Migration process of Venezuelan women to Brazil: living conditions and use of health services in Manaus and Boa Vista, 2018-2021.

BACKGROUND: The last decade saw the emergence of a new significant migration corridor due to the mass migration of Venezuelans to neighboring countries in South America. Since 2018, Brazil became the third host country of Venezuelan displaced populations. Little is known about how migratory processes affect needs, access to social programs, and public health services of migrant women. The goal of this study is to shed light on the socio-economic profile, living conditions, and use of health services of Venezuelan migrant women in two main reception cities in Brazil. METHODS: A survey was conducted using respondent-driven sampling (RDS) in the cities of Boa Vista (Roraima), and Manaus (Amazonas). The study included 2012 Venezuelan migrant women aged between 15 and 49 years old who migrated from Venezuela to Brazil between 2018 and 2021. Relative prevalence was calculated, and the χ2 test was used to analyse the homogeneity of proportions. All analyses considered the complex sampling. RESULTS: The main reasons for migrating relate to difficulties obtaining food (54%) and accessing health services (37.8%) in their country of origin. They were young and mixed race (65.7%) and had high school education (69.9%). In Manaus, 3.7% of the interviewees declared that they had no family income in the last month, while in Boa Vista, it was higher (66.2%) (p-value < 0.001). Almost one-third of them sought health care in the last 15 days, and 95% of them received care. The residents of Boa Vista arrived more recently and family income and access to paid work improved with time of residence in Brazil. CONCLUSIONS: Given the increasing flow of Venezuelan migrants crossing to Brazil, a reception system was established for the provision of food, shelter, access to health services, and income transfer programs to migrants. This was the case despite high unemployment and poverty levels and income inequality, particularly in the city of Boa Vista. However, the majority had legal migrant status and had access to the public and universal healthcare system in Brazil (SUS). The use of the SUS was similar in both cities, acting as a buffer for the differences in opportunities offered.

Prevalence of trachoma in indigenous and non-indigenous areas, Northeastern Brazil, 2019-2021.

Objective: To estimate the prevalence of trachoma in indigenous and non-indigenous populations in selected areas of the state of Maranhão, in northeastern Brazil. Methods: This was a population-based survey with probabilistic sampling. For the diagnosis of trachoma, external ocular examination was performed using head magnifying loupes, at 2.5X magnification. The prevalence of trachomatous inflammation - follicular (TF) in children aged 1-9 years and the prevalence of trachomatous trichiasis (TT) in the population aged ≥15 years were estimated. Relative frequencies of sociodemographic and environmental characteristics were obtained. Results: The study included 7 971 individuals, 3 429 from non-indigenous populations and 4 542 from indigenous populations. The prevalence of TF in non-indigenous and indigenous populations was 0.1% and 2.9%, respectively, and the prevalence of TT among indigenous populations was 0.1%. Conclusions: The prevalence of TF and TT in the two evaluation units in the state of Maranhão were within the limits recommended for the elimination of trachoma as a public health problem. However, the prevalence of TF was higher in the indigenous evaluation unit, indicating a greater vulnerability of this population to the disease. The prevalence of TF of below 5.0% implies a reduction in transmission, which may have resulted from improved socioeconomic conditions and/or the implementation of the World Health Organization SAFE strategy.

Sexual behavior and self-declaration of sexual orientation among people 18-64 years in Brazil: results from the Knowledge, Attitudes, and Practices survey, 2013 and the National Health Survey, 2019.

