Academic accountability to local communities and society through Programme Science: a case study from the HPV self-sampling programme HOPE in Peru.

INTRODUCTION: Health challenges in the 21st century underscore the need for adaptable and innovative approaches in public health. Academic institutions can and should contribute much more effectively to generate and translate scientific knowledge that will result in better programmes to improve societal health. Academic accountability to local communities and society requires universities to actively engage with local communities, understanding the context, their needs, and leveraging their knowledge and local experience. The Programme Science initiative provides a framework to optimize the scale, quality and impact of public health programmes, by integrating diverse approaches during the iterative cycle of research and practice within the strategic planning, programme implementation and programme management and evaluation. We illustrate how the Programme Science framework could be a useful tool for academic institutions to accomplish accountability to local communities and society through the experience of Project HOPE in Peru. DISCUSSION: Project HOPE applied the Programme Science framework to introduce HPV self-sampling into a women's health programme in Peru. Collaboration with local authorities and community members was pivotal in all phases of the project, ensuring interventions aligned with community needs and addressing social determinants of health. The HOPE Ladies-community women trained and empowered to promote and provide the HPV kits-crafted the messages used through the study and developed strategies to reach individuals and provided support to women's journey through health centres. By engaging communities in co-creating knowledge and addressing health inequities, academic institutions can generate contextually relevant and socially just scientific knowledge. The active participation of community women in Project HOPE was instrumental in improving service utilization and addressing barriers to self-sampling. CONCLUSIONS: The Programme Science approach offers a pathway for academic institutions to enhance their accountability to communities and society at large. By embedding researchers within public health programmes and prioritizing community engagement, academic institutions can ensure that research findings directly inform policy improvements and programmatic decisions. However, achieving this requires a realignment of research agendas and recognition of the value of community engagement. Establishing Programme Science networks involving academia, government and funding entities can further reinforce academic accountability and enhance the impact of public health programmes.

Validez de la evaluación del consumo de alcohol establecido en la norma técnica de atención integral del adulto con infección por el VIH

Objetivos: Determinar la validez de la evaluación de consumo de alcohol realizado en la Estrategia Nacional de Salud para la Prevención y Control de ITS-VIH / SIDA (ESNITSS) a pacientes con VIH que iniciaron tratamiento antirretroviral (TARV). Material y métodos: El tipo de estudio fue de evaluación de prueba diagnóstica en pacientes en TARV de un hospital del Ministerio de Salud (MINSA), entre septiembre de 2017 y enero de 2018; en base al análisis de datos de la Fase I del estudio "Efectividad de la Consejería en Enfermería en la Mejora de la Adherencia al TARV en pacientes con VIH y Conducta de Consumo de Alcohol". 4000 pacientes conformaron la población de estudio y 350 pacientes fueron seleccionados aleatoriamente. Se procedió a la validación de la evaluación del consumo de alcohol realizado por la ESNITSS con dos Gold estándar: i. la evaluación del consumo de alcohol en el último mes y ii. el consumo de riesgo identificado con el Alcohol Use Disorders Identification Test (AUDIT). Se calculó sensibilidad, especificidad, seguridad de la evaluación y razones de probabilidad. Resultados: La sensibilidad y especificidad fue regular para la evaluación de consumo de alcohol en el último mes (S=0,64, E=0,57), la especificidad fue mala para la evaluación de consumo de riesgo (E=0,48). Las razones de verosimilitud positivas demuestraron que la evaluación no tiene utilidad diagnóstica para ninguno de los casos (<2). Conclusiones: La evaluación de "consumo actual de alcohol" realizada por la ESNITSS no mostró utilidad diagnóstica.

SUMMARY Objectives: To determine the validity of the evaluation of alcohol consumption established by the national strategy to prevent and control STI-HIV-AIDS (ESNITSS) of HIV-infected adults that started anti-retroviral treatment (ART). Methods: Diagnostic study of HIV patients in a single hospital in Lima from September 2017 to January 2018 using data from a phase one study "Effectiveness of nursing counseling in improving adherence to ART among patient with alcohol consumption". Three hundred and fifty patients were randomly selected among 4000 participants. Two gold standards evaluated alcohol consumption: 1. Last month alcohol consumption and ii; alcohol consumption identified by the Alcohol Use Disorders Identification Test (AUDIT). Sensitivity, specificity, safety of the evaluation and probability rates. Results: sensitivity and specificity were moderate for last month alcohol consumption (s=0.64; e=0.57); specificity was low for evaluation of consumption risk (e=0.48). Positive validity rates demonstrated that the evaluation is not useful (<2). Conclusions: The evaluation of alcohol consumption followed by the ESNITSS has no diagnostic utility.

Cost analysis of chronic pain due to musculoskeletal disorders in Chile.

The magnitude of the cost of chronic pain has been a matter of concern in many countries worldwide. The high prevalence, the cost it implies for the health system, productivity, and absenteeism need to be addressed urgently. Studies have begun describing this problem in Chile, but there is still a debt in highlighting its importance and urgency on contributing to chronic pain financial coverage. This study objective is to estimate the expected cost of chronic pain and its related musculoskeletal diseases in the Chilean adult population. We conducted a mathematical decision model exercise, Markov Model, to estimate costs and consequences. Patients were classified into severe, moderate, and mild pain groups, restricted to five diseases: knee osteoarthritis, hip osteoarthritis, lower back pain, shoulder pain, and fibromyalgia. Data analysis considered a set of transition probabilities to estimate the total cost, sick leave payment, and productivity losses. Results show that the total annual cost for chronic pain in Chile is USD 943,413,490, corresponding an 80% to the five diseases studied. The highest costs are related to therapeutic management, followed by productivity losses and sick leave days. Low back pain and fibromyalgia are both the costlier chronic pain-related musculoskeletal diseases. We can conclude that the magnitude of the cost in our country's approach to chronic pain is related to increased productivity losses and sick leave payments. Incorporating actions to ensure access and financial coverage and new care strategies that reorganize care delivery to more integrated and comprehensive care could potentially impact costs in both patients and the health system. Finally, the impact of the COVID-19 pandemic will probably deepen even more this problem.

