Demographic, social, and clinical aspects associated with access to COVID-19 health care in Pará province, Brazilian Amazon.

Internal social disparities in the Brazilian Amazon became more evident during the COVID-19 pandemic. The aim of this work was to examine the demographic, social and clinical factors associated with access to COVID-19 health care in Pará Province in the Brazilian Amazon. This was an observational, cross-sectional, analytical study using a quantitative method through an online survey conducted from May to August 2023. People were eligible to participate if they were current residents of Pará, 18-years-old or older, with self-reported diagnoses of COVID-19 through rapid or laboratory tests. Participants completed an electronic survey was developed using Research Electronic Data Capture (REDCap) software-The adapted questionnaire "COVID-19 Global Clinical Platform: Case Report Form for Post-COVID Condition". Questions focused on access to COVID-19 treatment, demographic characteristics, COVID-19 vaccine and clinical characteristics. Respondent-driven sampling was applied to recruit participants. Multiple logistic regression was utilized to identify the associated factors. Overall, a total of 638 participants were included. The average age was 31.1 years. Access to COVID-19 health care was 68.65% (438/638). The participants most likely to access health care were those with moderate or severe COVID-19 (p = 0.000; OR: 19.8) and females (p = 0.001; OR: 1.99). Moreover, participants who used homemade tea or herbal medicines were less likely to receive health care for COVID-19 in health services (p = 0.002; OR: 0.54). Ensuring access to healthcare is important in a pandemic scenario.

Patterns of Chlamydia trachomatis and Neisseria gonorrhoeae in different anatomical sites among Pre-Exposure Prophylaxis (PrEP) users in Brazil.

BACKGROUND: The presence of untreated sexually transmitted infections (STIs) significantly increases the chance of acquiring HIV. In Brazil, testing for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) among Pre-Exposure Prophylaxis (PrEP) users is insufficient, and syndromic treatment is a priority in clinical practice. Multi-site testing for CT/NG improves thescreening of asymptomatic cases and ensures timely treatment. Therefore, it is essential for HIV prevention. This study aims to test the importance of two-site testing for better screening of these pathogens and to determine whether the presence of symptoms is an indicator of CT/NG infection. METHODS: This is a cross-sectional study carried out in four public infectious diseases clinics in São Paulo State, Brazil between January of 2022 and March of 2023. All participants had an anal swab and a first-pass or mid-stream urine collected for CT/NG analysis by Polymerase chain reaction (PCR). Data about sociodemographic, sexual behavioural and clinical aspects were collected. Pathway analysis was used to examine the direct and indirect relationships between variables according to the theoretical model. RESULTS: We screened 171 PrEP users which had two samples collected, resulting in 342 samples. Comparing the anatomic sites, the urine samples showed lower sensitivity for CT and NG than anal samples. Gonorrhoea was directly linked to lower age (ß= -0.161, p = 0.001). Time of PrEP use was directly associated with CT infection (ß = 0.202; p = 0.042) and inversely associated with dysuria (ß= -0.121, p = 0.009). Lower occurrence of yellow-green secretion was linked to detection of CT (ß= -0.089, p = 0.005) and NG (ß= -0.048, p = 0.002) infections. Foul-smelling discharge was directly associated with CT (ß = 0.275, p = 0.004) and NG (ß = 0.295, p = 0.037) infection. CONCLUSION: The symptoms are a bad indicator of CT and NG infection, and the screening must be done in more than one site since most of the positive results would be missed if only urines were tested. In the case of testing only one anatomical site, specifically the urethra, the CT/NG incidence and prevalence would be underestimated. The two-sites testing improves detection rates of CT/NG, and PrEP follow-up benefits people offering STI testing.

A pre-post quasi-experimental study: effect of an educational intervention on the quality of life, and coping strategies of people living with HIV (PLHIV).

INTRODUCTION: The current study provides people living with human immunodeficiency virus (PLHIV) the support to cope with this disease and to improve their quality of life, since their longevity has significantly increased. AIM: Investigating the effect of an educational intervention on PLHIV's strategies to cope with HIV. METHODOLOGY: Quasi-experimental, before-and-after study type, whose data were collected before and after educational intervention, was carried out with 75 PLHIV at a School Outpatient Clinic. The Brazilian version of the Ways of Coping Scale was herein used. It is a questionnaire comprising 4 disease-coping domains, namely: coping focused on problem, emotion and on seeking social support and religious practices. RESULTS: There was increased use of all coping-strategy domains after the educational intervention, as well as reduced standard deviation, and it pointed out that the recorded values were grouped closer to the mean therefore showing less variability. Coping focused on social support was the strategy mostly used after the educational intervention; it was followed by strategies focused on both emotion and problem. The least used strategy was the one focused on religion/fantasy. DISCUSSION: This study identified the need of introducing a new coping strategy focused on prejudice against patients with HIV.

Uso inconsistente del preservativo masculino en hombres VIH negativos que tienen sexo con hombres / Inconsistent use of male condoms among HIV-negative men who have sex with other men / Uso inconsistente do preservativo masculino entre homens HIV negativos que fazem sexo com homens