BACKGROUND: Population surveys involving the monitoring of high-risk sexual behavior have been recognized as important public health tools to control the HIV epidemic and other sexually transmitted infections (STIs). METHODS: Using data from the Knowledge, Attitudes, and Practices survey (PCAP-2013) and from the National Health Survey (PNS-2019), indicators of sexual behavior were compared according to sociodemographic characteristics among individuals aged 18-64 years, including size (%) estimates of men who have sex with men (MSM) and women who have sex with women (WSW). Specifically, the PNS-2019 prevalence estimates of homosexual, bisexual, heterosexual males and females were compared with those from the PCAP-2013. To compare PCAP and PNS proportional distributions, the Pearson's chi-square test, adjusted by the Rao-Scott's correction, was applied. RESULTS: Size (%) estimates of MSM and WSW obtained by direct questions from the PCAP-2013, showed higher homosexuality prevalence estimates than those resulting from the PNS-2019 self-declared sexual orientation. Significant differences were found between the MSM proportions according to the PCAP-2013 (3.7%; 95% CI 3.1-4.4%) and to the PNS-2019 (2.2%; 95% CI 1.9-2.5), and between the WSW proportions (4.6%; 95% CI 4.0-5.4%) and (2.1%; 95% CI 1.8-2.4), respectively. Results from both surveys showed MSM and WSW prevalence estimates increase with educational level, decrease with age, and is larger among people who do not live with partner, live in urban areas and in state capitals. Regarding condom use at last sexual intercourse, no differences between the PCAP-2013 and the PNS-2019 estimates were found at the national level, but significant improvements were found for MSM, people aged 18-24 and 25-34 years, and individuals not living with a partner. CONCLUSIONS: The underestimation of MSM and WSW prevalence by self-declared sexual orientation suggests that sexual minorities face many difficulties related to disclosing their sexuality and reinforces the importance of developing public health interventions for changing population attitudes and promoting sexual orientation disclosure. Moreover, the low use of condoms in both surveys (PCAP-2013 and PNS-2019) carried out 6 years apart highlights the need of public policies to expand prevention strategies for HIV infection and other STIs.

Sexual Violence and Low Rates of HIV Post-exposure Prophylaxis Access Among Female Sex Workers in Brazil.

Female sex workers (FSW) are disproportionately affected by sexual violence (SV) and HIV. Social and structural barriers limit their access to post-exposure prophylaxis (PEP). Respondent-driven sampling survey in 12 Brazilian cities among 4188 FSW aimed to estimate the rates of SV and factors associated with access to PEP use among FSW who experienced SV. The prevalence of SV was 26.3% (1199). Of the 1199, 7.5% sought out healthcare and used PEP, 19% sought out healthcare, but did not use PEP, and 73.5% did not seek out healthcare after SV. Factors associated with PEP use included PEP awareness, participation in HIV/STI prevention workshops, and disclosure of FSW status in healthcare services. Although Brazil has a PEP program free of charge, it is not readily accessible, even for FSW who seek out healthcare. The development of effective strategies to link FSW to HIV preventive services is urgently needed.

RESUMEN: Mujeres trabajadoras sexuales (MTS) se ven afectadas de manera desproporcionada por la violencia sexual (VS) y el VIH. Las barreras sociales y estructurales limitan su acceso a la profilaxis posexposición (PEP). Encuesta de muestreo dirigida por encuestados en 12 ciudades brasileñas con 4188 MTS para estimar la prevalencia de VS y los factores asociados al uso de PEP entre MTS que experimentaron VS. La prevalencia de VS fue del 26.3% (1199). De essas, el 7.5% buscó atención médica y usó PEP, el 19% buscó atención médica pero no usó PEP y el 73.5% no buscó atención después del SV. Factores asociados con el uso de PEP: conciencia de PEP; participación en talleres educativos y divulgación del trabajo en los servicios de salud. Aunque Brasil tiene un programa de PEP gratuito, no es de fácil acceso. Es urgente el desarrollo de estrategias efectivas para vincular las MTS con servicios de prevención.

Inequalities in infant mortality in Brazil at subnational levels in Brazil, 1990 to 2015.

BACKGROUND: In this study, infant mortality rate (IMR) inequalities are analyzed from 1990 to 2015 in different geographic scales. METHODS: The Ministry of Health (MoH) IMR estimates by Federative Units (FU) were compared to those obtained by the Global Burden of Disease (GBD) group. In order to measure the inequalities of the IMR by FU, the ratios from highest to lowest from 1990 to 2015 were calculated. Maps were elaborated in 2000, 2010, and 2015 at the municipality level. To analyze the effect of income, IMR inequalities by GDP per capita were analyzed, comparing Brazil and the FU to other same-income level countries in 2015, and the IMR municipal estimates were analyzed by income deciles, in 2000 and 2010. RESULTS: IMR decreased from 47.1 to 13.4 per 1000 live births (LB) from 1990 to 2015, with an annual decrease rate of 4.9%. The decline was less pronounced for the early neonatal annual rate (3.5%). The Northeast region showed the most significant annual decline (6.2%). The IMR estimates carried out by the GBD were about 20% higher than those obtained by the MoH, but in terms of their inequalities, the ratio from the highest to the lowest IMR among the 27 FU decreased from 4 to 2, for both methods. The percentage of municipalities with IMR higher than 40 per 1000 LB decreased from 23% to 2%, between 2000 and 2015. Comparing the IMR distribution by income deciles, all inequality measures of the IMR decreased markedly from 2000 to 2010. CONCLUSION: The results showed a marked decrease in the IMR inequalities in Brazil, regardless of the geographic breakdown and the calculation method. Despite clear signs of progress in curbing infant mortality, there are still challenges in reducing its level, such as the concentration of deaths in the early neonatal period, and the specific increases of post neonatal mortality in 2016, after the recent cuts in social investments.

