Brazilian Clinical Practice Guidelines for Sexually Transmitted Infections That Cause Urethral Discharge: Assessment According to the AGREE II and Critical Analysis Based on the WHO Recommendations.

BACKGROUND: Sexually transmitted infections (STI) can have severe consequences. In Brazil, case management is recommended by the Clinical Protocol and Therapeutical Guidelines for Comprehensive Care for People with STIs (PCDT-IST). This study assessed the quality of PCDT-IST (2021) and reviewed the main recommendations for the management of STI that cause urethral discharge compared with the World Health Organization (WHO) STI Guidelines. METHODS: The PCDT-IST (2021) quality was independently assessed by 4 appraisers using the Appraisal of Guidelines Research and Evaluation instrument, version II (AGREE II). The PCDT-IST (2021) and the WHO Guidelines for the Management of Symptomatic STI (2021) were compared considering 14 different assessment domains. RESULTS: The PCDT-IST (2021) scores in the AGREE II domains were: Rigor of Development (58%), Applicability (35%), Editorial Independence (38%), Scope and Purpose (78%), Stakeholder Involvement (74%), and Clarity and Presentation (82%). The overall score was 67%, and all appraisers recommended the Brazilian guideline. Regarding the PCDT-IST (2021) and the WHO STI Guidelines (2021) comparation, 10 domains would be relevant for further reviewing the Brazilian recommendations: Diagnostic tests; Etiological approach; Treatment for recurrent urethral discharge; Treatment for urethritis without etiological agent identification; Treatment for gonococcal urethritis; Treatment for chlamydial urethritis; Retreatment for gonococcal infections; Treatment for Mycoplasma genitalium urethritis; Treatment for Trichomonas vaginalis urethritis; 10. Flowcharts. CONCLUSIONS: The PCDT-IST (2021) has a reasonable degree of quality. However, the domains of Applicability, Rigor of Development, and Editorial Independence must be better ensured. The guidelines comparison will help to select key topics that should be addressed with priority in the following national STI guidelines updates.

Determinantes sociales de la salud y convergencias en agendas de salud de organismos regionales de América del Sur / Social determinants of health and convergence in health agendas of regional agencies in South America

Objetivo. Caracterizar áreas de cooperación interinstitucional y agendas con-vergentes de salud de la Organización Panamericana de la Salud/Organización Mundial de la Salud (OPS/OMS), del Consejo de Salud de la Unión de Naciones Suramericanas (UNASUR) y de la Organización del Tratado de Cooperación Amazónica (OTCA) en América del Sur a partir de los determinantes sociales de la salud. Métodos. Estudio cualitativo basado en fuentes documentales oficiales de las tres organizaciones. El abordaje metodológico desarrolló un análisis comparativo sobre las agendas de salud de esos organismos y la Declaración de Río (2011). La sistematización de la información se realizó por medio de una matriz analítica que identifica convergencias en las respectivas agendas. Resultados. La formulación de las agendas de salud de estos organismos recibe influencias de diversas fuerzas internacionales tales como la política externa de los Estados Miembros, estrategias y modelos de cooperación internacional y lineamientos político-estratégicos de las instituciones. Estas agendas revelan esfuerzos por fortalecer bloques, mecanismos de cooperación y acciones programáticas articuladas. Conclusiones. Las agendas de la OPS/OMS, del Consejo de Salud de la UNASUR y de la OTCA apuntan posibilidades de convergencias en diversas áreas programáticas, con énfasis en los determinantes sociales de la salud. A partir de los acuerdos globales de la Declaración de Río como un marco analítico que establece recomendaciones en cinco esferas decisorias, es posible desarrollar acciones de cooperación estructurante en los países de la región, mediadas en conjunto por estos organismos.

Objective. Characterize areas of interinstitutional cooperation and converging health agendas of the Pan American Health Organization/World Health Organization (PAHO/WHO), the Health Council of the Union of South American Nations (UNASUR), and the Amazon Cooperation Treaty Organization (ACTO) in South America based on social determinants of health. Methods. A qualitative study based on official documentary sources from the three organizations, using a comparative analysis of the health agendas of these agencies and the Rio Political Declaration on Social Determinants of Health (2011). Information was systematized using an analytical matrix that identifies convergences in the respective agendas. Results. Development of the health agendas of these agencies is influenced by various international forces such as Member States’ foreign policy, international cooperation strategies and models, and the institutions’ political and strategic guidelines. These agendas reveal efforts to strengthen blocs, cooperation mechanisms, and coordinated programmatic actions. Conclusions. The agendas of PAHO/WHO, the UNASUR Health Council, and ACTO point towards opportunities for convergence in various programmatic areas, emphasizing social determinants of health. Based on the overall agreements of the Rio Declaration as an analytical framework with recommendations in five decisionmaking spheres, structural cooperation actions can be carried out in the region’s countries, jointly mediated by these agencies.