The Annual costs of treating genital warts in the Public Healthcare Sector in Peru.

OBJECTIVES: To estimate the cost of six different techniques used to treat Genital Warts and the annual average cost of treating a typical GW patient in Peru. To estimate the annual economic burden diagnosing and treating GW in the Peruvian public healthcare system. METHODS: We developed a prevalence-based, cost-of-illness study from the provider's perspective, the healthcare facilities under the purview of Peruvian Ministry of Health. We used an activity-based costing approach. We conducted primary data collection in three regions in Peru and supplemented it with governmental data. Uncertainty of the costing estimates was assessed via Monte Carlo simulations. We estimated the average cost and associated confidence intervals for six treatment options - three topical and three surgical - and the overall cost per patient. RESULTS: The average treatment cost per patient was 59.9USD (95 %CI 45.5, 77.6). Given a population of 18.4 million adults between 18 and 60 years of age and a GW prevalence of 2.28 %, the annual cost of treating GW was 25.1 million USD (uncertainty interval 16.9, 36.6). CONCLUSIONS: This study provides the first quantification of the economic burden of treating genital warts in Peru and one of the few in Latin America. The costing data did not include other healthcare providers or out-of-pocket expenditures, and hence we present a conservative estimate of the COI of GW in Peru. Our findings bring attention to the financial burden of treating GW, a vaccine-preventable disease.

Characterization of HIV-Associated Neurocognitive Impairment in Middle-Aged and Older Persons With HIV in Lima, Peru.

Background: With widespread use of antiretroviral medications, people living with HIV (PWH) are living longer worldwide, increasing their risk of developing neurocognitive impairment (NCI). The proportion of Peruvians over age 60 is expected to increase to 25% of the population by 2050, including PWH. Therefore, the problem of aging and NCI, especially in the setting of HIV infection, is uniquely pressing. We sought to study the rates of and risk factors associated with NCI among middle-aged and older PWH in Lima, Peru. Materials and Methods: Sociodemographic, medical (infectious and non-infectious), and psychiatric comorbidity and laboratory data were collected. We administered a brief neuropsychological battery evaluating seven cognitive domains affected in HIV-associated NCI and a depression screening. Cognitive test raw scores were converted to T-scores that were demographically adjusted. Descriptive statistics were performed together with regression (unadjusted and adjusted) analyses to determine potential risk factors for NCI among PWH. Results: This was a cross-sectional study in which 144 PWH aged ≥40 years attending a large HIV clinic in Lima, Peru, were recruited from September 2019 to March 2020. Mean age was 51.6 ± 7.7 years, and mean years of education were 14.0 ± 3.1 with 15% females. Median [interquartile range (IQR)] current CD4 and nadir CD4 were 554 (371, 723) and 179 (83, 291), respectively, and 10% currently had AIDS. The prevalence of NCI was 28.5%, and many demonstrated difficulty with attention and working memory (70%). One-quarter of PWH had mild depression or worse on Patient Health Questionnaire 9 (PHQ-9 ≥ 5). In bivariate analyses, neither a depression history nor a higher PHQ-9 score correlated with NCI. No other non-communicable medical or psychiatric comorbidity nor HIV characteristic was predictive of NCI. Having a positive lifetime history of hepatitis B infection, pulmonary tuberculosis, or syphilis increased risk of NCI (PR 1.72; 95% CI 1.04-2.86) in unadjusted analyses, but not in adjusted analyses. Conclusions: NCI among older Peruvians with HIV was found to be highly prevalent with levels consistent with prior reports of HIV-associated NCI worldwide. Common latent HIV-associated co-infections, including latent syphilis, hepatitis B infection, or pulmonary tuberculosis, may increase the risk of NCI among middle-aged and older PWH in Peru.

Prevalence, burden of disease, and lost in health state utilities attributable to chronic musculoskeletal disorders and pain in Chile.

BACKGROUND: Musculoskeletal disorders are a leading cause of disability adjusted life years (DALY) in the world. We aim to describe the prevalence and to compare the DALYs and loss of health state utilities (LHSU) attributable to common musculoskeletal disorders in Chile. METHODS: We used data from the Chilean National Health Survey carried out in 2016-2017. Six musculoskeletal disorders were detected through the COPCOPRD questionnaire: chronic musculoskeletal pain, chronic low back pain, chronic shoulder pain, osteoarthritis of hip and knee, and fibromyalgia. We calculated the DALY for each disorder for 18 sex and age strata, and LHSU following an individual and population level approaches. We also calculated the fraction of LHSU attributable to pain. RESULTS: Chronic musculoskeletal pain disorder affects a fifth of the adult population, with a significant difference between sexes. Among specific musculoskeletal disorders highlights chronic low back pain with the highest prevalence. Musculoskeletal disorders are a significant cause of LHSU at the individual level, especially in the case of fibromyalgia. Chronic musculoskeletal pain caused 503,919 [283,940 - 815,132] DALYs in 2017, and roughly two hundred thousand LSHU at population level, which represents 9.7% [8.8-10.6] of the total LSHU occurred in that year. Discrepancy in the burden of musculoskeletal disorders was observed according to DALY or LSHU estimation. The pain and discomfort domain of LHSU accounted for around half of total LHSU in people with musculoskeletal disorders. CONCLUSION: Chronic musculoskeletal pain is a major source of burden and LHSU. Fibromyalgia should deserve more attention in future studies. Using the attributable fraction offers a straightforward and flexible way to explore the burden of musculoskeletal disorders.