Sex work stigma and non-disclosure to health care providers: data from a large RDS study among FSW in Brazil.

BACKGROUND: Stigma in health services may be detrimental to health seeking attitudes and practices. This study investigates non-disclosure of sex work to health care providers among female sex workers (FSW) in Brazil and its association with the utilization of health care services. METHODS: This study used cross-sectional respondent-driven sampling, carried out in 12 Brazilian cities to identify HIV risk behaviors among FSW. We first assessed statistical associations of sociodemographic, human right violations, health service access and utilization, and discrimination variables with non-disclosure of FSW status to health care providers as outcome. Secondly, we investigated the association of non-disclosure of FSW status with selected preventive health care outcomes: HIV testing, PAP smear exam, and post-exposure prophylaxis (PEP). Adjusted odds ratio with 95% confidence intervals were calculated by multivariable logistic regressions. RESULTS: Among 4245 recruited FSW, a high percentage received free condoms (82%) but only 24.4% were counseled on STI. Most FSW used non-specialized public healthcare routinely (62.6%), but only 51.5% had a Pap smear exam in the last two years and less than 40% were tested for HIV in the last 12 months. Among FSW who engaged in risky behavior (49.6%), only 8.3% used PEP. Regarding human rights violations, approximately 15% were required to give part of their earnings to owners of workplace establishments, 38% started sex work under 18 years old and 6% were required to periodically present their HIV test results. 21.3% reported having faced discrimination in health services, and 24.3% always disclosed their FSW status. Multivariable logistic models indicated significant associations of non-disclosure on the four healthcare outcomes, with lower odds of using preventive health services among women who did not disclose their sex work status, even after controlling for age, educational level, NGO affiliation, and type of health care routinely used. CONCLUSIONS: Our results indicate that sex work stigmatization within health services may be one of the main barriers to STI control and HIV response among FSW. It is essential to combat stigmatization and discrimination against FSW in health services to guarantee the appropriate uptake of preventive services available in the public health system in Brazil.

HIV Testing among men in Curitiba, Brazil.

In 2015, a community-wide intervention was launched in the city of Curitiba to evaluate the uptake of multiple HIV testing. A three-stage cluster sampling of 4800 men aged 15-64 years was selected in Curitiba. Logistic regression models were used to establish driving factors of HIV testing over the past 12 months. In the total sample, 49.5% have tested for HIV once in lifetime and 18.7% in the last 12 months. Among MSM, the proportions were much higher: 75.9% and 47.8% respectively. In the multivariate analysis, a significantly higher likelihood of HIV testing was found for young men (15-24 years), men with better educational level, those with more than 6 casual partners, and MSM compared to heterosexual men. The results indicate that the intervention to increase HIV diagnosis has substantially expanded MSM access to HIV testing.

Inequalities in healthy life expectancy by Brazilian geographic regions: findings from the National Health Survey, 2013.

