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O acidente de trabalho com material biológico de profissionais de saúde em serviços especializados em HIV/Aids é uma demanda complexa. O objetivo desta pesquisa foi compreender as vivências pós-acidente com material biológico por profissionais de saúde que trabalham em um serviço especializado em HIV/Aids. Realizou-se uma pesquisa qualitativa com sete profissionais de saúde que atuam nesse contexto, abordando as vivências dessa experiência por meio de entrevistas semiestruturadas. Os discursos foram categorizados pelo método de análise de conteúdo temática. Foram observados sentimentos de medo da infecção e do estigma perante o ocorrido. Demonstrou-se o impacto dessa experiência nas relações familiares, sociais e profissionais, além do insuficiente acolhimento e apoio emocional no serviço onde trabalhavam e foram atendidos. Evidencia-se a necessidade de repensar protocolos e processos de cuidado desses profissionais mediante a Educação Permanente, considerando a complexidade de suas vivências diante do acidente.
The work accident with biological material of health professionals in specialized services in HIV/Aids is a complex demand. This research objective was to understand the post-accident experiences with biological material by health professionals working in a service specialized in HIV/Aids. Qualitative research was conducted with seven health professionals who work in this context, approaching their experiences through semi-structured interviews. The discourses were categorized by thematic content analysis method. Feelings of fear of the infection and stigma were observed. The impact of this experience on family, social and professional relationships was demonstrated. There was lack of receptiveness and emotional support in the service where they worked and where they received care. There is an evident need to rethink protocols and care processes for these professionals, through Permanent Education, considering the complexity of their experiences in the face of the accident.
El accidente de trabajo con material biológico de profesionales de la salud en servicios especializados en VIH/SIDA es una demanda compleja. El objetivo de esta investigación fue comprender las vivencias post accidente con material biológico por parte de profesionales de la salud que trabajan en un servicio especializado en VIH/SIDA. Se realizó una encuesta cualitativa con siete profesionales de la salud que actúan en ese contexto, abordando las vivencias de esa experiencia por medio de entrevistas semiestructuradas. Los discursos se categorizaron por el método de análisis del contenido temático. Se observaron sentimientos de miedo de la infección y del estigma ante lo ocurrido. Se demostró el impacto de esa experiencia en las relaciones familiares, sociales y profesionales. Se constató la insuficiente acogida y el apoyo emocional en el servicio en donde trabajaban y fueron atendidos. Resulta evidente la necesidad de volver a pensar protocolos y procesos de cuidados de estos profesionales, por medio de la Educación Permanente, considerando la complejidad de sus vivencias ante el accidente.
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Abstract Objective: To analyze HIV Post-Exposure Prophylaxis (PEP) prescription and return for follow-up appointments. Methods: This was a descriptive cross-sectional study using data on people who sought PEP in emergency care units (UPAs) and specialized medical services in Salvador, BA, Brazil, between January-December/2018. Results: Of the 1,525 people who sought PEP at UPAs, 1,273 (83.5%) met PEP eligibility criteria, while 252 (16.5%) did not; of the eligible group, 1,166 (91.6%) had antiretrovirals prescribed, while 107 (8.4%) eligible people did not; of the total number of people with PEP prescriptions, only 226 (19.4%) returned for the first follow-up appointment, 115 (9.9%) for the second, and 33 (2.8%) for the third in order to complete the protocol. Conclusion: We found a significant proportion of eligible users who did not have PEP prescribed at UPAs and a significant loss of return for specialized service follow-up appointments.
Resumen Objetivo: Analizar la prescripción de Profilaxis Post Exposición (PPE) al Virus de la Inmunodeficiencia Humana (VIH) y la concurrencia a las consultas de control y seguimiento. Método: Estudio de datos descriptivo transversal de personas que solicitaron la PPE en Unidades de Atención de Emergencia (UPA) y servicios médicos especializados en Salvador, BA, Brasil, durante los meses de enero a diciembre de 2018. Resultados: De las 1.525 personas que consultaron por PEP en las unidades hospitalarias de emergencia, 1.273 (83,5%) cumplieron criterios de elegibilidad para profilaxis y 252 (16,5%) no los cumplieron; entre los elegibles, a 1.166 (91,6%) personas se les recetaron antirretrovirales (ARVs), pero 107 (8,4%) no los recibieron. Del total de personas que recibieron prescripción de PPE, solamente 226 (19,4%) regresaron a la primera consulta; 115 (9,9%) a la segunda consulta y 33 (2,8%) a la tercera consulta para completar el protocolo. Conclusión: Hubo una proporción significativa de usuarios elegibles que no recibieron prescripción de PEP en las Unidades de Atención de Emergencia y una pérdida significativa en las consultas de control al servicio especializado.
Resumo Objetivo: Analisar a prescrição da profilaxia pós-exposição (PEP) ao vírus da imunodeficiência humana (HIV) e o retorno às consultas de acompanhamento. Métodos: Estudo transversal descritivo, sobre dados de pessoas que buscaram a PEP em unidades de pronto atendimento (UPAs) e serviço médico de atenção especializada em Salvador, BA, Brasil, entre janeiro e dezembro/2018. Resultados: Das 1.525 pessoas que buscaram a PEP nas UPAs, 1.273 (83,5%) apresentaram critérios de elegibilidade à profilaxia e 252 (16,5%) não os apresentaram; entre os elegíveis, 1.166 (91,6%) pessoas tiveram prescrição dos antirretrovirais (ARVs), mas 107 (8,4%) não os receberam; do total de pessoas com prescrição de PEP, apenas 226 (19,4%) retornaram à primeira consulta, 115 (9,9%) à segunda consulta e 33 (2,8%) à terceira consulta para conclusão do protocolo. Conclusão: Observou-se proporção importante de usuários elegíveis que não receberam prescrição de PEP nas UPAs e perda significativa nas consultas de retorno ao serviço especializado.