Thyroid cancer overdiagnosis and overtreatment: a cross- sectional study at a thyroid cancer referral center in Ecuador.

BACKGROUND: In contrast to the rapid increase in thyroid cancer incidence, the mortality has remained low and stable over the last decades. In Ecuador, however, thyroid cancer mortality has increased. The objective of this study is to determine possible drivers of high rates of thyroid cancer mortality, through a cross-sectional analysis of all patients attending a thyroid cancer referral center in Ecuador. METHODS: From June 2014 to December 2017, a cross-sectional study was conducted at the Hospital de Especialidades Eugenio Espejo, a regional reference public hospital for endocrine neoplasia in adults in Quito, Ecuador. We identified the mechanism of detection, histopathology and treatment modalities from a patient interview and review of clinical records. RESULTS: Among 452 patients, 74.8% were young adults and 94.2% (426) were female. 13.7% had a family history of thyroid cancer, and patients' median tumor size was 2 cm. The incidental finding was 54.2% whereas 45.8% was non-incidental. Thyroid cancer histology reported that 93.3% had papillary thyroid cancer (PTC), 2.7% follicular, 1.5% Hurtle cells, 1.6% medullary, 0.7% poor differentiated, and 0.2% anaplastic carcinoma. The mean MACIS (metastasis, age, completeness, invasion, and size) score was 4.95 (CI 4.15-5.95) with 76.2% of the thyroid cancer patients having MACIS score less than or equal to 6. The very low and low risk of recurrence was 18.1% (79) and 62% (271) respectively. An analysis of 319 patients with non-metastatic thyroid cancer showed that 10.7% (34) of patients had surgical complications. Moreover, around 62.5% (80 from 128 patients with thyroglobulin laboratory results) of TC patients had a stimulated-thyroglobulin value equal or higher than 2 ng/ml. Overall, a poor surgical outcome was present in 35.1% (112) patients. Out of 436 patients with differentiated thyroid carcinoma, 86% (375) received radioactive iodine. CONCLUSION: Thyroid cancer histological characteristics and method of diagnosis are like those described in other reports without any evidence of the high frequency of aggressive thyroid cancer histology. However, we observed evidence of overtreatment and poor surgical outcomes that demand additional studies to understand their association with thyroid cancer mortality in Ecuador.

Cambios fisiológicos y morfológicos tempranos en el riñón remanente de donantes vivos / Early physiological and morphological changes in the remnant kidney of living donors

RESUMEN Con el objetivo de describir los cambios funcionales y morfológicos tempranos en el riñón remanente de donantes vivos, se realizó un estudio retrospectivo en el Hospital Cayetano Heredia, en el que se incluyeron 55 individuos. De las historias clínicas, se obtuvieron los datos clínicos y demográficos, así como la depuración de creatinina, la proteinuria, la presión arterial y las dimensiones renales a los 1, 2, 3, 6 y 12 meses después de la donación del riñón. La edad media fue de 40,88 (±9,84) años; el 80% eran mujeres y el índice de masa corporal medio fue de 25,68 (±3,5) kg/m2. Se utilizaron modelos lineales y cuadráticos para estudiar las variables fisiológicas y morfológicas. Durante el tiempo de seguimiento, la tasa de filtración glomerular, la proteinuria, la presión arterial diastólica y la longitud de los riñones mostraron cambios significativos (p < 0,05).

ABSTRACT In order to describe the early functional and morphological changes in the remnant kidney of living donors, a retrospective study was carried out at the Cayetano Heredia Hospital. Data from 55 individuals was included. Clinical and demographic data were obtained from the clinical records, as well as data for creatinine clearance, proteinuria, blood pressure and renal dimensions at 1, 2, 3, 6 and 12 months after kidney donation. The mean age was 40.88 (±9.84) years; 80% were women and the mean body mass index was 25.68 (±3.5) kg/m2. Linear and quadratic models were used to study physiological and morphological variables. During the follow-up time, glomerular filtration rate, proteinuria, diastolic blood pressure, and kidney length showed significant changes (p < 0.05).

Experiencia en la práctica clínica real de la efectividad y la tolerabi- lidad de tapentadol de liberación prolongada para el tratamiento de dolor crónico postraumático producido por accidentes de trabajo / Real-world clinical practice experience of the effectiveness and tolerability of pro- longed-release tapentadol for the treatment of chronic post-traumatic pain caused by occupational accidents

Se llevó a cabo un estudio observacional para analizar si tapentadol de liberación prolongada (LP) puede considerarse un tratamiento de primera línea para pacientes con dolor crónico postraumático (DCPT). Métodos: Se presenta una serie de casos de la práctica clínica real de pacientes con DCPT producido por accidentes de trabajo. Antes de ingresar al estudio, todos los pacientes recibían tramadol, que se interrumpió cuando se inició la administración de tapentadol LP. Las evaluaciones de dolor incluyeron una escala de valoración numérica, el cuestionario DN4 y la escala de Impresión Global de Cambio del Paciente (PGIC, Patients' Global Impression of Change). Se recuperaron y registraron los eventos adversos. Resultados: 94 pacientes participaron en el estudio y 77 (82 %) completaron todas las visitas predefinidas. Cerca de la mitad de los pacientes informaron dolor crónico que tenía una duración de al menos 3 años; se observó un componente neuropático en el 87 % de los pacientes. El puntaje de dolor se redujo en 1,5 puntos luego del primer mes de tratamiento con tapentadol LP y en 2,48 puntos luego de 4 meses (p<0,05). También se asoció la administración de tapentadol LP con una reducción del 28,9 % de la dosis concomitante de pregabalina (p<0,01). De acuerdo con el cuestionario PGIC, el 74 % y el 77,9 % de los pacientes informó mejoría luego de uno y cuatro meses de tratamiento, respectivamente. El perfil de seguridad fue consistente con los datos actuales sobre tapentadol LP. Conclusión: El dolor osteomuscular crónico es una enfermedad prevalente que se caracteriza por tener resultados terapéuticos deficientes y se asocia a una mayor discapacidad y una mala calidad de vida. En este estudio de la práctica clínica real en pacientes que trabajan y que cuentan con un componente de dolor neuropático elevado, se observó que tapentadol LP produce efectos beneficiosos en términos del control del DCPT, y se obtuvieron índices altos de eficacia y seguridad.

