dos próprios indígenas e de pessoas ligadas à causa indigenista que se estabeleceram para tal assistência, consolidaram a Reforma Sanitária também nesses territórios, na tentativa de universalidade no acesso, integralidade da atenção, promoção da equidade e redução de iniquidades.

ABSTRACT Brazil has always had historic practices and excluding politics that almost decimated the varied indigenous peoples. Seeking a voice and inclusion, the movement of original populations counted on the presence of communities' representatives to consolidate the Health Care Reform. Health indigenous advisors and indigenous heath agents promoted resilience to claim, protect, and cure relations, dealing with the biomedical perspective, and the performance of non-indigenous professionals. The present study aims to emphasize interdisciplinary placement and collaborative learnings among original populations' heath actors in the current Brazilian health system for the promotion of health among original peoples. Through an integrative review, it was proposed a glossing over the impact of professional qualification emphasizing ethnic issues and practices proper to such context, possibilities of a non-colonizational and inclusive actuation, and the contribution of several actors, indigenous or not, that made such health sub-system possible, considering its specificities and its own way of working in health. Autonomy, focused on empowerment, strengthened by the recognition of the essential role of indigenous peoples and non-indigenous contributors established for such health assistance, consolidated Health Reform also in these territories, trying to achieve universality in service access, integrality of care, promotion of equity, and reduction of inequities.

Oral Candida spp carriage and periodontal diseases in HIV-infected patients in Ribeirão Preto, Brazil.

The majority of HIV-infected patients develop Candida spp-associated clinical oral lesions. Studies have shown that asymptomatic oral colonization of Candida spp may lead to oral lesions or become a source of disseminated infections. The aim of this study was to verify the effects of periodontal conditions on Candida spp prevalence and Candida spp carriage in the oral cavity of HIV-infected patients compared to non-infected patients. Twenty-five patients not infected with HIV and 48 HIV-infected patients were classified according to periodontal conditions as being periodontal healthy or with periodontal disease. Candida spp carriage and classification were performed in oral rinse samples. Viral load and CD4+ T lymphocyte (CD4+L) counts were performed in blood samples from HIV-infected patients. No differences in Candida spp prevalence related to HIV status or periodontal condition were detected. However, Candida spp carriage was increased in periodontally affected HIV-infected patients when compared to periodontally healthy HIV-infected patients (p= 0.04). Periodontally healthy HIV-infected patients presented Candida spp carriage in similar levels as healthy or periodontally affected non-HIV-infected patients. Candida spp carriage was correlated with CD4+L counting in HIV-infected patients. We concluded that periodontal disease is associated with increased Candida spp carriage in HIV-infected patients and may be a predisposing factor to clinical manifestations of candidiasis.

Oral Candida spp carriage and periodontal diseases in HIV-infected patients in Ribeirão Preto, Brazil

ABSTRACT The majority of HIV-infected patients develop Candida spp-associated clinical oral lesions. Studies have shown that asymptomatic oral colonization of Candida spp may lead to oral lesions or become a source of disseminated infections. The aim of this study was to verify the effects of periodontal conditions on Candida spp prevalence and Candida spp carriage in the oral cavity of HIV-infected patients compared to non-infected patients. Twenty-five patients not infected with HIV and 48 HIV-infected patients were classified according to periodontal conditions as being periodontal healthy or with periodontal disease. Candida spp carriage and classification were performed in oral rinse samples. Viral load and CD4+ T lymphocyte (CD4+L) counts were performed in blood samples from HIV-infected patients. No differences in Candida spp prevalence related to HIV status or periodontal condition were detected. However, Candida spp carriage was increased in periodontally affected HIV-infected patients when compared to periodontally healthy HIV-infected patients (p= 0.04). Periodontally healthy HIV-infected patients presented Candida spp carriage in similar levels as healthy or periodontally affected non-HIV-infected patients. Candida spp carriage was correlated with CD4+L counting in HIV-infected patients. We concluded that periodontal disease is associated with increased Candida spp carriage in HIV-infected patients and may be a predisposing factor to clinical manifestations of candidiasis.

Oral health management of 97 patients living with HIV/AIDS in Ribeirão Preto, São Paulo, Brazil.

Considering the changes antiretroviral therapy (ART) has brought to the treatment of HIV infection, the current clinical and laboratory profiles of HIV/AIDS individuals referred to oral health centers are crucially important in instructing dentists about the oral health management of these patients. The aim of the present study was to determine the clinical and laboratory profiles of HIV-infected individuals referred to a clinic for patients with special needs between 2005 and 2012 by retrospectively analyzing their dental records. A total of 97 records of HIV patients referred to the School of Dentistry of Ribeirão Preto, Universidade de São Paulo - USP, were analyzed. The Mann-Whitney test was used to determine the associations between mean CD4+ counts, mean viral load, and the presence of HIV-related oral lesions (HIV-OL). Most of the patients were male, and their mean age was 38.3 years. Eighty-nine (92%) patients were on regular ART, 77 (79.4%) had a CD4+ count higher than 200 cells/mm3, and 63 (64.9%) had an undetectable viral load. Twenty patients (20.6%) presented with some HIV-OL, including pseudomembranous and/or erythematous candidiasis and angular cheilitis, which were correlated with a low CD4+ count and with an undetectable viral load (p < 0.05). Among the branches of dentistry, periodontics, followed by surgery and restorative dentistry, was the most sought-after specialty, and no intercurrent events were observed during the dental treatment. It may be concluded that there are no restrictions on the dental treatment of patients on regular ART, It is important, though, that the treatment be based on local characteristics and on the prevention of oral diseases.

Oral health management of 97 patients living with HIV/AIDS in Ribeirão Preto, São Paulo, Brazil

Considering the changes antiretroviral therapy (ART) has brought to the treatment of HIV infection, the current clinical and laboratory profiles of HIV/AIDS individuals referred to oral health centers are crucially important in instructing dentists about the oral health management of these patients. The aim of the present study was to determine the clinical and laboratory profiles of HIV-infected individuals referred to a clinic for patients with special needs between 2005 and 2012 by retrospectively analyzing their dental records. A total of 97 records of HIV patients referred to the School of Dentistry of Ribeirão Preto, Universidade de São Paulo - USP, were analyzed. The Mann-Whitney test was used to determine the associations between mean CD4+ counts, mean viral load, and the presence of HIV-related oral lesions (HIV-OL). Most of the patients were male, and their mean age was 38.3 years. Eighty-nine (92%) patients were on regular ART, 77 (79.4%) had a CD4+ count higher than 200 cells/mm3, and 63 (64.9%) had an undetectable viral load. Twenty patients (20.6%) presented with some HIV-OL, including pseudomembranous and/or erythematous candidiasis and angular cheilitis, which were correlated with a low CD4+ count and with an undetectable viral load (p < 0.05). Among the branches of dentistry, periodontics, followed by surgery and restorative dentistry, was the most sought-after specialty, and no intercurrent events were observed during the dental treatment. It may be concluded that there are no restrictions on the dental treatment of patients on regular ART, It is important, though, that the treatment be based on local characteristics and on the prevention of oral diseases.