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Objective@#To investigate the status of regular HIV testing and post exposure prophylaxis (PEP) behaviors among men who have sex with men (MSM) in Lishui City, Zhejiang Province, so as to provide the reference for developing targeted intervention strategies.@*Methods@#A total of 389 MSM were selected from Lishui City by convenient sampling method from April to August 2022, and demographic information, sexual behaviors, HIV testing and PEP behaviors were collected through questionnaire surveys. MSM were clustered using two step clustering analysis, and regular HIV testing and PEP behaviors among different groups of MSM were compared. Factors affecting regular HIV testing and PEP behaviors were evaluated using a multivariable logistic regression model.@*Results@#The MSM surveyed had a median age of 31.00 (interquartile range, 16.00) years. There were 146 MSM undergoing regular HIV testing, accounting for 37.53%, and 47 MSM receiving PEP, accounting for 12.08%. MSM were divided into two groups. There were 28.05% of MSM with regular HIV testing in group 1, which was lower than the 44.44% in group 2; and 22.56% receiving PEP, which was higher than the 4.44% in group 2 (both P<0.05). Multivariable logistic regression analysis identified age (OR=1.030, 95%CI: 1.011-1.050), sexual roles (both receptive and insertive, OR=2.999, 95%CI: 1.732-5.194) and homosexual behaviors in the past 6 months (use condoms every time, OR=4.567, 95%CI: 2.593-8.044) as factors affecting regular HIV testing among MSM; age (OR=0.970, 95%CI: 0.942-0.999), sexual orientation (OR=0.292, 95%CI: 0.139-0.612) and homosexual behaviors in the past 6 months (not use condoms, OR=0.135, 95%CI: 0.040-0.460; use condoms every time, OR=0.076, 95%CI: 0.018-0.326) as factors affecting PEP behaviors among MSM.@*Conclusion@#MSM with different characteristics of sexual behaviors have different preferences for HIV regular testing and PEP, with homosexual behaviors in the past 6 months, sexual roles and sexual orientation being the main influencing factors.
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El uso preventivo de antimicrobianos es de larga data y no se restringe a antibacterianos. Lo más consensuado y estructurado es la profilaxis antimicrobiana perioperatoria y ante procedimientos invasivos. Fuera de este contexto hay gran cantidad de situaciones, menos caracterizadas, con riesgo de infecciones en que se usan ampliamente, muchas veces con menor sistematización. Esta presentación presenta las bases conceptuales y operativas de este segundo tipo de profilaxis. Conceptualmente la profilaxis primaria pretende evitar la infección por agente único conocido o variados, por exposición ambiental o susceptibilidad específica de ese hospedero y es implementable antes o después de la exposición. Producida esta infección la meta de la profilaxis secundaria intenta evitar la enfermedad y puede tomar dos modalidades, en infecciones sin evidencias de enfermedad clínica o daños, la profilaxis corresponde a "tratamiento de infección latente" y, si aún en ausencia de manifestaciones clínicas, hay elementos de laboratorio precoces premonitorios de progresión, la profilaxis se denomina "tratamiento anticipatorio". Se presentan operacionalmente y resumidas las situaciones en contexto médico no invasivo con uso potencial preventivo de antimicrobianos en base a agentes posibles, situaciones ambientales de riesgo, vulnerabilidad del hospedero, medicamentos a usar, su duración y efectividad con enfoque mayoritario en medicina de adultos.
Antimicrobial use with preventive purpose probably began shortly after its therapeutic use, especially antibiotics. More consensus and sistematization exist with perioperative and invasive procedures prophylaxis. However, beyond that context, there is great number of non invasive medical situations with high risk of secondary infections either by acquisition of pathogens or activation of latent ones, in which antimicrobials are routinely used with preventive purpose, albeit with less sistematization and consensus. This presentation aims to lay down the conceptual and operational basis for antimicrobial prophylaxis in these settings, whose objective is preventing an infection (primary prophylaxis) by a known or a variety of pathogens, either by person to person transmission, enviromental exposure or particular susceptibility of the host, and can be implemented before or after exposure. If already infected, the antimicrobial prophylaxis goal is to avoid progression to disease (secondary prevention) and may take two conceptual approaches; first, without clinical disease but significant risk of progression, the modality can be called "treatment of latent infection". In the second, also clinically asymptomatic, but with premonitory laboratoy signs of impending progression present, early use of antimicrobial is called "preemptive treatment". This presentation will describe the most frequent medical situations where preventive use of antimicrobials is employed, together with the medications most consensually used, according to the host, the agent(s) and medical situation, with emphasis in adults.