BACKGROUND: The demographic shift and epidemiologic transition in Brazil have drawn attention to ways of measuring population health that complement studies of mortality. In this paper, we investigate regional differences in healthy life expectancy based on information from the National Health Survey (PNS), 2013. METHODS: In the survey, a three-stage cluster sampling (census tracts, households and individuals) with stratification of the primary sampling units and random selection in all stages was used to select 60,202 Brazilian adults (18 years and over). Healthy life expectancies (HLE) were estimated by Sullivan's method according to sex, age and geographic region, using poor self-rated health for defining unhealthy status. Logistic regression models were used to investigate socioeconomic and regional inequalities in poor self-rated health, after controlling by sex and age. RESULTS: Wide disparities by geographic region were found with the worst indicators in the North and Northeast regions, whether considering educational attainment, material deprivation, or health care utilization. Life expectancy at birth for women and men living in the richest regions was 5 years longer than for those living in the less wealthy regions. Modeling the variation across regions for poor self-rated health, statistically significant effects (p < 0.001) were found for the North and Northeast when compared to the Southeast, even after controlling for age, sex, diagnosis of at least one non-communicable chronic disease, and schooling or socioeconomic class. Marked regional inequalities in HLE were found, with the loss of healthy life much higher among residents of the poorest regions, especially among the elderly. CONCLUSIONS: By combining data on self-rated health status and mortality in a single indicator, Healthy Life Expectancy, this study demonstrated the excess burden of poor health experienced by populations in the less wealthy regions of Brazil. To mitigate the effects of social exclusion, the development of strategies at the regional level is essential to provide health care to all persons in need, reduce risk exposures, support prevention policies for adoption of healthy behaviors. Such strategies should prioritize population groups that will experience the greatest impact from such interventions.

Prenatal testing and prevalence of HIV infection during pregnancy: data from the "Birth in Brazil" study, a national hospital-based study.

BACKGROUND: The rate of vertical HIV transmission has decreased in Brazil, but regional inequalities suggest problems in implementing control measures during pregnancy and delivery. The aims of this study were to ascertain the coverage of HIV testing during prenatal care and estimate the prevalence of HIV infection during pregnancy in Brazil. METHODS: This was a national hospital-based study of 23,894 women that was conducted in 2011-2012. The data came from interviews with mothers during postpartum hospitalization, from hospital medical files and from prenatal cards. All the pregnant women with reactive serological results for HIV infection marked on their cards or with diagnoses of HIV infection during the hospital stay for delivery were considered cases of HIV infection. Univariate and multivariable logistic regression were performed to investigate factors associated with the prevalence of HIV infection and with performing at least one HIV test during pregnancy. RESULTS: Among participating women, the coverage of testing for HIV infection was 81.7% among those who presented with prenatal card and the prevalence of HIV infection among pregnant women was 0.4% (95% CI: 0.32-0.51%). In the adjusted analysis, there was higher coverage of testing among women living in the South and Southeast regions; of women aged 35 years and over; with greater schooling levels; who self-reported as white; with prenatal care provided in private services; with an early start to prenatal care; and with an adequate number of consultations, defined as a minimum of six for a term pregnancy. In the adjusted analyses there was a greater odds ratio of HIV infection among women living in the South region, aged 35 years and over, with schooling of less than 8 years, who self-reported race as black, without a partner, with syphilis coinfection and who were attended by public services. CONCLUSIONS: The prevalence of HIV infection among pregnant women in Brazil remains below 1% and the coverage of testing for HIV infection is over 80%. However, the regional and social inequalities in access to healthcare services and the missed opportunities for diagnoses of HIV infection indicate the importance of strengthening HIV infection control programs during pregnancy.

Correction of vital statistics based on a proactive search of deaths and live births: evidence from a study of the North and Northeast regions of Brazil.

BACKGROUND: In the last 20 years, Brazil has undergone dramatic changes in terms of socioeconomic development and health care. In the first decade of the 2000s, the Ministry of Health (MoH) developed a series of programs focused on reducing infant mortality, including the Family Health Program as a national policy for primary care. In this paper, we propose a method to correct underreporting of deaths and live births. After vital statistics are corrected, infant mortality trends are analyzed for the period 2000-2010 by macro-geographical region. METHODS: A proactive search of live births and deaths was carried out in the Amazon and Northeast regions in 2010 to find vital events that occurred in 2008 and were not reported to the Ministry of Health. The probabilistic sample of 133 municipalities was stratified by adequacy of vital information reporting. For each municipality, the adequacy analysis was based on the reported age-standardized mortality rate per 1,000 population and the ratio between reported and estimated live births. Correction factors were estimated by strata based on additional vital events found in the proactive search. The procedure was generalized to correct municipal vital statistics for the period 2000-2010. RESULTS: In the proactive search, 35% of non-reported deaths were found within the health system (hospitals and other health establishments), but 28% were found in non-official sources, like illegal cemeteries. In areas of extreme poverty and unreliable vital information, the estimated completeness of infant death reporting was only 33%. After correction of vital information, the estimated infant mortality rate decreased from 26.1 in 2000 to 16.0 in 2010, with an annual rate of decrease of 4.7%, greater than the required rate to achieve the Millennium Development Goal. Among Brazilian regions, the Northeast showed the largest decrease, from 38.4 to 20.1 per 1,000 live births. CONCLUSIONS: The proactive search for vital events was shown to be a good strategy both in terms of understanding local irregularities and for correcting vital statistics. The methodology could be applied in other countries to routinely assess the pattern and extent of birth and death under-registration in order to improve the utility of these data to inform health policies.