Objetivo: analizar los factores asociados con el uso inconsistente del preservativo masculino en hombres VIH negativos que tienen sexo con hombres. Método: estudio transversal, analítico, nacional realizado de forma online en todas las regiones de Brasil, en 2020, a través de redes sociales y sitios de citas. El uso inconsistente del preservativo se definió como el uso ocasional o no usarlo nunca. Se realizaron análisis estadísticos descriptivos, pruebas de asociación y regresión logística binaria. Resultados: 1222 (85%) de los 1438 participantes informaron uso inconsistente del preservativo. Las variables "homosexuales" (ORA: 2,03; IC 95%: 1,14-3,59; p = 0,016), "tener pareja estable" (ORA: 2,19; IC 95%: 1,55-3,09; p<0,001), "sexo oral" (ORA: 2,41; IC 95%: 1,31-4,43; p = 0,005), "anal insertivo" (ORA: 1,98; IC 95%: 1,10-3,58; p = 0,023) y "diagnóstico de ITS" (ORA: 1,59; IC 95%: 1,13-2,24; p = 0,007) se asociaron de forma independiente con el uso inconsistente del preservativo masculino. Las variables "recibió consejo de un amigo sobre la prueba del VIH" (ORA: 0,71; IC 95%: 0,52-0,96; p = 0,028) y "trabajador sexual" (ORA: 0,26; IC 95%: 0,11-0,60; p = 0,002) fueron factores protectores. Conclusión: las variables estudiadas indicaron que hay una fuerte relación entre las parejas estables y el aumento de la confianza y la baja adherencia al uso del preservativo, lo que coincide con otros estudios.

Objective: to analyze the factors associated with inconsistent use of male condoms among HIV-negative men who have sex with other men. Method: a cross-sectional, analytical and nationwide study conducted online in all the Brazilian regions in 2020, via networks and in dating websites. Inconsistent condom use was defined as occasional use or as never using it. Descriptive statistical analyses were performed, as well as association and binary logistic regression tests. Results: inconsistent condom use was reported by 1,222 (85%) of all 1,438 participants. The "homosexuals" (ORAdj: 2.03; 95% CI: 1.14-3.59; p=0.016), "having a fixed partner" (ORAdj: 2.19; 95% CI: 1.55-3.09; p<0.001), "oral sex" (ORAdj: 2.41; 95% CI: 1.31-4.43; p=0.005), "insertive anal" (ORAdj: 1.98; 95% CI: 1.10-3.58; p=0.023) and "STI diagnosis" (ORAdj: 1.59; 95% CI: 1.13-2.24; p=0.007) variables were independently associated with inconsistent use of male condoms. The "receiving advice on HIV test from a friend" (ORAdj: 0.71; 95% CI: 0.52-0.96; p=0.028) and "sex worker" (ORAdj: 0.26; 95% CI: 0.11-0.60; p=0.002) variables were protective factors. Conclusion: the variables under study pointed to a strong relationship between steady partners and increased trust and low adherence to condom use, corroborating other studies.

Objetivo: analisar os fatores associados ao uso inconsistente do preservativo masculino entre homens HIV negativos que fazem sexo com homens. Método: estudo transversal, analítico, de abrangência nacional realizado on-line em todas as regiões do Brasil, em 2020, por meio de redes sociais e em sites de relacionamento. O uso inconsistente do preservativo foi definido como uso ocasional ou nunca ter usado. Foram realizadas análises estatísticas descritivas, testes de associação e regressão logística binária. Resultados: o uso inconsistente do preservativo foi relatado por 1222 (85%) dos 1438 participantes. As variáveis "homossexuais" (ORA: 2,03; IC 95%: 1,14- 3,59; p = 0,016), "ter parceiro fixo" (ORA: 2,19; IC 95%: 1,55-3,09; p<0,001), "sexo oral" (ORA: 2,41; IC 95%: 1,31-4,43; p = 0,005), "anal insertivo" (ORA: 1,98; IC 95%: 1,10-3,58; p = 0,023) e "diagnóstico de IST" (ORA: 1,59; IC 95%: 1,13-2,24; p = 0,007) foram independentemente associadas ao uso inconsistente do preservativo masculino. As variáveis "recebeu aconselhamento de amigo sobre teste de HIV" (ORA: 0,71; IC 95%: 0,52-0,96; p = 0,028) e "profissional do sexo" (ORA: 0,26; IC 95%: 0,11-0,60; p = 0,002) foram fatores de proteção. Conclusão: as variáveis estudadas apontaram uma forte relação das parcerias fixas com o aumento da confiança e uma baixa adesão ao uso do preservativo, o que corrobora com outros estudos.

Lesiones cutáneas asociadas con el uso de respiradores N95 en profesionales de la salud de Brasil durante 2020 / Skin lesions associated with the use of N95 respirators among health professionals in Brazil in 2020 / Lesões de pele associadas ao uso de respiradores N95 entre profissionais de saúde no Brasil em 2020

Objetivo: investigar la prevalencia de lesiones cutáneas y factores asociados con el uso de respiradores N95 en profesionales de la salud de Brasil. Método: estudio transversal realizado con 11.368 profesionales de la salud en el que se empleó un método de muestreo dirigido por encuestados adaptado para entornos en línea. Se ejecutaron análisis univariados y multivariados para investigar la asociación entre la variable "lesiones cutáneas por utilizar respiradores N95" y sexo, categoría profesional, lugar de trabajo, capacitación, diagnóstico de COVID-19 y disponibilidad de suficiente provisión de Equipo de Protección Personal de buena calidad. Resultados: la prevalencia de lesiones cutáneas fue del 61,8%. Las mujeres fueron 1,203 veces (IC 95%: 1,154-1,255) más propensas a desarrollar lesiones que los hombres. La probabilidad de lesiones cutáneas en psicólogos (RP=0,805; IC 95%: 0,678-0,956) y dentistas (RP=0,884; IC 95%: 0,788-0,992) fue menor en comparación con la encontrada en los profesionales de Enfermería. Los profesionales con diagnóstico positivo de COVID-19 y que trabajan en la Unidad de Cuidados Intensivos son más propensos a sufrir lesiones cutáneas (RP=1,074; IC 95%: 1,042-1,107); (RP=1,203; IC 95%: 1,168-1,241), respectivamente, Conclusión: la prevalencia de lesiones cutáneas causadas por utilizar respiradores N95 fue del 61,8% y estuvo asociada al sexo femenino, a la categoría profesional, al lugar de trabajo, a la capacitación, a diagnóstico de COVID-19 y a la disponibilidad de suficiente provisión de Equipo de Protección Personal de buena calidad.