Subject(s)
Humans , Infection Control/methods , Antibiotic Prophylaxis/methods , Anti-Infective Agents/therapeutic use , Pneumonia, Pneumocystis/prevention & control , Tuberculosis/prevention & control , Post-Exposure Prophylaxis , Pre-Exposure Prophylaxis , Hepatitis B/prevention & controlABSTRACT
Introduction: Prevention strategies are key to combating the epidemic of infections such as HIV and syphilis. The epidemiological scenario of Porto Alegre/RS for these infections shows the need for greater efforts in the area of prevention, seeking to characterize both the population that uses these strategies and the services involved in the care of exposed people. Objective: This study aimed to characterize the clinical and epidemiological profile of patients who received post-exposure prophylaxis (PEP) to HIV treated in a public hospital in Porto Alegre/RS. Methods: This is a retrospective, research, descriptive study based on the Clinical Protocol and Therapeutic Guidelines for PEP, updated in 2018 by the Ministry of Health. Prophylaxis request forms and medical records of patients treated were analyzed. Results: The population consisted of 87 women who received PEP from January to September 2019. There was a predominance of women aged between 20 and 29 years old (55.2%). The most frequent sexual exposure was consensual (69.0%) followed by sexual assault (31.0%). Porto Alegre was the place of residence of most patients (73.6%). The most frequently used therapeutic regimen was the combination of atazanavir, ritonavir, and tenofovir plus lamivudine. On the first visit, 8.0% of the patients showed reactive results for the treponemal syphilis test. Only 23.0% and 14.9% of patients returned for anti-HIV tests in the first and third months after exposure, respectively, and the results were non-reactive. Only 19 patients (21.8%) attended the consultations between 0 and 28 days after PEP. Conclusion: It was identified that a considerable percentage of women already had reactive serology for syphilis, most women did not return for follow-up within 28 and 90 days after the first consultation, more than half of the women were aged between 20 and 29 years old, and the most frequent sexual exposure was consensual. In this sense, efforts are needed, such as adequate counseling, adoption of interventions such as sending messages by cell phone, telephone calls, and preparation of educational materials, seeking to improve adherence to treatment and follow-up in the service, which is important given the scenario of epidemiology in Porto Alegre.Keywords: HIV. Sexually transmitted diseases. Post-exposure prophylaxis. Disease prevention
Introdução: Estratégias de prevenção são fundamentais para o combate à epidemia de infecções como o vírus da imunodeficiência humana (HIV) e sífilis. O cenário epidemiológico de Porto Alegre/RS para essas infecções mostra a necessidade de maiores esforços na área de prevenção, buscando caracterizar tanto a população que utiliza essas estratégias quanto os serviços envolvidos no atendimento das pessoas expostas. Objetivo: Caracterizar o perfil clínico-epidemiológico das pacientes que receberam a profilaxia pós-exposição (PEP) ao HIV atendidas em um hospital público de Porto Alegre/RS. Métodos: Trata-se de um estudo retrospectivo, documental, descritivo e baseado no Protocolo Clínico e Diretrizes Terapêuticas para PEP, atualizado em 2021 pelo Ministério da Saúde. Foram analisados os formulários de solicitação da profilaxia e prontuários das pacientes atendidas. Resultados: A população foi composta de 87 mulheres que receberam a PEP no período de janeiro a setembro de 2019. Predominaram mulheres com idades entre 20 e 29 anos (55,2%). A exposição sexual mais frequente foi a consentida (69,0%), seguida pela violência sexual (31,0%). Porto Alegre foi o local de residência da maioria das pacientes (73,6%). O esquema terapêutico utilizado com maior frequência foi a combinação com atazanavir, ritonavir e tenofovir associado à lamivudina. No primeiro atendimento, 8,0% das pacientes demonstraram resultados reagentes para o teste treponêmico de sífilis. Retornaram para a realização dos testes anti-HIV no primeiro e terceiro mês após a exposição apenas 23,0 e 14,9% das pacientes, respectivamente, e os resultados foram não reagentes. Apenas 19 delas (21,8%) compareceram às consultas entre zero e 28 dias posteriores à PEP. Conclusão: Foi identificado que um percentual considerável de mulheres já apresentava sorologia reagente para sífilis, a maioria das mulheres não retornou para o seguimento no período de 28 e 90 dias após o primeiro atendimento, mais da metade delas tinha idade entre 20 e 29 anos e a exposição sexual mais frequente foi a consentida. Nesse sentido, são necessários esforços como aconselhamento adequado, adoção de intervenções como o envio de mensagens pelo celular, ligações telefônicas e elaboração de materiais educativos, buscando a melhoria da adesão ao tratamento e do acompanhamento no serviço, o que é importante diante do cenário epidemiológico de Porto Alegre.Palavras-chave: HIV. Infecções sexualmente transmissíveis. Profilaxia pós-exposição. Prevenção
Subject(s)
Humans , Female , Adult , Young Adult , HIV Infections/prevention & control , Anti-HIV Agents/administration & dosage , Post-Exposure Prophylaxis/statistics & numerical data , Retrospective Studies , Ritonavir/administration & dosage , Lamivudine/administration & dosage , Drug Therapy, Combination , Tenofovir/administration & dosage , Atazanavir Sulfate/administration & dosageABSTRACT
Introduction: Post-exposure prophylaxis (PEP) is the use of antiretroviral drugs (ARVs) to reduce the risk of human immunodeficiency virus (HIV) infection after potential risk exposure. ARV-based interventions are recommended as part of combination HIV prevention, especially for key populations. Objective: The aim of this study was to measure knowledge about PEP among university students. Methods: A cross-sectional study was conducted on university students from the Health, Education, Exact, and Human Sciences Departments of the State University of Bahia, Brazil. Sociodemographic data, information on sexual behavior, and knowledge of PEP were collected through a standardized self-applied questionnaire. Results: We analyzed 1580 questionnaires, of which 66.7% (1024/1536) were from females, with a mean age of 23.9 (±6.5) years, and 35.4% (448/1264) reported irregular use of condoms and regular use was not associated with being students from the health area (p=0.44, OR 0.90, 95%CI 0.691.17). Regarding PEP, 28.5% (449/1578) had known about it and their knowledge was statistically associated with men who have sex with men (MSM) (p<0.01, OR 3.92, 95%CI 2.456.28). It was noted that 94.0% (1485/1579) did not know the time limit for starting PEP, 95.1% (1500/1578) did not know the duration of prophylaxis, and 91.1% (1437/1577) did not know where to get PEP. Finally, 0.4% (7/1578) referred to previous use and 96.6% (1488/1540) would not change their sexual behavior after knowing about PEP. Conclusion: PEP is a prevention strategy available for decades and is safe, effective, and cost-effective. However, it is underutilized and a lack of knowledge on PEP is one of the main obstacles to access. Among university students, there is a limited knowledge about PEP acting as a barrier in preventing new infections, which shows the need for interventions based on sexual-health education, stimulating the reduction of risk behaviors and disseminating information about combination prevention.