An observational study was carried out to analyze whether prolonged-release (PR) tapentadol may be considered a first-line treatment for patients with chronic post-traumatic pain (PTD). Methods: A case series of cases of patients with PTFE caused by work accidents in a real clinical practice setting is described. Before entering the study, all patients were receiving tramadol, which was discontinued when PR tapentadol was started. Pain assessments included a numerical rating scale, the DN4 questionnaire, and the Patients' Global Impression of Change (PGIC) scale. Adverse events were retrieved and described. Results: 94 patients participated in the study and 77 (82%) completed all the predefined visits. About half of the patients reported chronic pain that lasted for at least 3 years. A neuropathic component was reported in 87% of patients. The pain score was reduced by 1.5 points after the first month of treatment with PR tapentadol and by 2.48 points after 4 months (p < 0.05). Administration of PR tapentadol was also associated with a concomitant reduction of pregabalin dose of 28.9% (p < 0.01). According to the PGIC questionnaire, 74% and 77.9% of patients reported improvement after one and four months of treatment, respectively. The safety profile was consistent with current data on PR tapentadol. Conclusion: Chronic musculoskeletal pain is a prevalent disease characterized by poor therapeutic results and associated with increased disability and poor quality of life. In our study in a real clinical practice setting with patients with a high neuropathic pain component, PR tapentadol produced beneficial effects in terms of DCPT control, and high efficacy and safety rates were obtained. Keywords: tapentadol, chronic pain, pain caused by work accidents, chronic post-traumatic pain, evidence from real clinical practice.

The impact of anti-tobacco legislation on birth weight in Peru.

Background: Tobacco exposure remains a significant issue for public health, especially for pregnant women. It increases the risk for premature labor, low birth weight and small for gestational age (SGA), among other effects. To reduce these risks, many countries have enacted public policies to curb tobacco exposure. Peru enacted anti-tobacco laws that forbid smoking in public places, require prevention text and images in products and publicity, along with restriction of sales to adults. We evaluated the effect of the implementation of this law on newborn outcomes: birth weight, prematurity and SGA. Methods: This was a quasi-experimental study that utilized data from the Peruvian Live Birth Registry. Children born to mothers from urban areas were the intervention group, while children born to mothers from rural areas were considered the control group. Only singletons with information on birth weight and gestational age, born to mothers aged 12 to 49 years were included in the study. In addition, newborns with birth weights greater than + 4 standard deviations (SD) or less than - 4 SD from the gestational age-specific mean were excluded. To measure the effect of legislation on birth weight we performed a difference in differences analysis. Results: A total of 2,029,975 births were included in the analysis. After adjusting for characteristics of the mother and the child, and contextual variables, the anti-tobacco law in Peru reduced the incidence of prematurity by 30 cases per 10,000 live births (95% CI: 19 to 42). Conclusions: The reform had negligible effects on overall birth weights and on the incidence of SGA. This modest result suggests the need for a more aggressive fight against tobacco, prohibiting all types of advertising and promotion of tobacco products, among others measures.

Seroprevalencia poblacional de la enfermedad celiaca en zonas urbanas del Perú / Population seroprevalence of celiac disease in urban areas of Peru

RESUMEN El objetivo del estudio fue determinar la seroprevalencia de la enfermedad celiaca (EC) en zonas urbanas del Perú, utilizando una muestra de base poblacional. Se tamizó una muestra aleatoria de mujeres y varones de 18 a 29 años de 26 ciudades del Perú. Para la detección de la EC se utilizó el kit anti-transglutaminasa tisular IgA. Los resultados mayores a 20 AU/ml fueron considerados positivos. La prevalencia ponderada de la EC fue de 1,2% (IC 95%: 0,0‒2,4) y se estima que el número de personas viviendo con EC en el Perú fue de 341 783. La prevalen cia de la EC en el Perú resultó ser similar al promedio mundial.

ABSTRACT The objective of the study was to determine the seroprevalence of celiac disease (CD) in urban areas of Peru using a population-based sample. A random sample of women and men 18 to 29 years old from 26 cities in Peru was screened. An anti-tissue transglutaminase IgA kit was used for the detection of CD. Results higher than 20 AU / ml were considered positive. The weighted prevalence of celiac disease was 1.2% (CI 95%: 0.0% - 2.4%), thus the estimated number of people living with CD in Peru was 341,783. CD prevalence in Peru is similar to the world average.