Using Respondent-Driven Sampling (RDS) to Identify the Healthcare Needs among Women of Reproductive Age Who Migrated from Venezuela to Brazil, 2018-2021.

In 2021, an RDS survey was conducted among Venezuelan migrant women of reproductive age who migrated to two Brazilian cities (Manaus and Boa Vista) from 2018 to 2021. To start the RDS recruitment, we chose seeds non-randomly in both cities. The study variables were age, educational level, self-rated health, pregnancy, migratory status and use of health services. We estimated the prevalence, confidence intervals and homophily effects by variable category. We used a multivariate logistic regression model to identify the main factors associated with healthcare use. A total of 761 women were recruited in Manaus and 1268 in Boa Vista. Manaus showed more irregular migrants than Boa Vista. The main reasons for using health services were as follows: illness, disease prevention and prenatal care. The logistic regression model showed the use of health services was associated with educational level and healthcare needs but not with migratory status. The social inclusion of Venezuelan migrants is extremely relevant, although many challenges must be overcome. The strategy of the Brazilian Federal Government for providing humanitarian assistance to Venezuelan migrants should be expanded to include and facilitate their integration into labor markets, access to healthcare and education, benefiting both migrants and the Brazilian people by reducing social inequality.

National health surveys: overview of sampling techniques and data collected using complex designs.

This article aimed to present an overview of national health surveys, sampling techniques, and components of statistical analysis of data collected using complex sampling designs. Briefly, surveys aimed at assessing the nutritional status of Brazilians and maternal and child health care were described. Surveys aimed at investigating access to and use of health services and funding, those aimed at surveillance of chronic noncommunicable diseases and associated behaviors, and those focused on risk practices regarding sexually transmitted infections were also addressed. Health surveys through social networks, including online networks, deserved specific attention in the study. The conclusion is that the development of health surveys in Brazil, in different areas and using different sampling methodologies, has contributed enormously to the advancement of knowledge and to the formulation of public policies aimed at the health and well-being of the Brazilian population.

The habit of drinking and driving in Brazil: National Survey of Health 2013 and 2019.

OBJECTIVE: To assess factors associated with the habit of drinking and driving and estimating the variations in the prevalence of this behavior in 2013 and 2019, considering information from the two editions of the Pesquisa Nacional de Saúde (PNS - National Survey of Health). METHODS: PNS is a nationwide cross-sectional home-based study. In 2013 and 2019, 60,202 and 85,854 individuals were interviewed, respectively. To assess the association between the indicator "drinking and driving" and the study variables, crude and adjusted odds ratios (ORs) were estimated using logistic regression models. To compare the prevalence between the studied years, a Pearson's chi-squared test adjusted by the Rao-Scott correction (which considers the effect of the sampling plan) and converted into an F statistic, tested at a 5% significance level, was used. RESULTS: The prevalence of drinking and driving was higher among men in 2013 (27.4%; 95%CI 25.6-29.3%) and 2019 (20.5%; 95%CI 19.4-21.7%) than among women (11.9%; 95%CI 9.9-14.2% and 7.2%; 95%CI 6.7-9.0%, respectively). Inidviduals aged 30 to 39, who lived without a partner, in rural areas, and were motorcycle drivers had significantly higher estimates. Men with higher income had higher prevalence of drinking and driving. From 2013 to 2019, the act of drinking and driving significantly decreased. Regarding traffic accidents, ORs were significant (p < 0.01) in the studied years for both men and women. DISCUSSION: Results show the need to continue policies to monitor blood alcohol level and traffic education, with specific actions directed to rural areas and motorcycle drivers.

Papanicolaou test in Brazil: analysis of the National Health Survey of 2013 and 2019.