Introdução: A Profilaxia Pós-Exposição (PEP) é o uso de medicamentos antirretrovirais (ARVs) para reduzir o risco de infecção pelo vírus da imunodeficiência humana (HIV) após uma potencial exposição. Intervenções baseadas em ARV são recomendadas como parte da prevenção combinada do HIV, especialmente para populações-chave. Objetivo: O objetivo deste estudo foi medir o conhecimento sobre PEP entre estudantes universitários. Métodos: Estudo transversal realizado entre universitários dos Departamentos de Saúde, Educação, Ciências Exatas e Humanas da Universidade do Estado da Bahia, Brasil. Dados sociodemográficos, informações sobre comportamento sexual e conhecimento sobre PEP foram coletados por meio de um questionário autoaplicável padronizado. Resultados: Foram analisados 1.580 questionários, 66,7% (1024/1536) do sexo feminino, idade média de 23,9 (±6,5) anos, 35,4% (448/1264) relatam uso irregular de preservativo, e o uso regular não foi associado ao fato de ser estudante da área da saúde (p=0,44, OR 0,90, IC95% 0,69-1,17). Em relação à PEP, 28,5% (449/1578) já tinham ouvido falar, e seu conhecimento foi estatisticamente associado a homens que fazem sexo com homens (HSH) (p<0,01, OR 3,92, IC95% 2,456,28). Destaca-se que 94,0% (1485/1579) não sabiam o tempo limite para iniciar o PEP, 95,1% (1500/1578) não sabiam o tempo de duração da profilaxia e 91,1% (1437/1577) não sabiam onde conseguir o PEP. Por fim, 0,4% (7/1578) referiu uso anterior e 96,6% (1488/1540) não mudaria seu comportamento sexual após saber da PEP. Conclusão: A PEP é uma estratégia de prevenção disponível há décadas, segura, eficaz e de baixo custo, porém, é subutilizada e seu desconhecimento é um dos principais obstáculos ao acesso. Há um conhecimento limitado sobre PEP entre universitários, destacando-se como uma barreira na prevenção de novas infecções, o que evidencia a necessidade de intervenções baseadas na educação em saúde sexual, estimulando a redução de comportamentos de risco e disseminando informações sobre prevenção combinada.
Subject(s)
Humans , Male , Female , Adult , Young Adult , Sexual Behavior , HIV Infections/prevention & control , Health Knowledge, Attitudes, Practice , Post-Exposure Prophylaxis , Brazil , Sexually Transmitted Diseases/prevention & control , Cross-Sectional Studies , Surveys and QuestionnairesABSTRACT
Objective@#To investigate the awareness of HIV non-occupational post-exposure prophylaxis (nPEP) among residents in Yangzhou City, Jiangsu Province, so as to provide basis for further publicity and application of nPEP in genenral population.@*Methods@#Community residents at ages of 18 years and older in Yangzhou City were sampled using the multi-stage random sampling method from January to June, 2022, and a cross-sectional survey was conducted to collect their demographic information, acquired immune deficiency syndrome (AIDS)-related knowledge, attitude and behaviors and awareness of nPEP. A multivariable logistic regression model was used to identify factors affecting awareness of nPEP.@*Results@#Totally 1 488 questionnaires were allocated, and 1 447 valid questionnaires were recovered, with an effective recovery rate of 97.24%. There were 644 males and 803 females, with mean age of (36.33±11.90) years. There were 585 residents (40.43%) employed by government agencies, enterprises and public institutions; 750 residents (51.83%) with awareness of AIDS; 413 (28.54%), 651 (44.99%) and 383 residents (26.47%) had low, medium and high levels of AIDS discrimination, respectively; 201 residents (13.89%) with HIV detection experience; and 792 residents (54.73%) with regular health checkup. The awareness rate of nPEP was 47.89%. Multivariable logistic regression analysis identified career (government agencies, enterprises and public institutions, OR=1.530, 95%CI: 1.170-1.999; students, OR=1.450, 95%CI: 1.027-2.047), awareness of AIDS (OR=3.201, 95%CI: 2.495-4.106), having HIV detection experience (OR=1.908, 95%CI: 1.339-2.719), regular health checkup (OR=2.308, 95%CI:1.807-2.949) and discrimination against AIDS (medium, OR=0.703, 95%CI: 0.532-0.928; high, OR=0.699, 95%CI: 0.502-0.974) as factors affecting awareness of nPEP.@*Conclusions@#The awareness of nPEP among residents in Yangzhou City needs to be improved. Employees in government agencies, enterprises and public institutions and students have higher awareness of nPEP.