[Social determinants of health and convergence in health agendas of regional agencies in South America]. / Determinantes sociales de la salud y convergencias en agendas de salud de organismos regionales de América del Sur.

OBJECTIVE: Characterize areas of interinstitutional cooperation and converging health agendas of the Pan American Health Organization/World Health Organization (PAHO/WHO), the Health Council of the Union of South American Nations (UNASUR), and the Amazon Cooperation Treaty Organization (ACTO) in South America based on social determinants of health. METHODS: A qualitative study based on official documentary sources from the three organizations, using a comparative analysis of the health agendas of these agencies and the Rio Political Declaration on Social Determinants of Health (2011). Information was systematized using an analytical matrix that identifies convergences in the respective agendas. RESULTS: Development of the health agendas of these agencies is influenced by various international forces such as Member States' foreign policy, international cooperation strategies and models, and the institutions' political and strategic guidelines. These agendas reveal efforts to strengthen blocs, cooperation mechanisms, and coordinated programmatic actions. CONCLUSIONS: The agendas of PAHO/WHO, the UNASUR Health Council, and ACTO point towards opportunities for convergence in various programmatic areas, emphasizing social determinants of health. Based on the overall agreements of the Rio Declaration as an analytical framework with recommendations in five decision-making spheres, structural cooperation actions can be carried out in the region's countries, jointly mediated by these agencies.

Point-of-care screening for syphilis and HIV in the borderlands: challenges in implementation in the Brazilian Amazon.

BACKGROUND: Point-of-care (POC) screening for HIV and syphilis using rapid testing was implemented in indigenous communities in the triple-border area of the Brazilian Amazon. We describe the context of the early introduction of POC screening, explore hindering and enabling factors for POC implementation, and recommend strategies for feasible, viable, and sustainable syphilis and HIV screening interventions. METHODS: This was a qualitative study based on grounded theory methodology. Data were collected using in-depth interviews, semi-structured questionnaires, and field observations and were analysed using the framework approach. Qualitative information was complemented by quantitative data for descriptive purposes. RESULTS: An overall high score for vulnerability to acquiring HIV and syphilis was observed among the indigenous communities. Health professionals reported satisfactory rapid testing acceptance, although concerns were raised about the pain of the fingerprick. Counselling-related challenges included ensuring the accuracy of translations, collaborating with translators and communicating positive test results. Over 3 months, 86.7% of the syphilis-positive individuals began treatment, and all of them notified their partners. Accessibility, measured as travel time via the local transportation network, was a barrier to health care access. A lack of gasoline for boats and other transportation was also a hindering factor at all levels of implementation. CONCLUSIONS: The recommendations address the preparation phase at the coordination level as well as at the training level. Tools such as strengths, weaknesses, opportunities, and threats (SWOT) analyses; checklists; context-adapted protocols; and fact sheets are very simple methods to facilitate implementation. The findings of this study are important because they may inform the implementation of new health technologies in low-resource national disease control programmes in remote communities.

Será que esse remédio vai valer a pena mesmo? Estudo antropológico sobre a adesão às terapias antirretrovirais entre grupos de mútua ajuda de pessoas vivendo com HIV/aids / Will these drugs be worthwhile? An anthropological study of adherence to antiretroviral therapies among support groups for people living with HIV and AIDS

A partir de uma perspectiva antropológica e do desenvolvimento de um registro etnográfico entre grupos de mútua ajuda de pessoas vivendo com aids do Distrito Federal, o estudo busca compreender o funcionamento e os potenciais benefícios dessas tecnologias para a vivência com o vírus, em particular para adesão à medicação antirretroviral. A abordagem metodológica envolveu um processo de observação participante em um dos grupos e entrevistas com frequentadores e facilitadores. Como resultados do estudo, pode-se melhor compreender os mecanismos de interação dentro dos grupos, além de concluir pelo seu potencial para a melhoria dos níveis de adesão à terapia antirretroviral a partir do encontro entre pares...

Anthropological study carried out by ethnographic method within the members of two HIV support groups for people living with HIV/AIDS, in the city of Brasilia. The research aims to understand the potential benefits of these forms of social organization for facing the daily life with the virus and the contribution to antiretroviral adherence. The methodological approach focused on the development of ethnographic work which included techniques such as participant observation and interviews with members and group coaches. Results led to the identification of interacting mechanisms within health staff and people living with HIV/AIDS, the adoption of attitudes to deal with the drug prescription, and input provided by the group to improve adherence to ARV by highlighting the role of networking and peer support...