Objective: to investigate the prevalence of skin lesions and factors associated with the use of N95 respirators among health professionals in Brazil. Method: cross-sectional study conducted with 11,368 health professionals using a respondent-driven sampling method adapted for online environments. Univariate and multivariate analyses were performed to investigate the association between the "skin lesions with the use of N95 respirators" variable and gender, professional category, workplace, training, COVID-19 diagnosis, and availability of sufficient and high-quality Personal Protective Equipment. Results: the prevalence of skin lesions was 61.8%. Women were 1.203 times (95% CI: 1.154-1.255) more likely to develop a lesion than men. The chances of skin lesions in psychologists (PR=0.805; 95% CI: 0.678-0.956) and dentists (PR=0.884; 95% CI: 0.788-0.992), were lower when compared to Nursing professionals. Professionals with a positive COVID-19 diagnosis and working in the Intensive Care Unit have an increased chance of presenting skin lesions (PR=1.074; 95% CI: 1.042-1.107); (PR=1.203; 95% CI: 1.168-1.241), respectively. Conclusion: the prevalence of skin lesions caused by the use of N95 respirators was 61.8% and was associated with female gender, professional category, workplace, training, COVID-19 diagnosis, and availability of sufficient and highquality Personal Protective Equipment.

Objetivo: investigar a prevalência de lesões de pele e fatores associados ao uso de respiradores N95 entre profissionais de saúde no Brasil. Método: estudo transversal realizado com 11.368 profissionais de saúde por meio de um método de amostragem dirigido por respondentes adaptado para ambientes online. Análises univariadas e multivariadas foram realizadas para investigar a associação entre a variável "lesão de pele com uso de respirador N95" e sexo, categoria profissional, local de trabalho, treinamento, diagnóstico de COVID-19 e disponibilidade suficiente de equipamentos de proteção individual de qualidade. Resultados: a prevalência de lesões cutâneas foi de 61,8%. As mulheres foram 1,203 vezes (IC 95%: 1.154-1.255) mais propensas a desenvolver uma lesão do que os homens. As chances de lesão de pele em psicólogos (RP=0,805; IC 95%: 0,678-0,956) e dentistas (RP=0,884; IC 95%: 0,788-0,992) foram menores quando comparados aos profissionais de Enfermagem. Profissionais com diagnóstico positivo para COVID-19 e que trabalham em Unidade de Cuidados Intensivos têm maior chance de apresentar lesões de pele (RP=1,074; IC 95%: 1,042-1,107); (RP=1,203; IC 95%: 1,168- 1,241), respectivamente. Conclusão: a prevalência de lesões de pele causadas pelo uso do respirador N95 foi de 61,8% e esteve associada ao sexo feminino, categoria profissional, local de trabalho, treinamento, diagnóstico de COVID-19 e disponibilidade suficiente de equipamentos de proteção individual de qualidade.

Factors Associated with Late Diagnosis of Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) in a University Hospital in Brazil: Challenges to Achieving the 2030 Target.

INTRODUCTION: This study aimed to identify factors associated with late diagnosis and clinically monitor newly diagnosed HIV/AIDS patients. METHOD: Retrospective study, based on secondary data from a specialized unit at the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto of the University of Sao Paulo. Data collection included sociodemographic, behavioral, clinical, and laboratory data of newly diagnosed HIV patients between 2015 and 2019. Data analysis was undertaken using inferential statistical tests. RESULTS: A total of 314 individuals were newly diagnosed with HIV/AIDS, 86.6% (272) had a late diagnosis and 53.8% (169) were diagnosed very late. Using the adjusted odds ratio, we observed that bisexual and MSM patients were less likely to have a late diagnosis compared to straight patients. Individuals who entered through the emergency department and Outpatient Clinic had a lower chance of having a very late diagnosis compared to those diagnosed in the ward/inpatient unit. Having a higher education and university education were protective factors against having a very late diagnosis of HIV infection compared to elementary school education only. In addition, male patients were more likely to have a very late diagnosis compared to female patients. CONCLUSIONS: This study evidenced a high prevalence of late and very late diagnoses. Therefore, attention should be directed towards factors related to late and very late presentation.

Resilience, depression and self-efficacy among Brazilian nursing professionals during the COVID-19 pandemic. / Resiliência, depressão e autoeficácia entre profissionais de enfermagem brasileiros na pandemia de COVID-19.

This aim of this study was to analyze levels of resilience, depression and self-efficacy among Brazilian nursing professionals during the COVID-19 pandemic. We conducted an analytical cross-sectional study between October and December 2020. Student's t test, analysis of variance and multiple linear regression were used to investigate the impact of two main factors (Resilience and Self-efficacy) on depression. A total of 8,792 nursing professionals participated in the study; 5,124 (58.8%) had low levels of resilience. The mean overall score for Depression was 0.74, ranging from 0.59 to 0.80, while the mean overall score for Self-efficacy was 0.68, ranging from 0.56 to 0.80. The variable that had the strongest impact on depression levels was Resilience, explaining 6.6% of the outcome (p < 0.001, AdjustedR2 = 0.066). In general, respondents had low levels of resilience and self-efficacy and showed high mean depression scores. Level of resilience had an impact on depression. The findings reveal an urgent need for actions to promote the psychological health of nursing professionals working in crisis situations such as pandemics.