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@#Abstract: Objective To investigate the drug demand and related influencing factors of AIDS non-occupational post-exposure prophylaxis (nPEP) among men who have sex with men (MSM) in Wuhan, and to provide a scientific basis for the development of subsequent intervention policies for MSM. Methods With the assistance of social organizations in Wuhan, MSM was recruited by the snowball method to carry out an online questionnaire survey to collect information on demographics, AIDS-related knowledge, high-risk behaviors, and the need for nPEP medication. The χ2 test and unconditional Logistic regression were used to analyze the related factors of the demand for nPEP medication. Results A total of 308 valid subjects were included in this study, with predominantly 18-29 years old (78.57%, 242/308). The self-reported sexual orientation was mainly homosexuality (82.47%, 254/308), and the awareness rate of AIDS knowledge was high (89.29%, 275/308). Among the survey respondents, 35.06% (108/308) did not know the situation of HIV infection among MSM population in Wuhan; 55.19% (170/308) had two or more same-sex sexual partners in the last six months; 90.91% (280/308) had heard of nPEP before participating in this survey. After passing nPEP and informing the protective effect of nPEP, 59.42% (183/308) of them needed nPEP. After HIV exposure, 73.38% (226/308) were willing to spend money to buy nPEP drugs, and 88.64% (273/308) were willing to take nPEP drugs because of the known side effects. Logistic regression analysis showed that in the last six months, the needs for taking nPEP medication in those who had 2 or more same-sex sexual partners (OR=2.121, 95%CI: 1.329-3.386) and who had received peer education (OR=1.740, 95%CI: 1.088-2.781) were higher than those of those who had a same-sex sexual partner in the last six months and who had not received peer education. Conclusions The MSM population in Wuhan has a great demand for nPEP drugs, and peer education is an important way to carry out nPEP publicity and promotion. At the same time, we should continue to strengthen warning publicity and education and behavioral intervention to reduce MSM risky sexual behaviors and reduce new HIV infections.
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@#Abstract: In recent years, the HIV prevention intervention strategy has had a positive effect on reducing the HIV infection prevalence in China. HIV non-occupational post-exposure prophylaxis (nPEP) has become an effective measure to prevent HIV for men who have sex with men (MSM) exposed to possible risks. From the perspective of the "knowledge, attitude, and practice" theory, domestic and overseas scholars used outpatient data and questionnaires to investigate the awareness, attitude, usage, medication, follow-up, and drug prescription of HIV nPEP among MSM in China. This article reviewed the above-mentioned and found that the overall awareness rate of HIV nPEP among MSM in China is high with a positive attitude, but the actual utilization rate is very low. On a regional level, their follow-up after the medication is not ideal despite good medication. Drug prescription varies between different regions domestically. The prescription rate of tenofovir + emtricitabine + raltegravir is the highest, followed by the prescription rate of tenofovir + emtricitabine + dolutegravir, and tenofovir + lamivudine + dolutegravir. In the future, researchers should expand the number of study objects and the scope of the research sites in China, analyze the "knowledge, attitude, and practice" of HIV nPEP, medication follow-up, and medication prescription among MSM, and increase the research on HIV nPEP service areas to provide the reference for further formulating and refining the comprehensive HIV prevention intervention strategy among MSM in China.
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Background Rabies is an incurable zoonotic disease of public health concern. After exposure the only effective intervention is Post-Exposure Prophylaxis (PEP). Surveillance data in Rwanda shows that a high number of dog bites do not get PEP in time. Objectives Determine factors associated with delays in post-exposure prophylaxis among victims of dog bites. Methods The retrospective cross-sectional study was conducted in Nyagatare District. It targeted people bitten by dogs and who attended Nyagatare district from January 2017 to December 2019. Review of registers and interview with victims were used to collected data using excel and analyze them using STATA version 15. Odds ratio (OR) and confidence interval (CI) were reported. Results Among 412 dog bite victims, 161 (39%) delayed getting PEP. The more likely to delay in getting PEP, were people living in rural areas, AOR = 3.54, 95%CI [2.12, 5.90], and those without medical insurance, AOR = 4.40, 95%CI [1.82-10.62]. Conclusion Seeking PEP among dog bites victims is subject to delay in Nyagatare district. Local leaders should establish initiatives to support people to get medical insurance while public health officers need to prioritize sensitization for PEP for people living in rural areas.
Subject(s)
Humans , Male , Female , Bites and Stings , Dogs , Post-Exposure ProphylaxisABSTRACT
ABSTRACT Background: Rabies is an anthropozoonosis that greatly impacts public health and is transmitted by infected mammals. Aggression by animals is notifiable and may result in anti-rabies post-exposure prophylaxis (PEP). This study aimed to characterize anti-rabies PEP notifications in São Paulo state, Brazil. Methods: A descriptive study was conducted using data provided by the SINAN between 2013 and 2017. Results: A total of 572,889 aggressions were recorded during the study period, characterized mostly by dogs (83.5%), single wounds (56.9%), superficial wounds (58.6%), and hands/feet (34.6%). Conclusions: Animal observation was the most frequent recommendation, even in cases of attacks from non-domestic animals.
ABSTRACT
A Profilaxia Pós-Exposição (PEP) ao Virus da Imunodeficiência Humana (HIV) trata-se de uma urgência médica que deve ser realizada durante 28 dias com medicamentos específicos em indivíduos que tiveram uma exposição com materiais biológicos e situações específicas considerados de risco no intervalo de até 72 horas em indivíduos não reagentes ao vírus do HIV. Objetivo: descrever o perfil epidemiológico dos usuários da PEP no município de Parnaíba, Piauí. Metodologia: Trata-se de um estudo transversal retrospectivo com abordagem quantitativa dos casos de pessoas residentes em Parnaíba, que utilizaram a PEP no período do estudo de 2017 a 2021 analisados por estatística descritiva. Resultados: Foram registrados 202 pacientes que utilizaram a PEP. Dentre estes a maioria foram homens cis com 129 (64%), na faixa etária de 30 a 59 anos foi de (49%) nos casos, a orientação sexual de héteros com (44%), a maioria dos pacientes possuíam o ensino médio (62%), a raça/cor foi maior em pardos (52%). O tipo de exposição mais ocorrente foi sexo consentido (79%), realizaram o tratamento sem intercorrência (84%) dos casos, 62% utilizaram álcool e/ou outras drogas e maioria dos pacientes (57%) referiam não conhecer a situação sorológica dos seus parceiros sexuais. Conclusão: A PEP tem sido uma das formas de prevenção combinada que minimiza as possibilidades de infecção pelo HIV. Percebeu-se que o aumento da população adulta-jovem tem buscado a prevenção, possivelmente devido as práticas consideradas de risco que apresentam maior ocorrência entre os casos.