OBJECTIVES: To compare the coverage of cervical cancer screening in Brazil in 2013 and 2019, investigating the factors associated with having the test performed and the reasons given for not doing it. Additionally, a comparison is made concerning the time taken to receive the test result in SUS (Sistema Único de Saúde) and in the private health services. METHODS: Using data from the National Health Survey (Pesquisa Nacional de Saúde - PNS), prevalence rates and corresponding confidence intervals were calculated to determine the frequency of recent cervical cancer screenings among women aged between 25 and 64 years old in Brazil, for both 2013 and 2019. Poisson regression models were employed to compare the prevalence of the outcome according to sociodemographic characteristics. The reasons for not having the test and the time between performing and receiving the result were also analyzed. RESULTS: The findings revealed an increase in the coverage of preventive cervical cancer exams in Brazil from 78.7% in 2013 to 81.3% in 2019. Additionally, there was a decline in the proportion of women who had never undergone the exam, from 9.7% to 6.1%. Prevalence of test uptake was higher among white women, those with higher levels of education and income, and those residing in the South and Southeast regions of the country. The most commonly cited reasons for not taking the test were the impression it was unnecessary (45% in both 2013 and 2019) and never having been asked to undergo the test (20.6% in 2013 and 14.8% in 2019). CONCLUSIONS: Despite the high coverage of screening achieved in the country, there is great inequality in access to the test, and a non-negligible number of women are at greater risk of dying from a preventable disease. Efforts must be made to structure an organized screening program that identifies and captures the most vulnerable women.

Prevalence and incidence of insufficient physical activity in Brazilian adolescents during the pandemic: data from ConVid Adolescents. / Prevalência e incidência da prática insuficiente de atividade física em adolescentes brasileiros durante a pandemia: dados da ConVid Adolescentes.

OBJECTIVE: To evaluate the prevalence and incidence of insufficient physical activity in Brazilian adolescents and identify the most affected subgroups during the pandemic. METHODS: This study used data from the "ConVid Adolescents - Behavior Survey", which evaluated the behavior of 9,470 Brazilian adolescents during the period of social restriction due to the COVID-19 pandemic in 2020, through a self-administered online questionnaire. Participants were invited through a virtual "snowball" sampling procedure. Information was reported on the frequency of physical activity before and during the pandemic. The exposure variables used were gender, age group, race/skin color, region of Brazil, type of school, maternal education, financial difficulties during the pandemic, and social restrictions. Logistic regression models were used. RESULTS: Adolescents engaged in less physical activity during the pandemic, as the prevalence of insufficient physical activity increased from 71.3% in the previous period to 84.3% during the pandemic. The incidence of insufficient physical activity during the pandemic was 69.6%. The subgroups of adolescents most affected were those who self-declared as black or with dark skin color, reported financial difficulties during the pandemic, lived in the Southeast and South regions of the country, and practiced intense or complete social distancing. CONCLUSION: High incidences of insufficient physical activity were observed among Brazilian adolescents during the COVID-19 pandemic. It is recommended that further studies explore periods after those analyzed to identify the behavioral dynamics of adolescents upon returning to in-person activities.

OBJETIVO: Avaliar a prevalência e a incidência de atividade física insuficiente em adolescentes brasileiros e identificar os subgrupos mais afetados durante a pandemia. MÉTODOS: Este estudo utilizou dados da ConVid Adolescentes - Pesquisa de Comportamentos, que avaliou, por meio de um questionário online autopreenchido, o comportamento de 9.470 adolescentes brasileiros no período de restrição social, em virtude da pandemia da COVID-19 em 2020. Os participantes foram convidados por meio de um procedimento de amostragem em cadeia denominado "bola de neve" virtual. Foram relatadas informações sobre a frequência de atividade física antes e durante a pandemia. As variáveis de exposição utilizadas foram sexo, faixa etária, raça/cor da pele, região do Brasil, tipo de escola, escolaridade materna, dificuldades financeiras durante a pandemia e restrições sociais. Foram utilizados modelos de regressão logística. RESULTADOS: Os adolescentes praticaram menos atividade física durante a pandemia, visto que a prevalência de atividade física insuficiente aumentou de 71,3% no período anterior para 84,3% durante a pandemia. A incidência de atividade física insuficiente durante a pandemia foi de 69,6%. Os subgrupos de adolescentes mais afetados foram os que se autodeclararam da raça/cor da pele preta, que relataram dificuldades financeiras durante a pandemia, residentes nas regiões Sudeste e Sul do país e que realizaram restrição social intensa e total. CONCLUSÃO: Altas incidências de atividade física insuficiente foram observadas entre adolescentes brasileiros durante a pandemia da COVID-19. Recomenda-se que novos estudos explorem períodos posteriores aos analisados para identificar a dinâmica comportamental dos adolescentes a partir do retorno das atividades presenciais.