O objetivo deste artigo é analisar os níveis de resiliência, depressão e autoeficácia entre profissionais de enfermagem brasileiros na pandemia de COVID-19. Estudo transversal analítico realizado entre os meses de outubro e dezembro de 2020. Foram empregados o teste T de Student, a análise de variância e a regressão linear múltipla com o objetivo de investigar em que medida os dois grandes fatores (resiliência e autoeficácia) impactavam nos níveis de depressão. Participaram do estudo 8.792 profissionais de enfermagem, 5.124 (58,8%) tiveram baixos níveis de resiliência. A média da pontuação geral para "depressão" foi de 0,74 e variou de 0,59 a 0,80. A média da pontuação geral para "autoeficácia" foi de 0,68 e variou de 0,56 a 0,80. Quanto aos preditores de depressão, a variável que mais fortemente impactou os níveis de depressão foi resiliência, explicando 6,6% do desfecho (p < 0,001, R2 Ajustado = 0,066). Os participantes deste estudo tiveram, em geral, baixos níveis de resiliência e autoeficácia e maiores pontuações médias para depressão. Os níveis de resiliência impactaram a variável depressão. Urge a necessidade de ações voltadas para a promoção da saúde psicológica de profissionais de enfermagem inseridos em contextos pandêmicos.

Resiliência, depressão e autoeficácia entre profissionais de enfermagem brasileiros na pandemia de COVID-19 / Resilience, depression and self-efficacy among Brazilian nursing professionals during the COVID-19 pandemic

Resumo O objetivo deste artigo é analisar os níveis de resiliência, depressão e autoeficácia entre profissionais de enfermagem brasileiros na pandemia de COVID-19. Estudo transversal analítico realizado entre os meses de outubro e dezembro de 2020. Foram empregados o teste T de Student, a análise de variância e a regressão linear múltipla com o objetivo de investigar em que medida os dois grandes fatores (resiliência e autoeficácia) impactavam nos níveis de depressão. Participaram do estudo 8.792 profissionais de enfermagem, 5.124 (58,8%) tiveram baixos níveis de resiliência. A média da pontuação geral para "depressão" foi de 0,74 e variou de 0,59 a 0,80. A média da pontuação geral para "autoeficácia" foi de 0,68 e variou de 0,56 a 0,80. Quanto aos preditores de depressão, a variável que mais fortemente impactou os níveis de depressão foi resiliência, explicando 6,6% do desfecho (p < 0,001, R2 Ajustado = 0,066). Os participantes deste estudo tiveram, em geral, baixos níveis de resiliência e autoeficácia e maiores pontuações médias para depressão. Os níveis de resiliência impactaram a variável depressão. Urge a necessidade de ações voltadas para a promoção da saúde psicológica de profissionais de enfermagem inseridos em contextos pandêmicos.

Abstract This aim of this study was to analyze levels of resilience, depression and self-efficacy among Brazilian nursing professionals during the COVID-19 pandemic. We conducted an analytical cross-sectional study between October and December 2020. Student's t test, analysis of variance and multiple linear regression were used to investigate the impact of two main factors (Resilience and Self-efficacy) on depression. A total of 8,792 nursing professionals participated in the study; 5,124 (58.8%) had low levels of resilience. The mean overall score for Depression was 0.74, ranging from 0.59 to 0.80, while the mean overall score for Self-efficacy was 0.68, ranging from 0.56 to 0.80. The variable that had the strongest impact on depression levels was Resilience, explaining 6.6% of the outcome (p < 0.001, AdjustedR2 = 0.066). In general, respondents had low levels of resilience and self-efficacy and showed high mean depression scores. Level of resilience had an impact on depression. The findings reveal an urgent need for actions to promote the psychological health of nursing professionals working in crisis situations such as pandemics.

Human immunodeficiency virus epidemic scenery among brazilian women: a spatial analysis study.

BACKGROUND: Approximately 37.7 million people worldwide are infected with human immunodeficiency virus (HIV). Although HIV detection among women, they still representing 53% of population living with the virus. Spatial analysis techniques are powerful tools for combating HIV allowing the association of the phenomenon with socioeconomic and political factors. Therefore, the main goal of this study was to spatially analyze HIV prevalence among Brazilian women from 2007 to 2020. METHODS: ecological study was conducted using secondary databases of the Notifiable Diseases Information System (SINAN) for HIV and Acquired Immunodeficiency Syndrom (AIDS) in Brazilian women 15 years old and over. Age-adjusted HIV/AIDS incidence rates were analyzed using spatial distribution, autocorrelation, and spatiotemporal risk analysis techniques. RESULTS: During the study period, 119,890 cases of HIV/AIDS were reported among Brazilian women. The southeastern region had a higher age-adjusted HIV/AIDS incidence than other Brazilian regions. Hotspot HIV/AIDS incidence rates decreased in all Brazil. Piauí, Paraná, and Minas Gerais were the only states with an increased number of cold spots. Previous spatiotemporal risk zones were observed in the states of São Paulo, Rio Grande do Sul, and Rio de Janeiro. Belém was a risk zone with a later spatiotemporal risk. CONCLUSIONS: The efficiency of public policies fighting HIV has not been uniform among municipalities, although HIV/AIDS cases have decreased among Brazilian women. The social determinants of health in each municipality should be considered when local health authorities implement policies. Women empowerment should be promoted, and access to preventive, diagnostic, and treatment healthcare places should be expanded and guaranteed.

Effectiveness of educational intervention among seropositive women about knowledge about HIV sexual transmission.