Post-Exposure Prophylaxis (PEP) to the Human Immunodeficiency Virus (HIV) is a medical emergency that must be performed for 28 days with specific medications in individuals who have been exposed to biological materials and specific situations considered at risk in the interval up to 72 hours in HIV-negative individuals. Objective: to describe the epidemiological profile of PEP users in the city of Parnaíba, Piauí. Methodology: This is a retrospective cross-sectional study with a quantitative approach to the cases of people residing in Parnaíba, who used the PEP in the study period from 2017 to 2021, analyzed using descriptive statistics. Results: 202 patients who used PEP were registered. Among these, the majority were cis men with 129 (64%), in the age group of 30 to 59 years old (49%) in cases, the sexual orientation of heterosexuals with (44%), most patients had high school (62%), race/color was higher in pardos (52%). The most frequent type of exposure was consensual sex (79%), underwent treatment without intercurrence (84%) of cases, 62% used alcohol and/or other drugs and most patients (57%) reported not knowing the serological status of the their sexual partners. Conclusion: PEP has been one of the forms of combined prevention that minimizes the possibilities of HIV infection. It was noticed that the increase in the young adult population has sought prevention, possibly due to practices considered to be risky, with a higher occurrence among cases.
La Profilaxis Post-Exposición (PEP) al Virus de la Inmunodeficiencia Humana (VIH) es una emergencia médica que debe realizarse durante 28 días con medicamentos específicos en individuos que han estado expuestos a materiales biológicos y situaciones específicas consideradas de riesgo en el intervalo hasta 72 horas en personas VIH negativas. Objetivo: describir el perfil epidemiológico de los usuarios de PEP en la ciudad de Parnaíba, Piauí. Metodología: Se trata de un estudio transversal retrospectivo con abordaje cuantitativo de los casos de personas residentes en Parnaíba, que utilizaron el PEP en el período de estudio de 2017 a 2021, analizados mediante estadística descriptiva. Resultados: Se registraron 202 pacientes que usaron PEP. Entre estos, la mayoría eran hombres cis con 129 (64%), en el grupo de edad de 30 a 59 años (49%) en los casos, la orientación sexual de los heterosexuales con (44%), la mayoría de los pacientes tenían estudios secundarios (62 %), raza/color fue mayor en pardos (52%). El tipo de exposición más frecuente fue sexo consentido (79%), realizó tratamiento sin intercurrencia (84%) de los casos, 62% consumía alcohol y/u otras drogas y la mayoría de los pacientes (57%) refirieron no conocer el estado serológico de sus pacientes. parejas sexuales. Conclusión: La PEP ha sido una de las formas de prevención combinada que minimiza las posibilidades de infección por el VIH. Se percibió que el aumento de la población adulta joven ha buscado la prevención, posiblemente por prácticas consideradas de riesgo, con mayor ocurrencia entre los casos.
ABSTRACT
Background: Rabies is a fatal but preventable zoonotic disease and prevention of rabies following exposure is largely dependent on proper wound care and timely initiation and completion of post-exposure prophylaxis (PEP) which again dependent on awareness of general population regarding prevention of rabies and economic burden related to PEP. Aims and Objectives: With this background, the present study was carried out to estimate the economic burden, knowledge, and practice regarding prevention of rabies and to determine predictor of practices. Materials and Methods: Facility-based, observational, descriptive, and cross-sectional epidemiological study was conducted in Rabies Immunization Clinic, Medical College, Kolkata, among 110 animal bite victims (>18 year age) who are attending for PEP during study period (January 2022 to June 2022). Results: About 48.2% study participants had poor knowledge score related to prevention of rabies. Although direct economic burden for all participants was nil, 53.6% participants faced heavy indirect economic burden. Only 62.7% study participants cleaned wound properly following exposure. About 73.6% of study participants had history of timely initiation as well as completion of PEP with regularity. Proper wound care following exposure was mainly determined by awareness level of study participants regarding prevention of rabies, whereas timely initiation as well as completing PEP with regularity was mainly predicted by economic burden incurred by the participants. Conclusion: For achieving zero human deaths due to dog-mediated Rabies by 2030, more emphasis to be given on awareness generation among general population and combating economic burden related to PEP.