Validation of a counseling guide for adherence to antiretroviral therapy using implementation science / Validação de um guia de aconselhamento para a adesão ao tratamento antirretroviral usando ciência da implementação / Validación de Guía de Consejería para adherencia al tratamiento antirretroviral usando ciencia de la implementación

Objective: to determine the contents that must be included in the usual counseling to improve the adherence to antiretroviral therapy (ART) of HIV patients, according to their different levels of alcohol consumption, and to determine the validity of the Counseling Guide in improving the adherence to ART in patients who consume alcohol using Implementation Science. Method: this is an observational study with formative and validation phases. The formative phase defined the content, approach and structure of the counseling. Validation included focus groups with patients and nurses, trial process by an expert and a pilot test. The criteria evaluated based on Implementation Science were: intervention source, evidence strength and quality, relative advantage, and complexity. The following criteria were also evaluated: usefulness, practicality, acceptability, sustainability, effectiveness; content consistency and congruence; procedural compliance and difficulties, and time spent in counseling. Results: the strength of evidence of the counseling is High-IIA, with strong level of recommendation and presenting usefulness, practicality, acceptability, sustainability and effectiveness. Eight in 11 experts argued that the Guide is clear, consistent and congruent. Initial counseling takes around 24 minutes; and follow-up counseling, 21. The instruments of the Guide present reliability levels between good and high (0.65 ≥ alpha ≤ 0.92). Conclusion: the Counseling Guide is valid to improve the adherence to antiretroviral therapy in patients who consume alcohol.

Objetivo: determinar os conteúdos que devem ser incluídos no aconselhamento habitual para melhorar a adesão ao TARV de pacientes com HIV, conforme seus diferentes níveis de consumo de álcool, e determinar a validade do Guia de Aconselhamento para melhorar a adesão ao TARV em pacientes que consomem álcool, usando a Ciência da Implementação. Método: estudo observacional com fase formativa e de validação. A fase formativa permitiu definir o conteúdo, a abordagem e a estrutura do aconselhamento. A validação incluiu grupos focais com pacientes e enfermeiras, processo de julgamento de especialista e teste piloto. Estes foram os critérios avaliados com base na Ciência da Implementação: fonte de intervenção, força e qualidade da evidência, vantagem relativa e complexidade. Foram avaliados ainda: utilidade, praticidade, aceitabilidade, sustentabilidade, efetividade; consistência e congruência do conteúdo; cumprimento, dificuldades do procedimento e tempo empregado no aconselhamento. Resultados: o aconselhamento tem força de evidência Alta -IIA, forte nível de recomendação, apresenta utilidade, praticidade, aceitabilidade, sustentabilidade e efetividade. Oito de 11 especialistas argumentaram que o Guia é claro, consistente e congruente. O aconselhamento de início leva em torno de 24 minutos; e o de acompanhamento, 21. Os instrumentos do Guia têm um nível de confiabilidade entre bom e alto (0,65 ≥ alfa ≤ 0,92). Conclusão: o guia de aconselhamento é válido para melhorar a adesão ao tratamento antirretroviral em pacientes que consomem álcool.

Objetivo: determinar los contenidos necesarios a incluir a la consejería habitual para mejorar la adherencia al TARV de pacientes con VIH según sus diferentes niveles de consumo de alcohol, y determinar la validez de la Guía de Consejería para mejorar la adherencia al TARV en paciente que consumen alcohol usando Ciencia de la Implementación. Método: estudio Observacional con fase formativa y de validación. La fase formativa permitió definir el contenido, enfoque y estructura de la consejería. La validación incluyó grupos focales con pacientes y enfermeras, juicio experto y prueba piloto. Los criterios evaluados en base a la Ciencia de la Implementación fueron: fuente de intervención, fuerza y calidad de la evidencia, ventaja relativa y complejidad. También se evaluó: utilidad, practicidad, aceptabilidad, sostenibilidad, efectividad; consistencia y congruencia del contenido; cumplimiento, dificultades del procedimiento y tiempo empleado en la consejería. Resultados: la consejería tiene fuerza de evidencia Alta -IIA, fuerte nivel de recomendación, presenta utilidad, practicidad, aceptabilidad, sostenibilidad y efectividad. Ocho de 11 expertos, sostuvieron que la Guía es clara, consistente y congruente. La consejería de inicio toma en promedio 24 minutos y 21 minutos la de seguimiento. Los instrumentos de la Guía tienen un nivel de fiabilidad entre bueno y alto (0,65 ≥ alfa ≤ 0,92). Conclusión: la guía de consejería es válida para mejorar la adherencia al tratamiento antirretroviral en pacientes que consumen alcohol.

Validation of a counseling guide for adherence to antiretroviral therapy using implementation science / Validação de um guia de aconselhamento para a adesão ao tratamento antirretroviral usando ciência da implementação / Validación de Guía de Consejería para adherencia al tratamiento antirretroviral usando ciencia de la implementación

Objective: to determine the contents that must be included in the usual counseling to improve the adherence to antiretroviral therapy (ART) of HIV patients, according to their different levels of alcohol consumption, and to determine the validity of the Counseling Guide in improving the adherence to ART in patients who consume alcohol using Implementation Science. Method: this is an observational study with formative and validation phases. The formative phase defined the content, approach and structure of the counseling. Validation included focus groups with patients and nurses, trial process by an expert and a pilot test. The criteria evaluated based on Implementation Science were: intervention source, evidence strength and quality, relative advantage, and complexity. The following criteria were also evaluated: usefulness, practicality, acceptability, sustainability, effectiveness; content consistency and congruence; procedural compliance and difficulties, and time spent in counseling. Results: the strength of evidence of the counseling is High-IIA, with strong level of recommendation and presenting usefulness, practicality, acceptability, sustainability and effectiveness. Eight in 11 experts argued that the Guide is clear, consistent and congruent. Initial counseling takes around 24 minutes; and follow-up counseling, 21. The instruments of the Guide present reliability levels between good and high (0.65 ≥ alpha ≤ 0.92). Conclusion: the Counseling Guide is valid to improve the adherence to antiretroviral therapy in patients who consume alcohol.