OBJECTIVES: to assess the effectiveness of a group and telephone educational intervention with seropositive women about knowledge about HIV sexual transmission prevention. METHODS: a quasi-experimental before-and-after study, carried out with 151 women living with HIV in a Specialized Care Service in a Brazilian capital. The educational intervention was carried out in three moments, with the assessment being carried out before the first and after the last moment. RESULTS: 97.4% of study participants were cisgender women aged between 18 and 58 years; 55.6% considered themselves brown; and 32.5% of interviewees had elementary school. Regarding knowledge about HIV sexual transmission, in 78.5% of items, there was an association (p<0.005) with increased participants' knowledge after receiving the intervention. CONCLUSIONS: the educational intervention helped to increase the knowledge of women living with HIV about the sexual transmission of the infection.

Cultural Adaptation and Validation of the Barriers to HIV Testing Scale-Karolinska Version for Brazilian Men Who Have Sex With Men.

ABSTRACT: The aim of this study was to perform the cultural adaptation and validation of the Barriers to HIV testing scale-Karolinska version for Brazilian men who have sex with men. A methodological study was conducted for cultural adaptation and validation of the scale. Reliability analyses, exploratory factor analysis, confirmatory factor analysis, and convergent and discriminant validity tests were performed. Four factors were extracted: F1, personal consequences; F2, structural barriers; F3, confidentiality; F4, economic consequences and individual concerns. Good fit indexes were obtained: (χ 2 )/GL (2.71); goodness of fit index (0.94); root-mean-square error of approximation (0.052; 90% CI [0.045-0.059]); Tucker-Lewis index (0.94); normed fit index (0.93); IFI (0.95); comparative fit index (0.95). Convergent validity results were greater than 0.7 for the four factors. The adapted version of the scale showed satisfactory reliability and validity for assessing barriers to HIV testing among men who have sex with men.

Amplified HIV Transmission Risk Among People Living With HIV in Southeast Brazil.

ABSTRACT: This study investigated the factors associated with amplified HIV transmission risk among people living with HIV from a city in southeast Brazil. A cross-sectional study was conducted with 397 people living with HIV recruited in infectious diseases clinics. Data on risk of HIV transmission, sociodemographic characteristics, sexual behaviors, professional counseling, serological HIV status, HIV-related clinical data, and beliefs about risk of HIV transmission were collected through interviews and medical records. Hierarchical ordered multinomial regression analyses were performed. Amplified HIV risk transmission was associated with lower age, alcohol consumption before having sex, illicit drug use before sexual intercourse, and not receiving professional counseling about HIV transmission. The belief that HIV can be transmitted to a partner not living with HIV was associated with lower likelihood of amplified risk for HIV transmission. Our findings suggest the importance of minimizing substance use before having sex, professional counseling, and beliefs about HIV transmission on amplified HIV risk transmission.

Barriers to Pre-Exposure Prophylaxis (PrEP) use for HIV: an integrative review.

OBJECTIVES: to identify and synthesize scientific evidence on the barriers and difficulties for Pre-exposure Prophylaxis (PrEP) use and compliance for HIV. METHODS: an integrative literature review, using the MEDLINE/PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Academic Search Premier and Scopus (Elsevier) databases. RESULTS: all (100%) the articles included identified that PrEP users experience some type of structural barrier related to health services such as long distance from the units, suboptimal logistics for taking pills and professional resistance to prescribing PrEP. Furthermore, 63.21% identified social barriers, such as stigma about sexuality and HIV, in addition to individual barriers such as alcohol use, adverse effects, and concerns about long-term toxicity. CONCLUSIONS: the barriers to PrEP use are multifactorial. Effective interventions are needed to support PrEP users in accessing, complying with, and retaining health services.

Inconsistent use of male condoms among HIV-negative men who have sex with other men. / Uso inconsistente del preservativo masculino en hombres VIH negativos que tienen sexo con hombres.

OBJECTIVE: to analyze the factors associated with inconsistent use of male condoms among HIV-negative men who have sex with other men. METHOD: a cross-sectional, analytical and nationwide study conducted online in all the Brazilian regions in 2020, via networks and in dating websites. Inconsistent condom use was defined as occasional use or as never using it. Descriptive statistical analyses were performed, as well as association and binary logistic regression tests. RESULTS: inconsistent condom use was reported by 1,222 (85%) of all 1,438 participants. The "homosexuals" (ORAdj: 2.03; 95% CI: 1.14-3.59; p=0.016), "having a fixed partner" (ORAdj: 2.19; 95% CI: 1.55-3.09; p<0.001), "oral sex" (ORAdj: 2.41; 95% CI: 1.31-4.43; p=0.005), "insertive anal" (ORAdj: 1.98; 95% CI: 1.10-3.58; p=0.023) and "STI diagnosis" (ORAdj: 1.59; 95% CI: 1.13-2.24; p=0.007) variables were independently associated with inconsistent use of male condoms. The "receiving advice on HIV test from a friend" (ORAdj: 0.71; 95% CI: 0.52-0.96; p=0.028) and "sex worker" (ORAdj: 0.26; 95% CI: 0.11-0.60; p=0.002) variables were protective factors. CONCLUSION: the variables under study pointed to a strong relationship between steady partners and increased trust and low adherence to condom use, corroborating other studies.

Skin lesions associated with the use of N95 respirators among health professionals in Brazil in 2020. / Lesiones cutáneas asociadas con el uso de respiradores N95 en profesionales de la salud de Brasil durante 2020.