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Introduction: There is a necessitated need for canvassing and prioritizing measures towards rabies elimination beyond existing statuesque post-exposure prophylaxis. Moreover, there is a need to characterize the psychological and intrusive experiences of dog-bite victims to portray a picture beyond the public health perspective. To get an expressive understanding of the psychological and lived-in experience ofObjective: dog bite victims' to complement existing concepts. The study was conducted at the anti-rabiesMethod: clinic(ARC) of SMHS hospital which receives animal bite cases from the whole of Kashmir valley. Participants were selected by purposive sampling based on the inclusion criteria, and data saturation was reached with eleven participant interviews. One to one in-depth interviews were conducted with eleven (11) dog bite victims, using a preformed interview guide. Data analysis was performed using Colaizzi's phenomenological method to describe the individualistic experiences faced in peculiar conditions with familiar phenomena embedded in them. Data analysis yielded three overarching themes and nine subthemes viz:-Results: 1.Spiritual and emotional ineffectualness. (Suffering and affliction, Spiritual sulkiness, Emotional emergence) 2. Flashbacks of being hindered and defenseless. (Lack of focus in one's work, lacking the courage to protect, Being shaky) 3. Social and economical implications. (Financial loss, group and peer detachment, preferring isolation) The results of this study showed that dog bite patients experience an unpleasantConclusion: phenomenon in the face of being bitten by the dogs and are subjected to severe psychological pressures that require attention and support of medical professionals, psychologists and government authorities.
ABSTRACT
Needle stick injuries (NSI) are occupational injuries in Health Care Workers (HCWs) on using sharps. Though there are more than 20 pathogens transmitted through NSI, human immune de?ciency virus (HIV), hepatitis B & C virus (HBV&HCV)[1] are of signi?cance due to grave complications and minimum available preventive measures. According to WHO, nearly 40% of HBV and 2.5% of HIV infections among HCWs is attributed to NSI[2]. The occurrence of NSI can be reduced if Standard Work Precautions are strictly adhered by all HCWs at all times and also by taking Post Exposure Prophylaxis for HIV & HBV within the golden period of 2 hour. This study is done to assess the knowledge, attitude and practice of HCWs of various categories on NSI and PEP. A Self structured questionnaire was administered to the study population (n=307) including Post graduates, Interns, Staff nurses, Nursing students , Lab technicians, Lab technical students. There was 10 questions under three sections.1) KNOWLEDGE 2) ATTITUDE 3) PRACTICE . This study revealed that knowledge regarding transmission of all three viruses (HIV,HBV,HCV) was less among paramedics compared to medicos, but the practice of HBV vaccination is the same. 53.1% of HCWs had NSI in our study. Majority incurred NSI during recapping needles. Attitude of HCW after being exposed to report NSI is very low (30.7%). Though 37.5% of the respondents not aware of golden hour of PEP, most of them aware of initiating PEP within 72 hours of exposure . Applying disinfectants/pressure over exposed area (38.9%) & recapping (31.6%) is still prevalent among study population. And 20 % of the HCWs were not vaccinated against Hepatitis B yet.
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Rabies is an acute viral zoonotic disease that affects all warm-blooded animals including mammals and occurs in more than 150 countries and territories. Although rabies is a 100% fatal disease, it can be pre-vented by the use of potent anti-rabies vaccines (ARV). The present study was a hospital based descrip-tive longitudinal study conducted during February 2019 to July 2020 amongst the animal bite patients attending the Anti -Rabies clinic (ARC) of Vardhman Mahavir Medical College and Safdarjung Hospital (VMMC & SJH), New Delhi, to study the adverse events (vaccine reactions) if any following administra-tion of the ARV. The age of the study participants ranged from 2 to 65 years and the mean age was (29.315.2) years. No severe or serious adverse events were reported. Of the minor reactions, the most commonly reported symptom was pain at the injection site (34; 9.4%) followed by occurrence of tingling sensation (29; 8.1%), headache (22; 6.1%) and itching at the injection site (19; 5.3%). These findings corroborate with those found in previous studies in the literature. It was concluded that although there are possible local or mild or systemic adverse reactions to rabies vaccination, but once initiated, rabies prophylaxis should not be interrupted or discontinued.
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Introduction : Rabies is a fatal but vaccine-preventable viral disease. Animal bite victims who report in primary and secondary level health care lack some measures which can help in protecting and preventing deaths due to rabies. The most important factor for prevention of death due to rabies is the timely administration of post-exposure prophylaxis (PEP) among animal bite victims. Therefore, in addition to an understanding of the epidemiological distribution of animal bites, it is necessary to explore the factors leading to delay in PEP initiation. Objective: To determine the determinants of delay in initiation of post exposure prophylaxis for rabies prevention among animal bite cases attending anti-rabies clinic of a ruraltertiary care hospital in Sonepat, Haryana. Method: This cross-sectional study was conducted at an Immunization-cum-antirabies clinic of Bhagat Phool Singh Government Medical Collegefor Women, Khanpur Kalan, Sonepat, Haryana. A pre tested, structured questionnaire was used to collect information among 410 participants after taking consent. The Institutional Ethics Committee of institute approved the study. The groups were compared with Chi-square test for categorical data. Results: Delay was present among 27.3% of participants. Significant factors of delay were no local wound treatment, any treatment taken prior to anti-rabies vaccine administration, rabies clinic closed on holidays, unawareness about PEP, non-availability of accompaniment, transportation issues and money problem for transportation. Knowledge also played significant role as delay was significantly more among the participants not having knowledge regarding source of infection, mode of transmission and incubation period of rabies. Conclusions: Delay ininitiation of PEP was common and were significantly associated with lack of knowledge and unawareness, closure of rabies clinic on Sundays/holidays, non-availability of accompaniment and money problem during transportation
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Objetivo: Analisar os atendimentos antirrábicos humanos de profilaxia pós-exposição no Brasil. Métodos: Estudo descritivo utilizando dados do Sistema de Informação de Agravos de Notificação no Brasil, de 2014 a 2019. Resultados: Foram notificados 4.033.098 atendimentos antirrábicos, com média de 672.183 ao ano. Houve maior percentual de atendimentos em pessoas do sexo masculino (n = 2.111.369; 52,4%), menores de 19 anos de idade (n = 1.423.433; 35,3%), residentes em área urbana (n = 3.386.589; 88,1%), agredidas por cães (n = 3.281.190; 81,5%) e com mordeduras (n = 3.575.717; 81,9%), principalmente em mãos e pés (n = 1.541.201; 35,3%). A conduta profilática mais frequente foi observação e vacina (n = 1.736.036; 44,2%). A conduta profilática foi adequada em 57,8% (n = 2.169.689) e inadequada em 42,2% (n = 1.582.411) dos casos. Conclusão: Apesar das condutas profiláticas adequadas, foram observadas indicações inadequadas que, quando insuficientes, podem acarretar casos de raiva humana e, quando desnecessárias, desperdícios, inclusive desabastecimento de imunobiológicos.
