HCV-Related Mortality Among HIV/HCV Co-infected Patients: The Importance of Behaviors in the HCV Cure Era (ANRS CO13 HEPAVIH Cohort).

Mortality among individuals co-infected with HIV and hepatitis C virus (HCV) is relatively high. We evaluated the association between psychoactive substance use and both HCV and non-HCV mortality in HIV/HCV co-infected patients in France, using Fine and Gray's competing-risk model adjusted for socio-demographic, clinical predictors and confounding factors, while accounting for competing causes of death. Over a 5-year median follow-up period, 77 deaths occurred among 1028 patients. Regular/daily cannabis use, elevated coffee intake, and not currently smoking were independently associated with reduced HCV-mortality (adjusted sub-hazard ratio [95% CI] 0.28 [0.10-0.83], 0.38 [0.15-0.95], and 0.28 [0.10-0.79], respectively). Obesity and severe thinness were associated with increased HCV-mortality (2.44 [1.00-5.93] and 7.25 [2.22-23.6] versus normal weight, respectively). Regular binge drinking was associated with increased non-HCV-mortality (2.19 [1.10-4.37]). Further research is needed to understand the causal mechanisms involved. People living with HIV/HCV co-infection should be referred for tobacco, alcohol and weight control interventions and potential benefits of cannabis-based therapies investigated.

Estimating the Size of the HCV Infection Prevalence: A Modeling Approach Using the Incidence of Cases Reported to an Official Notification System.

In this paper we propose two methods to give a first rough estimate of the actual number of hepatitis C virus (HCV)-infected individuals (prevalence) taking into account the notification rate of newly diagnosed infections (incidence of notification) and the size of the liver transplantation waiting list (LTWL) of patients with liver failure due to chronic HCV infection. Both approaches, when applied to the Brazilian HCV situation converge to the same results, that is, the methods proposed reproduce both the prevalence of reported cases and the LTWL with reasonable accuracy. We use two methods to calculate the prevalence of HCV that, as a first, and very crude approximation, assumes that the actual prevalence of HCV in Brazil is proportional to the reported incidence to the official notification system with a constant denoted [Formula: see text]. In the paper we discuss the limitations and advantages of this assumption. With the two methods we calculated [Formula: see text], which reproduces both the reported incidence and the size of the LTWL. With the value of [Formula: see text] we calculated the prevalence I(a) (the integral of which resulted in 1.6 million people living with the infection in Brazil, most of whom unidentified). Other variables related to HCV infection (e.g., the distribution of the proportion of people aged a who got infected n years ago) can be easily calculated from this model. These new variables can then be measured and the model can be recursively updated, improving its accuracy.

The Brazilian comprehensive response to hepatitis C: from strategic thinking to access to interferon-free therapy.

BACKGROUND: Hepatitis C affects over 185 million people around the world. This silent disease is responsible for up to 700,000 deaths per year. Despite the scientific revolution in diagnosis and treatment, hepatitis C control remains a huge challenge due to the cost of effective medications. In response to the global outcry of hepatitis epidemic and the need to improve the nation's public health response, the Ministry of Health of Brazil revolutionized hepatitis C treatment by incorporating highly effective drugs that can be accessed through sustainable and universal means. DISCUSSION: This paper describes the unique process of implementing evidence-informed policy to respond to hepatitis C epidemic through the update of hepatitis C treatment in Brazil based on the estimate of disease prevalence, current international guidelines, and the cost-effectiveness impact in the Brazilian Unified Health System. Through a debate of an experience report, the authors underlie the strategic plan implemented according to the situation analysis that emphasized the need to improve its current response over a relatively short-term period. The comprehensive response is detailed comprising three main objectives: improve treatment outcomes by evaluating and incorporating new and effective medications at a sustainable price; elaborate on clinical guidelines to treat hepatitis C patients; and develop awareness and diagnosis campaigns targeted at the population of interest. In this scenario, Brazil was able to obtain an unprecedented discount for a high-medium income country; provided treatment to more than 7000 individuals in the last 2 months of 2015; and expects to treat 38,000 new patients in 2016. The remarkable process applied in Brazil was developed according to epidemiological data and scientific evidence, and it was motivated by the engagement of the country in the Sustainable Development Goals, which may inspire other developing countries to identify ways to achieve these goals by 2030.