OBJECTIVE: to investigate the prevalence of skin lesions and factors associated with the use of N95 respirators among health professionals in Brazil. METHOD: cross-sectional study conducted with 11,368 health professionals using a respondent-driven sampling method adapted for online environments. Univariate and multivariate analyses were performed to investigate the association between the "skin lesions with the use of N95 respirators" variable and gender, professional category, workplace, training, COVID-19 diagnosis, and availability of sufficient and high-quality Personal Protective Equipment. RESULTS: the prevalence of skin lesions was 61.8%. Women were 1.203 times (95% CI: 1.154-1.255) more likely to develop a lesion than men. The chances of skin lesions in psychologists (PR=0.805; 95% CI: 0.678-0.956) and dentists (PR=0.884; 95% CI: 0.788-0.992), were lower when compared to Nursing professionals. Professionals with a positive COVID-19 diagnosis and working in the Intensive Care Unit have an increased chance of presenting skin lesions (PR=1.074; 95% CI: 1.042-1.107); (PR=1.203; 95% CI: 1.168-1.241), respectively. CONCLUSION: the prevalence of skin lesions caused by the use of N95 respirators was 61.8% and was associated with female gender, professional category, workplace, training, COVID-19 diagnosis, and availability of sufficient and highquality Personal Protective Equipment. (1) The overall prevalence of skin lesions was 61.8%. (2) The most affected professional category was Nursing. (3) Women were more likely to develop skin lesions than men.

Barriers to Pre-Exposure Prophylaxis (PrEP) use for HIV: an integrative review / Barreras para el uso de la Profilaxis Previa a la Exposición (PrEP) para el VIH: una revisión integradora / Barreiras para o uso da Profilaxia Pré-Exposição (PrEP) ao HIV: uma revisão integrativa

ABSTRACT Objectives: to identify and synthesize scientific evidence on the barriers and difficulties for Pre-exposure Prophylaxis (PrEP) use and compliance for HIV. Methods: an integrative literature review, using the MEDLINE/PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Academic Search Premier and Scopus (Elsevier) databases. Results: all (100%) the articles included identified that PrEP users experience some type of structural barrier related to health services such as long distance from the units, suboptimal logistics for taking pills and professional resistance to prescribing PrEP. Furthermore, 63.21% identified social barriers, such as stigma about sexuality and HIV, in addition to individual barriers such as alcohol use, adverse effects, and concerns about long-term toxicity. Conclusions: the barriers to PrEP use are multifactorial. Effective interventions are needed to support PrEP users in accessing, complying with, and retaining health services.

RESUMEN Objetivos: identificar y sintetizar evidencias científicas sobre las barreras y dificultades para el uso y la adherencia a la Profilaxis Pre-Exposición (PrEP) para el VIH. Métodos: revisión integrativa de la literatura, utilizando las bases de datos MEDLINE/PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Academic Search Premier y Scopus (Elsevier). Resultados: todos (100%) de los artículos incluidos identificaron que los usuarios de PrEP experimentan algún tipo de barrera estructural relacionada con los servicios de salud, como la larga distancia de las unidades, la logística subóptima para la toma de pastillas y la resistencia profesional a prescribir la PrEP. Además, el 63,21% identificó barreras sociales, como el estigma sobre la sexualidad y el VIH, además de las barreras individuales como el consumo de alcohol, los efectos adversos y las preocupaciones sobre la toxicidad a largo plazo. Conclusiones: las barreras para el uso de la PrEP son multifactoriales. Se necesitan intervenciones eficaces para ayudar a los usuarios de la PrEP a acceder, adherirse y conservar los servicios de salud.

RESUMO Objetivos: identificar e sintetizar as evidências científicas sobre as barreiras e dificuldades para o uso e adesão da Profilaxia Pré-exposição (PrEP) para o HIV. Métodos: revisão integrativa da literatura, utilizando as bases de dados MEDLINE/PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Academic Search Premier e Scopus (Elsevier). Resultados: todos (100%) os artigos incluídos identificaram que os usuários da PrEP experimentam algum tipo de barreira estrutural relacionada aos serviços de saúde, como longa distância das unidades, logística subótima para retirada de pílulas e resistência profissional para prescrição da PrEP. Ademais, 63,21% identificaram barreiras sociais, como estigma sobre a sexualidade e HIV, além de barreiras individuais, como uso de álcool, efeitos adversos e preocupações com a toxicidade a longo prazo. Conclusões: multifatoriais são as barreiras para o uso da PrEP. Intervenções efetivas são necessárias para apoiar os usuários da PrEP no acesso, adesão e retenção nos serviços de saúde.

Prevalência de doenças crônicas não transmissíveis em pessoas vivendo com HIV / Prevalencia de enfermedades crónicas no transmisibles en personas que viven con el VIH / Prevalence of chronic non-communicable diseases in people living with HIV

Resumo Objetivo Identificar a prevalência de doenças crônicas não transmissíveis e fatores associados em pessoas vivendo com HIV (PVHIV). Métodos Trata-se de um estudo transversal retrospectivo realizado por meio de uma análise secundária dos dados coletados entre outubro de 2014 a maio de 2018. O banco analisado incluiu amostra de 550 pessoas, provenientes de cinco Serviços de Atendimento Especializado. Foi realizado teste qui-quadrado, Odds Ratio (OR), Razão de Prevalência (RP) e seus respectivos Intervalos de Confiança (IC) de 95%, teste de Wald da estimativa e valor p<0,05. Resultados As doenças crônicas não transmissíveis mais prevalentes foram hipertensão arterial (17,89%), diabetes mellitus (7,51%) e Doença Renal Crônica (4,83%). Ter doença crônica foi associado ao sexo feminino (RP=1,18, OR=1,3, p=0,022), idade maior que 45 anos (RP=2,15, OR=6,36, p=0,001), tempo de estudo menor ou igual a oito anos (RP=1,23, OR=1,92, p=0,005), ter dislipidemia (RP=1,16, OR=2,01, p=0,001), carga viral detectável (RP=2,32, OR=2,59, p=0,001) e a contagem de células TCD4+ menor que 350 células/mm3 (RP=1,5, OR= 1,6, p=0,019), o padrão se repetiu com a razão de prevalência. Conclusão Identificou-se alta prevalência de doenças crônicas não transmissíveis entre pessoas vivendo com HIV e diversos fatores associados, considerando assim uma exposição multifatorial. Neste contexto, ressalta-se o importante papel da equipe multiprofissional na prevenção das comorbidades.