Objetivo: Analizar la atención antirrábica humana de profilaxis post exposición en Brasil, de 2014 a 2019. Métodos: Estudio descriptivo utilizando datos del Sistema de Información de Agravamientos de Notificación en Brasil, de 2014 a 2019. Resultados: Se notificaron 4.033.098 atendimientos antirrábicos, con un promedio de 672.183 al año. Hubo mayor porcentual de atención a personas del sexo masculino (n = 2.111.369; 52,4%), menores de 19 años (n = 1.423.433; 35,3%), residentes en área urbana (n = 3.386.589; 88,1%), agredidas por perros (n = 3.281.190; 81,5%) y con mordidas (n = 3.575.717; 81,9%), principalmente en las manos y pies (n = 1.541.201; 35,3%). La conducta profiláctica más frecuente fue la observación y vacuna (n = 1.736.036; 44,2%). La conducta profiláctica fue adecuada en 57,8% (n = 2.169.689) e inadecuada en 42,2% (n = 1.582.411) de los casos. Conclusión: A pesar de las conductas profilácticas adecuadas, se observaron indicaciones inadecuadas que, cuando insuficientes, pueden resultar en casos de rabia humana y, cuando desnecesarias, desperdicios, incluso desabastecimiento de inmunobiológicos.
Objective: To analyze human anti-rabies post-exposure prophylaxis notifications in Brazil. Methods: This was a descriptive study using data from the Notifiable Diseases Information System in Brazil, from 2014 to 2019. Results: A total of 4,033,098 anti-rabies medical consultations were notified, averaging 672,183 a year. Percentage care was higher among males (n = 2,111,369; 52.4%), those under 19 years old (n = 1,423,433; 35.3%), living in urban areas (n = 3,386,589; 88.1%), attacked by dogs (n = 3,281,190; 81.5%) and bitten (n = 3,575,717; 81.9%), mainly on the hands and feet (n = 1,541,201; 35.3%). The most frequent prophylactic procedure was observation plus vaccination (n = 1,736,036; 44.2%). Prophylactic procedure was appropriate in 57.8% (n = 2,169,689) of cases and inappropriate in 42.2% (n = 1,582,411) of cases. Conclusion: Although there were appropriate prophylactic procedures, we also found procedures that were inappropriate and which, when insufficient, can result in cases of human rabies and, when unnecessary, can result in waste, including shortage of immunobiological products.
Subject(s)
Humans , Animals , Rabies/therapy , Rabies/epidemiology , Post-Exposure Prophylaxis/statistics & numerical data , Bites and Stings/virology , Brazil/epidemiology , Rabies Vaccines/therapeutic use , Disease Notification , Neglected Diseases/epidemiologyABSTRACT
@#Occupational sharps injury remains a never-ending issue faced by healthcare workers (HCWs). There were several types of post-exposure management available. Thus, it was hoped that a narrative overview could further illuminate this. Methodology: A search was conducted to review published and unpublished studies through searches of online databases (i.e., PubMed/MEDLINE, Google Scholar, Google search and Science Direct) on occupational sharps injury management, including bloodborne diseases, post-exposure management and rationale of the follow-up interval. Results: Working in a healthcare setting, sharps appeared to be an inevitable hazard faced every day by individual HCWs. While PEP was available for HIV and Hepatitis B, none was available for Hepatitis C, albeit the latter seemed to have curative treatment for it. Conclusion: We hoped that this narrative overview could provide an impetus towards the understanding of post-exposure management in our local healthcare setting.
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Objective To evaluate nPEP willingness and uptake among MSM in Shanghai. Methods MSM were recruited through a NGO-based HIV voluntary counseling testing clinic and several virtual communities using snowball sampling. Results A total of 606 MSM were successfully recruited in which 82.8% (502/606) had heard of nPEP and 81.2% (492/606) were willing to use nPEP. MSM who had been diagnosed with sexually transmitted diseases (STD) were more likely to hold willingness in using nPEP. High cost was the most common reason for being unwilling to use nPEP. 9.9% (60/606) had used nPEP in which 51.7% (31/60) had used twice or more, and 50%(30/60) had missed medication in the last nPEP. MSM who were heterosexual or with other sex orientations except for being bisexuality (OR=2.943, 95%CI: 1.057‒8.191), being receptor in anal intercourse (OR=3.361, 95%CI: 1.552‒7.282), having 2 or more sexual partners in the last 30 days (OR=2.242, 95%CI: 1.225‒4.105), having been diagnosed with STI (OR=2.317, 95%CI: 1.223‒4.389), and using drugs (OR=2.177,95%CI: 1.052‒4.503) were more likely to use nPEP. Conclusion MSM in Shanghai have a relatively high willingness to use and uptake of nPEP. Comprehensive strategies need to be developed on improving adherence and reducing HIV-risk behaviors.