Objetivo: determinar os conteúdos que devem ser incluídos no aconselhamento habitual para melhorar a adesão ao TARV de pacientes com HIV, conforme seus diferentes níveis de consumo de álcool, e determinar a validade do Guia de Aconselhamento para melhorar a adesão ao TARV em pacientes que consomem álcool, usando a Ciência da Implementação. Método: estudo observacional com fase formativa e de validação. A fase formativa permitiu definir o conteúdo, a abordagem e a estrutura do aconselhamento. A validação incluiu grupos focais com pacientes e enfermeiras, processo de julgamento de especialista e teste piloto. Estes foram os critérios avaliados com base na Ciência da Implementação: fonte de intervenção, força e qualidade da evidência, vantagem relativa e complexidade. Foram avaliados ainda: utilidade, praticidade, aceitabilidade, sustentabilidade, efetividade; consistência e congruência do conteúdo; cumprimento, dificuldades do procedimento e tempo empregado no aconselhamento. Resultados: o aconselhamento tem força de evidência Alta -IIA, forte nível de recomendação, apresenta utilidade, praticidade, aceitabilidade, sustentabilidade e efetividade. Oito de 11 especialistas argumentaram que o Guia é claro, consistente e congruente. O aconselhamento de início leva em torno de 24 minutos; e o de acompanhamento, 21. Os instrumentos do Guia têm um nível de confiabilidade entre bom e alto (0,65 ≥ alfa ≤ 0,92). Conclusão: o guia de aconselhamento é válido para melhorar a adesão ao tratamento antirretroviral em pacientes que consomem álcool.

Objetivo: determinar los contenidos necesarios a incluir a la consejería habitual para mejorar la adherencia al TARV de pacientes con VIH según sus diferentes niveles de consumo de alcohol, y determinar la validez de la Guía de Consejería para mejorar la adherencia al TARV en paciente que consumen alcohol usando Ciencia de la Implementación. Método: estudio Observacional con fase formativa y de validación. La fase formativa permitió definir el contenido, enfoque y estructura de la consejería. La validación incluyó grupos focales con pacientes y enfermeras, juicio experto y prueba piloto. Los criterios evaluados en base a la Ciencia de la Implementación fueron: fuente de intervención, fuerza y calidad de la evidencia, ventaja relativa y complejidad. También se evaluó: utilidad, practicidad, aceptabilidad, sostenibilidad, efectividad; consistencia y congruencia del contenido; cumplimiento, dificultades del procedimiento y tiempo empleado en la consejería. Resultados: la consejería tiene fuerza de evidencia Alta -IIA, fuerte nivel de recomendación, presenta utilidad, practicidad, aceptabilidad, sostenibilidad y efectividad. Ocho de 11 expertos, sostuvieron que la Guía es clara, consistente y congruente. La consejería de inicio toma en promedio 24 minutos y 21 minutos la de seguimiento. Los instrumentos de la Guía tienen un nivel de fiabilidad entre bueno y alto (0,65 ≥ alfa ≤ 0,92). Conclusión: la guía de consejería es válida para mejorar la adherencia al tratamiento antirretroviral en pacientes que consumen alcohol.

Burden of genital warts in Peru: an observational study.

Genital warts (GW) are mucosal or skin lesions caused by sexual transmission of human papillomavirus (HPV). This study estimates the frequency of GW cases in physicians' clinics and physicians' usual practices of GW referral and diagnosis in Peru. Participants in this study were a convenience sample of 100 physicians in five specialties: primary care (17), gynecology (37), urology (10), dermatology (31), and infectious diseases (5). Physicians completed a survey and daily log of all patients aged 18-60 years seen over ten days in their offices located in Peru. The survey recorded GW referral patterns and the daily log recorded patient demographic information and GW diagnosis. Among 12,058 patients, the annual GW prevalence (95% confidence interval [CI]) was 2.28% (2.02-2.56) and cumulative incidence (95% CI) was 1.60% (1.38-1.84). Physicians reported that most GW patients were direct consult (73.5% of male and 67.9% of females) and physicians treated most GW patients themselves (73.4% of males and 76.7% of females). As reported, the most common reasons for referring were 'serious cases requiring more specialized treatment' (73.2% of male and 72.2% of female) and 'lack of resources to treat' (26.8% of male and 27.8% of female). We conclude that GW cases are commonly seen by physicians in Peru.

[Preferences and satisfaction towards a screening program with self-administered human papilloma virus detection tests]. / Preferencias y satisfacción hacia un programa de tamizaje con pruebas autoadministradas de detección del virus de papiloma humano.

Cross-sectional study describing preferences and satisfaction towards a cervical cancer screening program with selfadministered rapid tests for the detection of human papillomavirus (HPV). Of 2 090 users picked by the program in Ventanilla Callao - Peru, 97 were randomly selected to be surveyed. In addition, interviews were conducted with women leaders of the community, in charge of providing the evidence. 74.2% of the users felt, at least, satisfied with the program. 68% of women prefer to take the test, mainly by demanding less time. Of women who prefer to take the test at the Health Center, 90.3% do so for the safety of the test being done correctly. The inclusion of community leaders in the program allowed a good diffusion of the test and the steps to carry it out.

Estudio transversal que describe preferencias y satisfacción hacia un programa de tamizaje de cáncer cervical con pruebas rápidas autoadministradas, para la detección del virus de papiloma humano (VPH). De las 2090 usuarias captadas por el programa en Ventanilla Callao-Perú, se seleccionó aleatoriamente a 97 para ser encuestadas. Asimismo, se realizaron entrevistas a mujeres líderes de la comunidad, encargadas de ofrecer las pruebas. El 74,2% de las usuarias se sintió, cuanto menos, satisfecha con el programa. El 68% de las mujeres prefiere la autotoma de la prueba, principalmente por demandar menos tiempo. De las mujeres que prefieren la toma en el centro de salud, el 90,3% lo hace por la seguridad de que la prueba sea realizada correctamente. La inclusión de líderes comunitarias en el programa permitió una buena difusión de la prueba y de los pasos para realizarla.