Resumen Objetivo Identificar la prevalencia de enfermedades crónicas no transmisibles y factores asociados en personas que viven con el VIH (PVVIH). Métodos Se trata de un estudio transversal retrospectivo realizado mediante un análisis secundario de los datos recopilados entre octubre de 2014 y mayo de 2018. El banco analizado incluyó la muestra de 550 personas provenientes de cinco Servicios de Atención Especializada. Se realizó la prueba χ2 de Pearson, Odds Ratio (OR), Razón de Prevalencia (RP) y sus respectivos Intervalos de Confianza (IC) del 95 %, prueba de Wald de la estimación y valor p<0,05. Resultados Las enfermedades crónicas no transmisibles más prevalentes fueron la hipertensión arterial (17,89 %), diabetes mellitus (7,51 %) y enfermedad renal crónica (4,83 %). Padecer enfermedad crónica estuvo asociado al sexo femenino (RP=1,18, OR=1,3, p=0,022), edad superior a 45 años (RP=2,15, OR=6,36, p=0,001), tiempo de estudio inferior o igual a ocho años (RP=1,23, OR=1,92, p=0,005), padecer dislipidemia (RP=1,16, OR=2,01, p=0,001), carga viral detectable (RP=2,32, OR=2,59, p=0,001) y el recuento de células TCD4+ inferior a 350 células/mm3 (RP=1,5, OR= 1,6, p=0,019), el patrón se repitió con la razón de prevalencia. Conclusión Se Identificó alta prevalencia de enfermedades crónicas no transmisibles en personas que viven con el VIH y distintos factores asociados, considerando, de esa forma, una exposición multifactorial. En este contexto, se destaca el importante papel del equipo multiprofesional para la prevención de las comorbilidades.

Abstract Objective To identify the prevalence of chronic non-communicable diseases and associated factors in people living with HIV (PLHIV). Methods This is a retrospective cross-sectional study carried out through a secondary data analysis, collected between October 2014 and May 2018. The analyzed database included a sample of 550 people from five Specialized Care Services. Chi-square test, Odds Ratio (OR), Prevalence Ratio (PR) and their respective Confidence Intervals (CI) of 95%, Wald test of the estimate and p-value <0.05 were performed. Results The most prevalent chronic non-communicable diseases were hypertension (17.89%), diabetes mellitus (7.51%) and chronic kidney disease (4.83%). Having a chronic disease was associated with being female (PR=1.18, OR=1.3, p=0.022), age greater than 45 years (PR=2.15, OR=6.36, p=0.001), study time less than or equal to eight years (PR=1.23, OR=1.92, p=0.005), having dyslipidemia (PR=1.16, OR=2.01, p=0.001), detectable viral load (PR=2.32, OR=2.59, p=0.001) and TCD4+ cell count less than 350 cells/mm3 (PR=1.5, OR= 1.6, p=0.019). The pattern was repeated with the Prevalence Ratio. Conclusion A high prevalence of chronic non-communicable diseases was identified among people living with HIV and several associated factors, thus considering a multifactorial exposure. In this context, the important role of a multidisciplinary team in comorbidity prevention is emphasized.

Tratamento como prevenção na perspectiva de pessoas vivendo com HIV/aids / Tratamiento como prevención en la perspectiva de personas que viven con el VIH/sida / Treatment as prevention from the perspective of people living with HIV/AIDS

Resumo Objetivo Analisar os fatores associados ao conhecimento sobre a eficácia do tratamento como prevenção de pessoas que vivem com o HIV. Métodos Estudo transversal e analítico realizado com pessoas que vivem com HIV/aids atendidas em cinco serviços de atendimento especializado em um município do interior paulista. Os dados foram coletados por meio de entrevistas individuais onde se utilizou de um questionário semiestruturado. Os resultados foram analisados por meio da estatística descritiva, univariada e regressão logística. Resultados 286 pessoas vivendo com HIV participaram do estudo, 108 (37.8%) homens que fazem sexo com homens, com idade superior a 45 anos (36.4%). Foi identificado que apenas 15,0% dos participantes apresentaram conhecimento sobre a eficácia do tratamento como prevenção. Não ter conhecimento sobre a eficácia do tratamento como prevenção foi associado com ter 2 e 4 parceiros sexuais 0.24 (IC 95% 0.08,0.68), usar o preservativo de forma inconsistente 2.69 (IC 95% 1.26,5.77), não buscar a informação 4.31(IC 95% 1.18,15.78) e não revelar o diagnóstico aos parceiros 3.02 (IC 95%1.41,6.48). Conclusão O conhecimento sobre a eficiência do tratamento como prevenção foi baixo e se associou a comportamentos e práticas de maior risco. Intervenções voltadas para as pessoas que vivem com HIV que têm relacionamentos sorodiferentes são urgentes e podem beneficiar ambos os parceiros, ser incentivo para a obtenção e manutenção da supressão viral, motivação para adesão do tratamento com a terapia antirretroviral e prevenção da transmissão sexual do HIV.

