Demand creation and retention strategies for oral pre-exposure prophylaxis for HIV prevention among men who have sex with men and transgender women: a systematic review and meta-analysis.

BACKGROUND: Men who have sex with men (MSM) and transgender women (TGW) have a disproportionately higher risk of human immunodeficiency virus (HIV) infection than other groups. Oral HIV pre-exposure prophylaxis (PrEP) is an effective prevention tool and should be offered to those at higher risk. Identifying demand creation strategies (DCS) and retention strategies (RS) to improve PrEP persistence is essential to control the HIV epidemic. AIM: We aimed to identify the (DCS and RS with higher proportions among MSM and TGW. METHODS: A systematic review and meta-analysis of prospective studies were conducted, with studies retrieved from five databases until November, 2022 following the Cochrane and PRISMA guidelines. The study protocol was registered in PROSPERO (CRD42022323220). The outcomes were DCS and RS for PrEP use among MSM and TGW. Strategies used for users enrolled in the PrEP-recruited (DCS) were classified as face-to-face (peer educator recruitment at social venues, nongovernmental organizations, and parties; direct referrals by health services; friends and/or sexual partners); online (chatbot or peer educator recruitment on social media [e.g., , Instagram or Facebook] or dating/hook-up apps [e.g., Grindr, Tinder, Badoo, and Scruff]); and mixed (face-to-face and online). RS was classified as provider counseling (face-to-face by a health professional; prevention of HIV risk counseling, distribution of condoms, lubricants, and testing for HIV or other sexually transmitted infections); online counseling (text messages, chatbots, telephone calls, social media, and peer educators); and mixed (all previous strategies). Subgroup analyses were conducted for each treatment strategy. Meta-analyses were performed using the R software version 4.2.1. RESULTS: A total of 1, 129 studies were retrieved from the five databases. After eligibility, 46 studies were included. For MSM, most DCS and RS were online at 91% (95% CI: 0.85-0.97; I2=53%), and 83% (95% CI: 0.80-0.85; I2=17%) respectively. For TGW, mixed DCS and RS were the most frequent at85% (95% CI: 0.60-1.00; I2=91%) and online counseling at 84% (95% CI: 0.64-0.95) compared to other strategies. CONCLUSION: Critical issues play. Pivotal role in increasing PrEP awareness among MSM and TGW, minimizing access gaps, and ensuring retention of PrEP services. Offering oral PrEP using online DCS and RS can reach and retain high numbers of MSM and TGW, and reduce HIV incidence in these populations.

Rural work and COVID-19: challenges and proposals for the prevention of damages.

The COVID-19 pandemic has highlighted the inequalities in health care access in Brazil, exarcerbating vulnerabilities and social determinants of health. Inequality is part of the context of rural populations, especially rural workers and family and subsistence farmers due to both the direct consequences of work activity and the unfavorable socioeconomic context, especially regarding service provision, the guaranteeing of rights, and the coordination of care networks. This article reviews challenges to the health of these workers and outlines proposals for disease prevention in the context of the COVID-19 pandemic.

Apandemia de covid-19 no mundo trouxe à tona as desigualdades vivenciadas no acesso à saúde no Brasil, escancarando as vulnerabilidades e os determinantes sociais de saúde. É nesse ínterim de iniquidades que as populações rurais se inserem, em especial trabalhadores e trabalhadoras rurais e membros da agricultura familiar e de subsistência, tanto pelas consequências diretas da atividade laboral quanto pelo contexto socioeconômico desfavorável, especialmente no que diz respeito a oferta de serviços, garantia de direitos e articulação das redes de assistência. Frente a isso, o presente trabalho discute os desafios relacionados à saúde desses trabalhadores e traça propostas para a prevenção de agravos da referida população no contexto da pandemia de covid-19.

Dental service coverage and oral health promotion community actions in primary care in Brazil between 2003 and 2019.

Objective: This study analyzes the Brazilian experience regarding the implementation of collective actions of supervised tooth brushing in schools, use of topical fluoride and coverage of dental consultations in public primary dental service based on the transformations of the political context from 2003 to 2019. Method: This was a retrospective study of the Brazilian case between 2003 and 2019, regarding the collective actions of supervised tooth brushing, topical fluoride strategies, access to dental consultations in public primary care services and the coverage of exclusively private dental plans, estimating the trend of indicators. Results: From 2003 to 2010, the coverage of the first consultation reached 13.3%. Supervised tooth brushing and topical fluoride strategies increased 4.5% and 1.4%, respectively. The use of fluoride mouthwash remained stable. From 2011 to 2019, most of public dental services indicators decreased. Private dental insurance plans increased in both periods. Conclusion: The Brazilian case disclosed an expansion of the public dental sector. In political situations of greater austerity and economic crisis, there is an upsurge and also setbacks in the coverage of public dental consultations and collective actions aimed at oral health promotion in the public sector; however, an expansion was observed in the private sector.