Smoking among Brazilian adolescents during the COVID-19 pandemic: a cross-sectional study.

BACKGROUND: The social distancing measures during the coronavirus disease 2019 (COVID-19) pandemic resulted in mental suffering among adolescents, leading to risky consumption of psychoactive substances such as tobacco. OBJECTIVE: To analyze the factors associated with tobacco use among adolescents during the COVID-19 social distancing period in Brazil. DESIGN AND SETTING: Cross-sectional study used data from ConVid Adolescentes survey in Brazil. METHODS: Tobacco use was assessed before and during social distancing. The explanatory variables investigated were sex, age, race/skin color, type of school, maternal education, region of residence, adherence to social restriction measures, number of close friends, sleep quality during the pandemic, mood, passive smoking, use of alcoholic beverages during the pandemic, sedentary behavior, and physical activity. A logistic regression model was used for the data analysis. RESULTS: Tobacco use by adolescents did not change during the pandemic (from 2.58% to 2.41%). There was a higher chance of tobacco use among adolescents aged between 16 and 17 years, self-reported black ones, residing in the South and Southeast regions, reported feeling sad and loneliness, had sleeping problems that worsened, were using alcoholic beverages during the pandemic, and were passive smokers at home. Adolescents whose mothers had completed high school or higher, had strict social restrictions, and increased their physical activity during the pandemic had a lower chance of tobacco use. CONCLUSION: Tobacco uses during the COVID-19 pandemic was higher in vulnerable groups, such as black adolescents and those with mental suffering.

Population Prevalence of Trachoma in Nine Rural Non-Indigenous Evaluation Units of Brazil.

PURPOSE: To assess the contemporary prevalence of trachoma in Brazil's non-indigenous population, surveys of those thought to be at greatest risk of disease were conducted. METHODS: Rural census tracts of non-indigenous population from nine mesoregions were selected to compose the survey evaluation units (EUs) by considering previously endemic municipalities at greatest risk of trachoma. In each of the nine EUs, we conducted a population-based prevalence survey. Every resident of selected households aged ≥1 year was examined for trachomatous inflammation - follicular (TF) and trachomatous trichiasis (TT). Additionally, data were collected on household-level access to water, sanitation, hygiene (WASH) and education. RESULTS: A total of 27,962 individuals were examined across nine EUs. The age-adjusted TF prevalence in 1-9-year-olds was <5% in each EU. The age- and gender-adjusted prevalence of TT unknown to the health system in ≥15-year-olds was <0.2% in eight EUs; in one EU, it was 0.22%. The median number of households surveyed per EU with access to an improved drinking water source within a 30-minute roundtrip of the house was 66%. School attendance was >99% of surveyed children. CONCLUSIONS: The prevalence of TF was well below the target for elimination as a public health problem in all EUs. Because EUs surveyed were selected to represent the highest-risk non-indigenous areas of the country, TF prevalence is unlikely to be ≥5% in non-indigenous populations elsewhere. In one EU, the prevalence of TT was above the target threshold for elimination. Further investigation and possibly improvement in TT surgical provision are required in that EU.

Prevalence of trachoma in the non-indigenous Baixo Jaguaribe micro-region, Ceará State, Northeast Brazil.