Preferencias y satisfacción hacia un programa de tamizaje con pruebas autoadministradas de detección del virus de papiloma humano / Preferences and satisfaction towards a screening program with self-administered human papilloma virus detection tests

Estudio transversal que describe preferencias y satisfacción hacia un programa de tamizaje de cáncer cervical con pruebas rápidas autoadministradas, para la detección del virus de papiloma humano (VPH). De las 2090 usuarias captadas por el programa en Ventanilla Callao-Perú, se seleccionó aleatoriamente a 97 para ser encuestadas. Asimismo, se realizaron entrevistas a mujeres líderes de la comunidad, encargadas de ofrecer las pruebas. El 74,2% de las usuarias se sintió, cuanto menos, satisfecha con el programa. El 68% de las mujeres prefiere la autotoma de la prueba, principalmente por demandar menos tiempo. De las mujeres que prefieren la toma en el centro de salud, el 90,3% lo hace por la seguridad de que la prueba sea realizada correctamente. La inclusión de líderes comunitarias en el programa permitió una buena difusión de la prueba y de los pasos para realizarla.

Cross-sectional study describing preferences and satisfaction towards a cervical cancer screening program with selfadministered rapid tests for the detection of human papillomavirus (HPV). Of 2 090 users picked by the program in Ventanilla Callao - Peru, 97 were randomly selected to be surveyed. In addition, interviews were conducted with women leaders of the community, in charge of providing the evidence. 74.2% of the users felt, at least, satisfied with the program. 68% of women prefer to take the test, mainly by demanding less time. Of women who prefer to take the test at the Health Center, 90.3% do so for the safety of the test being done correctly. The inclusion of community leaders in the program allowed a good diffusion of the test and the steps to carry it out.

Prevalencia de vaginosis bacteriana y factores asociados en veinte ciudades del Perú / Prevalence of bacterial vaginosis and associated factors in twenty peruvian cities

RESUMEN Objetivos. Determinar la prevalencia de vaginosis bacteriana (VB) y factores asociados en mujeres peruanas de 18 a 29 años de edad en 20 ciudades a partir de datos del proyecto PREVEN. Materiales y métodos. Estudio de tipo transversal, la definición de VB se realizó previa selección de una muestra de secreción vaginal en una lámina portaobjetos. Las láminas fueron teñidas usando la tinción Gram para ser observadas al microscopio usando el puntaje de Nugent, el diagnóstico de VB se aplicó a los puntajes 7-10. Se estimaron razones de prevalencias (RP) y sus intervalos de confianza al 95% (IC 95%) mediante el uso de modelos lineales generalizados. Resultados. Un total de 6322 mujeres contestaron la encuesta epidemiológica y proporcionaron muestras vaginales. La prevalencia de VB fue de 23,7% (IC95%: 22,6-24,7) y se asoció con tener un mayor número de parejas sexuales en los últimos 12 meses (RP: 1,22, IC 95%: 1,03-1,44, p=0,020; para dos parejas y RP: 1,46, IC 95%: 1,23-1,74, p<0,001 para tres o más parejas), no usar condón en la última relación sexual (RP: 1,16, IC 95%: 1,01-1,34, p=0,034), ser residente de la sierra (RP: 1,18, IC 95%: 1,05-1,31, p=0,004) y tener flujo vaginal anormal o con mal olor (RP: 1,20, IC 95%: 1,09-1,33, p<0,001). Conclusiones. La alta prevalencia de VB encontrada remarca la necesidad de fortalecer los servicios de salud para la detección y tratamiento de esta condición.

ABSTRACT Objetives. To determine the prevalence of bacterial vaginosis (BV) and associated factors among 18-29-year-old women in 20 Peruvian cities using PREVEN project data. Materials and Methods. In this cross-sectional study, BV was defined using previously provided vaginal discharge samples on slides, which were Gram stained and observed under a microscope to determine the Nugent scores. A BV diagnosis was applied to samples with scores of 7-10. Prevalence ratios (PR) and 95% confidence intervals (95% CI) were estimated using generalized linear models. Results. A total of 6,322 women participated in the epidemiological survey and provided vaginal swabs. The prevalence of BV was 23.7% (95% CI: 22.6-24.7) and was associated with a greater number of sexual partners in the last 12 months (PR: 1.22, 95% CI: 1.03-1.44, p=0.020 for two partners; PR: 1.46, 95% CI: 1.23-1.74, p<0.001 for three or more partners), not using a condom during last intercourse (PR: 1.16, 95% CI: 1.01-1.34, p=0.034), being a sierra resident (PR: 1.18, 95% CI: 1.05-1.31, p=0.004), and having abnormal vaginal discharge or a bad smell (PR: 1.20, 95% CI: 1.09-1.33, p<0.001). Conclusions. The high prevalence of BV highlights the need to strengthen health services aimed at the detection and treatment of this condition.

Sexually transmitted infection screening uptake and knowledge of sexually transmitted infection symptoms among female sex workers participating in a community randomised trial in Peru.