Impact of Alcohol and Coffee Intake on the Risk of Advanced Liver Fibrosis: A Longitudinal Analysis in HIV-HCV Coinfected Patients (ANRS HEPAVIH CO-13 Cohort).

BACKGROUND: Coffee intake has been shown to modulate both the effect of ethanol on serum GGT activities in some alcohol consumers and the risk of alcoholic cirrhosis in some patients with chronic diseases. This study aimed to analyze the impact of coffee intake and alcohol consumption on advanced liver fibrosis (ALF) in HIV-HCV co-infected patients. METHODS: ANRS CO13-HEPAVIH is a French, nationwide, multicenter cohort of HIV-HCV-co-infected patients. Sociodemographic, behavioral, and clinical data including alcohol and coffee consumption were prospectively collected using annual self-administered questionnaires during five years of follow-up. Mixed logistic regression models were performed, relating coffee intake and alcohol consumption to ALF. RESULTS: 1019 patients were included. At the last available visit, 5.8% reported high-risk alcohol consumption, 27.4% reported high coffee intake and 14.5% had ALF. Compared with patients with low coffee intake and high-risk alcohol consumption, patients with low coffee intake and low-risk alcohol consumption had a lower risk of ALF (aOR (95% CI) 0.24 (0.12­0.50)). In addition, patients with high coffee intake had a lower risk of ALF than the reference group (0.14 (0.03­0.64) in high-risk alcohol drinkers and 0.11 (0.05­0.25) in low-risk alcohol drinkers). CONCLUSIONS: High coffee intake was associated with a low risk of liver fibrosis even in HIV-HCV co-infected patients with high-risk alcohol consumption.

Avaliação das capacidades de detecção, avaliação e notificação das potenciais emergências em saúde pública de importância nacional e internacional pelo Centro de Informações Estratégicas em Vigilância em Saúde, Ministério da Saúde, Brasil / Assessment of the capabilities of detection, evaluation and reporting of potential public health emergencies of national and international importance by the Center for Strategic Information in Health Surveillance, Ministry of Health, Brazil

O Regulamento Sanitário Internacional – RSI (2005) é o instrumento jurídico internacional elaborado com a finalidade de proteção dos países quanto à disseminação internacional de doenças e articulação frente às emergências em saúde pública causadas por agentes biológicos, substâncias químicas, materiais radioativos e alimentos contaminados. Para tais finalidades, o RSI (2005) orienta o estabelecimento de Pontos Focais Nacionais nos Estados Partes, permanentemente acessíveis para comunicação direta com os Pontos de Contato da Organização Mundial da Saúde (OMS). Dentre as exigências de capacidades básicas segundo o RSI (2005), encontram-se as atividades de vigilância, informes e notificação. O Centro de Informações Estratégicas em Vigilância em Saúde da Secretaria de Vigilância em Saúde (SVS) do Ministério da Saúde (MS) – CIEVS/MS foi institucionalizado no contexto do RSI (2005) como estratégia de vigilância das emergências em saúde pública, a fim de desenvolver os processos de detecção, avaliação e notificação das potenciais emergências em saúde pública de importância nacional e internacional, na representação do Ponto Focal Nacional do Brasil para o RSI (2005). O objetivo geral deste estudo foi avaliar as capacidades de detecção, avaliação e notificação das potenciais emergências em saúde pública de importância nacional e internacional pelo CIEVS/MS no período de janeiro a dezembro de 2012. O método proposto foi a pesquisa avaliativa com a utilização do modelo lógico, segundo o qual foram estruturados os indicadores para avaliar o processo de trabalho do CIEVS/MS, considerando os aspectos político, técnico e organizacional, nos componentes de detecção, avaliação e notificação.

A classificação final das capacidades de detecção, avaliação e notificação das emergências em saúde pública pelo CIEVS/MS foi parcialmente adequada, correspondendo à distribuição de 50 por cento a 70 por cento de indicadores classificados como Bom nas três dimensões estratégicas e nos três componentes do processo de trabalho. No entanto, o componente notificação e a dimensão técnica mantiveram capacidade insuficiente. O estudo possibilitou identificar as potencialidades e as fragilidades do processo de trabalho do CIEVS/MS, além de propor a sistematização das rotinas e das atividades. Dentre as recomendações da pesquisa, destacam-se o aprimoramento do registro das informações, a documentação técnica do CIEVS/MS e a divulgação dos resultados do estudo aos dirigentes da SVS responsáveis pela definição das ações desenvolvidas pelo CIEVS/MS.