Resumen Objetivo Analizar los factores asociados a los conocimientos sobre la eficacia del tratamiento como prevención de personas que viven con el VIH. Métodos Estudio transversal y analítico realizado con personas que viven con el VIH/sida atendidas en cinco servicios de atención especializada en un municipio del interior del estado de São Paulo. Los datos fueron recopilados por medio de entrevistas individuales donde se utilizó un cuestionario semiestructurado. Los resultados fueron analizados mediante la estadística descriptiva, univariada y regresión logística. Resultados Participaron del estudio 286 personas que viven con el VIH, 108 (37,8 %) hombres que tienen relaciones sexuales con hombres, de edad superior a 45 años (36,4 %). Se observó que solo el 15,0 % de los participantes tenía conocimientos sobre la eficacia del tratamiento como prevención. La falta de conocimientos sobre la eficacia del tratamiento como prevención se relacionó con tener dos y cuatro parejas sexuales 0.24 (IC 95 % 0.08,0.68), usar preservativo de forma inconsistente 2.69 (IC 95 % 1.26,5.77), no buscar información 4.31 (IC 95 % 1.18,15.78) y no informar el diagnóstico a las parejas 3.02 (IC 95 % 1.41,6.48). Conclusión Los conocimientos sobre la eficiencia del tratamiento como prevención fueron bajos y se asoció a comportamientos y prácticas de mayor riesgo. Es urgente realizar intervenciones orientadas a personas que viven con el VIH que tienen relaciones serodiscordantes, ya que pueden beneficiar a las dos personas de la pareja, ser un incentivo para la obtención y el mantenimiento de la supresión viral y ser motivación para la adhesión al tratamiento antirretroviral y prevención de la transmisión sexual del VIH.

Abstract Objective To analyze factors associated with knowledge about the effectiveness of treatment as prevention for people living with HIV. Methods This is a cross-sectional and analytical study carried out with people living with HIV/AIDS treated at five specialized care services in a city in the countryside of São Paulo. Data were collected through individual interviews using a semi-structured questionnaire. The results were analyzed using descriptive and univariate statistics and logistic regression. Results 286 people living with HIV participated in the study, 108 (37.8%) men who have sex with men, aged over 45 years (36.4%). It was identified that only 15.0% of participants had knowledge about the effectiveness of treatment as prevention. Not having knowledge about the effectiveness of treatment as prevention was associated with having 2 and 4 sexual partners 0.24 (95%CI 0.08,0.68), using condoms inconsistently 2.69 (95%CI 1.26,5.77), not seeking information 4.31 (95%CI 1.18,15.78) and not disclosing the diagnosis to partners 3.02 (95%CI 1.41,6.48). Conclusion Knowledge about the effectiveness of treatment as prevention was low and was associated with higher risk behaviors and practices. Interventions targeting people living with HIV who have serodifferent relationships are urgent and can benefit both partners, be an incentive for achieving and maintaining viral suppression, motivation for treatment compliance with antiretroviral therapy and HIV transmission prevention.

Identificação e condução de manifestação oftálmica de mpox pela vigilância epidemiológica: relato de experiência / Identification and management of ophthalmic manifestation of mpox by epidemiological surveillance: experience report / Identificación y manejo de la manifestación oftálmica del mpox mediante vigilancia epidemiológica: informe de una experiencia

Objetivo: descrever o processo de condução de um caso com manifestação oftálmica pela mpox, destacando o trabalho da enfermagem na prevenção de complicações da doença. Método: relato de experiência da condução de um caso de mpox ocorrido em setembro de 2022 com manifestação oftálmica. Resultados: a pronta identificação da complicação oftálmica, com a presença de conjuntivite e edema palpebral, apresentada por um paciente com suspeita de mpox pela equipe de enfermagem da vigilância epidemiológica durante as ações de monitoramento, e o envolvimento da equipe com outras equipes de diversos níveis da assistência à saúde permitiram a instituição precoce do tratamento com antiviral recomendado pelo Ministério da Saúde, o que contribuiu para um melhor desfecho. Conclusão: é importante que se dissemine o conhecimento sobre as manifestações oftálmicas associadas à mpox para que a equipe de enfermagem, que atua nos diversos níveis de atenção à saúde, esteja atenta para implementar, de forma precoce, medidas de prevenção, diagnóstico e tratamento adequados.

Objective: to describe the process of conducting a case with ophthalmic manifestation by mpox, highlighting the work of nursing in preventing complications of the disease. Method: experience report of managing a case of mpox that occurred in September 2022 with ophthalmic manifestation. Results: the prompt identification of the ophthalmic complication, with the presence of conjunctivitis and eyelid edema, presented by a patient with suspected mpox by the epidemiological surveillance nursing team during monitoring actions and the team's involvement with other teams from different levels of the health care allowed the early initiation of antiviral treatment recommended by the Ministry of Health, which contributed to a better outcome. Conclusion: it is important to disseminate knowledge about ophthalmic manifestations associated with mpox for the nursing team that works at different levels of health care to be attentive to implement preventive measures, diagnosis and adequate and early treatment.

Objetivo: describir el proceso de manejo de un caso con manifestación of- talmológica por mpox, destacando la labor de enfermería en la prevención de complica- ciones de la enfermedad. Material y método: relato de experiencia de manejo de un caso de mpox ocurrido en septiembre de 2022 con manifestación oftálmica. Resultados: la rápida identificación de la complicación oftálmica, con la presencia de conjuntivitis y edema de párpados, presentada por un paciente con sospecha de mpox por el equipo de enfermería de vigilancia epidemiológica durante las acciones de monitoreo y la partici- pación del equipo con otros equipos de diferentes niveles de la asistencia sanitaria per- mitió el inicio precoz del tratamiento antiviral recomendado por el Ministerio de Salud, lo que contribuyó a un mejor resultado. Conclusión: es importante difundir el conoci- miento sobre las manifestaciones oftálmicas asociadas a la viruela del mono para que el equipo de enfermería que actúa en los diferentes niveles de atención a la salud esté atento a implementar medidas preventivas, diagnósticas y de tratamiento adecuado y precoz.