This study aims to evaluate condom use, sexually transmitted infection (STI) screening, and knowledge of STI symptoms among female sex workers in Peru associated with sex work venues and a community randomised trial of STI control. One component of the Peru PREVEN intervention conducted mobile-team outreach to female sex workers to reduce STIs and increase condom use and access to government clinics for STI screening and evaluation. Prevalence ratios were calculated using multivariate Poisson regression models with robust standard errors, clustering by city. As-treated analyses were conducted to assess outcomes associated with reported exposure to the intervention. Care-seeking was more frequent in intervention communities, but differences were not statistically significant. Female sex workers reporting exposure to the intervention had a significantly higher likelihood of condom use, STI screening at public health clinics, and symptom recognition compared to those not exposed. Compared with street- or bar-based female sex workers, brothel-based female sex workers reported significantly higher rates of condom use with last client, recent screening exams for STIs, and HIV testing. Brothel-based female sex workers also more often reported knowledge of STIs and recognition of STI symptoms in women and in men. Interventions to promote STI detection and prevention among female sex workers in Peru should consider structural or regulatory factors related to sex work venues.

HPV Prevalence in Multiple Anatomical Sites among Men Who Have Sex with Men in Peru.

BACKGROUND: Human Papilloma Virus (HPV) infection is the most common sexually transmitted viral infection worldwide. HPV is highly prevalent in sexually active men who have sex with men (MSM) and has been associated with anal cancer, penile cancer, and oropharyngeal cancer. METHODS: From March to September 2011, we conducted a cross-sectional study of HPV prevalence among MSM above age 18 years. Participants were recruited using respondent driven sampling at Clinica Cayetano Heredia. All participants provided anal, genital, and oral samples for HPV DNA testing, and blood for HIV and HPV antibody testing. RESULTS: A total of 200 MSM were recruited in the study. The mean age was 34 years (range 18-59 years, SD = 9.4) and101 participants were HIV negative (99 HIV positive). HPV 6/11/16/18 or quadrivalent HPV vaccine (HPV4) genotype seroprevalence among HIV negative and positive MSM was 64.3% (55%-75.9%) and 93.8% (87.6%-99.2%) respectively (p<0.001). HIV positivity was associated with a higher prevalence of HPV4 and HPV 16/18 DNA at external genital sites and the anal canal. HPV4 DNA prevalence at external genital sites among HIV negative and positive MSM was 14.9% and 28.7% (p = 0.02) respectively, at anal canal was 50.9% and 79.0% (p = 0.001), and at the oral cavity was 9.9% and 8.5% (p = 0.6). CONCLUSIONS: HPV4 seroprevalence was high in our study among both HIV positives and negatives, with HPV DNA prevalence much lower, and the anal canal being the anatomical site with the highest HPV DNA prevalence. HPV prevention interventions are needed among MSM at high-risk for HIV infection.

Síndrome cardiorrenal tipo 1 en la unidad de cuidados intensivos coronarios del Hospital Nacional Arzobispo Loayza / Cardiorenal syndrome type 1 in the intensive coronary care unit of the Hospital Nacional Arzobispo Loayza

Objetivos: Evaluar la incidencia de síndrome cardiorrenal tipo 1 (SCR1) en una unidad de cuidados intensivos coronarios y su asociación a mortalidad intrahospitalaria a 30 días, así como a otras características epidemiológicas. Métodos: Se revisaron las historias clínicas de todos los pacientes hospitalizados con diagnóstico de falla cardíaca aguda en un periodo de 4 años. Se definió como SCR1 la presencia de falla cardíaca aguda más una creatinina al ingreso ≥ 0.3 mg/dL con respecto a la creatinina basal calculada por la fórmula MDRD75, y/o una elevación ≥ 50% de la creatinina al ingreso en un periodo de 48 h. Resultados: La incidencia de SCR1 fue del 27.87%, IC95%: 20.13-36.71 (34 de 122). Hubo una mayor frecuencia de SCR1 en los pacientes que ingresaron con diagnóstico de shock cardiogénico (RR: 2.02; IC95%: 1.20-3.93; p = 0.0378) y en los que tenían niveles más altos de hemoglobina (p = 0.0412). El SCR1 se asoció a una mayor mortalidad intrahospitalaria a 30 días (HR: 4.11; IC95%: 1.20-14.09; p = 0.0244). Conclusiones: La incidencia de SCR1 en la unidad de cuidados intensivos coronarios encontrada en nuestro estudio es similar a la descrita en estudios extranjeros. La presencia de shock cardiogénico como causa de falla cardíaca y valores más altos de hemoglobina se asociaron a una mayor incidencia de SCR1. Los pacientes con SCR1 tuvieron mayor mortalidad intrahospitalaria a 30 días.

Objectives: This study sought to evaluate the incidence of cardiorenal syndrome (CRS) type 1 in a coronary care unit and its association with hospital mortality within 30 days of admission, as well as other epidemiological characteristics. Methods: The medical records of all the patients who were hospitalized with the diagnosis of acute heart failure in a 4-year period were reviewed. CRS type 1 was characterized by the presence of acute heart failure and an elevation of serum creatinine ≥ 0.3 mg/dL in comparison to the baseline creatinine calculated by the MDRD75 equation and/or the elevation of ≥ 50% of the admission serum creatinine within a 48 h period. Results: The incidence of CRS type 1 was 27.87%, 95% CI: 20.13-36.71 (34 of 122). There was a higher frequency of CRS type 1 in those patients who were admitted with the diagnosis of cardiogenic shock (adjusted RR 2.02, 95% CI: 1.20-3.93, p = 0.0378) and in those with higher hemoglobin levels (p = 0.0412). The CRS type 1 was associated with an increase of 30-day mortality (HR: 4.11, 95% CI: 1.20-14.09, p = 0.0244). Conclusions: The incidence of CRS type 1 in the coronary care unit found in our study is similar to those found in foreign studies. The history of stroke and the higher values of hemoglobin were associated with a higher incidence of cardiorenal syndrome type 1. Patients with CRS type 1 had a higher hospital mortality within 30 days of admission.