The International Health Regulations – IHR (2005) is the legal instrument with the purpose to protect countries against the international spread of disease and to provide the cooperation between Member States to prevent public health emergencies due to biological agents, chemical substances, radiological materials and contaminated food. In accordance with the IHR (2005), each State Party shall establish a National IHR Focal Point, which shall be accessible at all times for communications with the World Health Organization (WHO) IHR Contact Points. According to IHR (2005), State Parties are designated to develop certain minimum core public health capacities such as surveillance, reporting and notification. The Strategic Information Center for Health Surveillance from the Secretariat of Health Surveillance, Ministry of Health (CIEVS/MS, acronym in Portuguese) was institutionalized in the context of IHR (2005) as the strategy for surveillance of public health emergencies, with the objective to ensure detection, assessment and notification of events that may constitute public health emergencies of national and international concern, representing the National IHR Focal Point of Brazil. The main purpose of this study was to evaluate CIEVS/MS capacities for detection, assessment and notification of potential public health emergencies of national and international concern between January and December 2012. The proposed method was the evaluation research using the logic model, whereby the indicators were formulated to evaluate CIEVS/MS work process, according to political, technical and institutional aspects in detection, assessment and notification components.

The capacities for detection, assessment and notification were classified as partially appropriate, corresponding to the distribution of 50 per cent to 70 per cent of indicators rated as Good in the three strategic dimensions and the three components of the work process. However, the technical dimension and the notification component remained insufficient capacity. The study identified the strengths and weaknesses of CIEVS/MS work process, besides proposing routines and activities systematization. Among the recommendations, there are mainly the improvements of information recording, technical documentation of CIEVS/MS work process and dissemination of study results to the government leaders responsible for decision making to define the activities executed by CIEVS/MS.

Formando grupos no internato: critérios de escolha, satisfação e sofrimento psíquico / Formation of groups during internship: selection criteria, satisfaction, and psychological distress

OBJETIVO: Descrever os critérios para formação de grupos no internato e a avaliação que os alunos fazem do relacionamento grupal, analisando as variáveis associadas. MÉTODO: Trata-se de um estudo transversal, que utilizou questionário autopreenchido, com perguntas sobre dados sociodemográficos, autoavaliação do desempenho escolar, critérios para formação e satisfação com grupo de internato. Sofrimento psíquico foi avaliado a partir do Self Report Questionnaire. Utilizou-se o teste do qui-quadrado e regressão logística para análise multivariada. RESULTADOS:A taxa de resposta no internato foi de mais de 90 por cento. A maioria dos alunos utilizou critérios ligados à rede social (82,6 por cento) e predominaram sujeitos satisfeitos com seu grupo (81,2 por cento). Após análise multivariada, apenas autoavaliação do desempenho escolar "boa ou ótima" e critérios de escolha relacionados à rede de apoio se mantiveram associados à satisfação com o grupo. CONCLUSÕES: Apesar de ser um estágio da formação profissional, os alunos se escolheram por questões ligadas à rede social. Sendo uma profissão na qual o trabalho em equipe é inerente, deveriam ser criadas estratégias durante o curso médico para elaborar as dificuldades de relacionamento grupal entre alunos de Medicina.

OBJECTIVE: To describe the criteria used in forming groups during medical internship and the students' evaluation of group relations, including analysis of the associated variables. METHOD: Cross-sectional study using self-completed questionnaires consisting of questions on socio-demographic data, self-rating of academic performance, selection criteria, and satisfaction with the group of interns. Psychological distress was assessed based on the Self-Report Questionnaire. The chi-square test and logistic regression were used for multivariate analysis. RESULTS: Response rate among interns was over 90 percent. The majority of the students used criteria related to the social network (82.6 percent) and reported satisfaction with their groups (81.2 percent). After multivariate analysis, only "good or excellent" self-evaluated academic performance and selection criteria related to the support network remained associated with group satisfaction. CONCLUSIONS: Although internship is a stage of professional training, in this study students chose each other based on reasons related to social networking. Given that teamwork is inherent to the medical profession, strategies should be created during the course to help students overcome their difficulties with group relations in order to reduce stress and improve training.