BACKGROUND: The aim of the current study was to estimate the population prevalence of trachoma in non-indigenous populations in the Baixo Jaguaribe micro-region, in the state of Ceará, northeast region of Brazil, 2021-2022. METHODS: A population-based prevalence survey focusing on detecting cases of trachomatous inflammation-follicular (TF) in children aged 1-9 y and trachomatous trichiasis (TT) 'unknown to the health system' in people aged ≥15 y, was conducted in rural areas of the Baixo Jaguaribe micro-region in the state of Ceará. Indigenous populations will be further researched. RESULTS: There was no detection of cases of TF and TT. In 900 households, 2234 people were examined. In the Baixo Jaguaribe micro-region, females (54.6%; 1219/2234) and the mixed/Pardo-Brazilian ethnicity (68.1%; 1521/2234) predominated. The most commonly reported educational level was elementary and middle school (41.8%; 702/1679). In 56.2% (506/900) of households, there was a source of water within the household. The monthly income range of 50%-100% of the minimum wage predominated in the families of the Baixo Jaguaribe micro-region (43.1%; 388/900). CONCLUSIONS: Although no cases of TF and TT were detected in the Baixo Jaguaribe micro-region in the state of Ceará during the study period, considering the historical endemicity, we emphasise the need for monitoring and sustainability of surveillance actions in areas at risk for trachoma, common contexts for neglected populations.

Recent HIV infection and annualized HIV incidence rates among sexual and gender minorities in Brazil and Peru (ImPrEP seroincidence study): a cross-sectional, multicenter study.

Background: HIV incidence estimation is critical for monitoring the HIV epidemic dynamics and the effectiveness of public health prevention interventions. We aimed to identify sexual and gender minorities (SGM) with recent HIV infections, factors associated with recent HIV infection, and to estimate annualised HIV incidence rates. Methods: Cross-sectional multicentre study in HIV testing services in Brazil and Peru (15 cities). Inclusion criteria: 18+ years, SGM assigned male at birth, not using pre-/post-exposure prophylaxis. We identified recent HIV infection using the Maxim HIV-1 LAg-Avidity EIA assay as part of a recent infection testing algorithm (RITA). Annualized HIV incidence was calculated using the UNAIDS/WHO incidence estimator tool. Multivariable logistic regression models were used to estimate factors associated with recent HIV infection. Trial registration: NCT05674682. Findings: From 31-Jan-2021 to 29-May-2022, 6899 individuals participated [Brazil: 4586 (66.5%); Peru: 2313 (33.5%)]; 5946 (86.2%) cisgender men, 751 (10.9%) transgender women and 202 (2.9%) non-binary/gender diverse. Median age was 27 (IQR: 23-34) years. HIV prevalence was 11.4% (N = 784/6899); 137 (2.0%) SGM were identified with recent HIV infection. The overall annualized HIV incidence rate was 3.88% (95% CI: 2.86-4.87); Brazil: 2.62% (95% CI: 1.78-3.43); Peru: 6.69% (95% CI: 4.62-8.69). Participants aged 18-24 years had higher odds of recent HIV infection compared to those aged 30+ years in both countries. Interpretation: Our results highlight the significant burden of HIV epidemic among SGM in large urban centres of Brazil and Peru. Public health policies and interventions to increase access to effective HIV prevention methods such as PrEP are urgently needed in Latin America. Funding: Unitaid, WHO (Switzerland), Ministry of Health from Brazil and Peru.

Gender differences in the surgical management of trachomatous trichiasis: an exploratory analysis of global trachoma survey data, 2015-2019.

BACKGROUND: Trachomatous trichiasis (TT) is a painful, potentially blinding eye condition that can be managed through epilation or surgery. Women are affected by TT approximately twice as often as men and are believed to face gendered barriers to receiving surgical care to prevent vision loss. METHODS: We used data from 817 cross-sectional surveys conducted during 2015-2019 in 20 African countries to estimate the prevalence difference (PD) between female and male eyes for four outcomes potentially indicating gender-related differences in TT management: (1) received surgery and developed postoperative TT (PTT), (2) never offered surgery, (3) offered surgery but declined it, and (4) offered epilation but never offered surgery. RESULTS: The prevalence was modestly elevated among female eyes compared with male eyes for having PTT (PD:1.8 [95% confidence limits (CL): 0.6, 3.0]) and having declined surgery for the eye (PD: 6.2 [95% CL: 1.8, 10.7]). The proportion offered epilation was similar by gender (PD:0.5 [95% CL: -0.4, 1.3]), while never having been offered surgery was somewhat more prevalent among male eyes (PD: -2.1 [95% CL: -3.5, -0.7]). CONCLUSIONS: Our results suggest potential gender differences in TT management. More research is needed to determine the causes and implications of the observed differences.