HIV pre-exposure prophylaxis and incidence of sexually transmitted infections in Brazil, 2018 to 2022: An ecological study of PrEP administration, syphilis, and socioeconomic indicators.

BACKGROUND: Human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) is one of the pillars of a combination prevention strategy for reducing the risk of new infections caused by HIV. The daily use of antiretroviral drugs by individuals who are not infected with HIV is required to prevent infection. Although its efficacy has been well established in the literature, in recent years, the decreased supply of antiretroviral drugs has been associated with an increase in the incidence of sexually transmitted infections (STI) and changes in the social determinants of health. An ecological study was conducted covering a five-year period (2018-2022), starting from the year of initiation of PrEP administration in Brazilian state capitals. PRINCIPAL FINDINGS: Descriptive analysis was performed, and the spatial distribution of study data was taken into account. Correlation analysis was used to assess the association between PrEP administration, the incidence and detection rate of STI, and socioeconomic data. The southern region showed the highest incidence rates of STI, but the northern and northeastern regions demonstrated the worst socioeconomic indicators, especially those related to illiteracy and basic sanitation. PrEP administration was significantly correlated with illiteracy (ρ = -0.658), per capita income (ρ = 0.622), public garbage collection (ρ = 0.612), syphilis (ρ = 0.628) and viral hepatitis (ρ = 0.419) incidences. Further, all STI were significantly associated with illiteracy and per capita income. SIGNIFICANCE: Our findings highlight the need to continue exploring PrEP use and rising syphilis rates. In terms of policy, PrEP administration appears to be inversely associated with regions of greater social vulnerability. Further efforts should focus on the social determinants and health needs of this population to improve access to PrEP and reduce social disparities.

Disease burden of congenital Zika virus syndrome in Brazil and its association with socioeconomic data.

Zika virus (ZIKV) infection became a global public health concern, causing an epidemic in Latin America from 2015 to 2016, when a sudden increase in cases of microcephaly and other congenital anomalies was observed. In 2016, the Centers for Disease Control and Prevention and the World Health Organization defined congenital Zika-associated syndrome (CZS) as a set of congenital anomalies seen in children born to mothers with a history of gestational Zika fever, who have microcephaly as the most prevalent clinical sign. In order to describe the magnitude of CZS in Brazil, this study estimated the burden of disease due to CZS in Brazil using the disability-adjusted life years (DALY) indicator and other frequency measures, such as incidence and mortality rate, during the years 2015-2020. The association of these indicators with socioeconomic variables was also evaluated using Spearman's correlation coefficient. Choropleth maps were used to evaluate the spatial distribution of the indicators evaluated and the spatial autocorrelation was verified by the Bivariate Moran Local Index. From 2015 to 2020, 3,591 cases of CZS were confirmed in Brazil, with an incidence of 44.03 cases per 1000 live births, and a specific mortality of 12.35 deaths per 1000 live births. A global loss of 30,027.44 DALYs was estimated from 2015 to 2020. The Northeast region had the highest values for all health indicators assessed. Spatial correlation and autocorrelation analyses showed significant associations between health and socioeconomic indicators, such as per capita income, Gini index, illiteracy rate and basic sanitation. The study allowed us to have access to all reported cases of CZS, showing us the possible situation of the disease in Brazil; therefore, we believe that our results can help in the understanding of future studies.

Adherence to antiretroviral therapy in people living with HIV with moderate or severe mental disorder.

Human immunodeficiency virus (HIV) infection remains a serious public health concern, with an estimated 38 million people living with HIV (PLHIV). PLHIV are often affected by mental disorders at higher rate than the general population. One challenge in the control and prevention of new HIV infections is adherence to antiretroviral therapy (ART), with PLHIV with mental disorders having seemingly lower adherence than PLHIV without mental disorders. This cross-sectional study assessed adherence to ART in PLHIV with mental disorders who attended the Psychosocial Care Network health facilities in Campo Grande, Mato Grosso do Sul, Brazil, from January 2014 to December 2018. Data from health and medical databases were used to describe clinical-epidemiological profiles and adherence to ART. To assess the associated factors (potential risk or predisposing factors) with ART adherence, we used logistic regression model. Adherence was extremely low (16.4%). Factors associated with poor adherence were lack of clinical follow-up, particularly in middle-aged PLHIV. Other apparently associated factors were living on the streets and having suicidal ideation. Our findings reinforce the need for improvements in the care for PLHIV with mental disorders, especially in the integration between specialized mental health and infectious disease health facilities.

Congenital anomalies during the 2015-2018 Zika virus epidemic: a population-based cross-sectional study.

BACKGROUND: Congenital anomalies are associated with several clinical and epidemiological complications. Following the Zika epidemic onset in Latin America, the incidence of congenital anomalies increased in Brazil. This study aimed to determine the frequency of congenital anomalies in one Brazilian state and assess potential factors associated with them. METHODS: This cross-sectional descriptive study was based on data concerning congenital anomalies recorded in the Brazilian Live-Born Information System during the Zika epidemic in Mato Grosso do Sul state from 2015 to 2018. Congenital anomalies were stratified according to year of birth and classified using ICD-10 categories. RESULTS: In total, 1,473 (0.85%) anomalies were registered. Within the number of cases recorded, microcephaly showed the greatest frequency and variations, with a 420% increase observed in the number of cases from 2015 to 2016. We identified an increase in the incidence of central nervous system anomalies, with the highest peak observed in 2016 followed by a subsequent decrease. Musculoskeletal, nervous, and cardiovascular system anomalies, and eye, ear, face, and neck anomalies represented 73.9% of all recorded anomalies. There was an increased chance of congenital anomalies in uneducated (odds ratio [OR] 5.56, 95% confidence interval [CI] 2.61-11.84) and Indigenous (OR 1.32, 95% CI 1.03-1.69) women, as well as among premature births (OR 2.74, 95% CI 2.39-3.13). CONCLUSIONS: We estimated the incidence of congenital anomalies during the Zika epidemic. Our findings could help to support future research and intervention strategies in health facilities to better identify and assist children born with congenital anomalies.

Consumption of antidepressants and economic austerity in Brazil.

OBJECTIVE: To describe consumption of antidepressants in Brazil through dispensing data from pharmacy retail outlets, in between 2011 and 2017, and explore the relationship between consumption patterns and changing economic context during this period. METHODS: A time-series analysis of dispensing data from pharmacy retail outlets was carried out considering 10 commonly used antidepressants. DDDs/1000 inhabitants/year for each drug were calculated for each quarter. Ttime-series graphs were constructed to analyze the volumes of drugs purchasedRelationship between economic context and consumption was assessed using the following indicators: annual percent change in Gross Domestic Product (GDP), public debt (% of GDP), and annual net savings (in billions of Brazilian reais - BRL). RESULTS: Overall consumption of antidepressants increased over the study period despite a sharp fall of -3.55% in annual percent change in GDP, negative net annual savings of -53.568 BRL, and an increase in public debt exceeding 32% of the GDP during the economic crisis of 2015. CONCLUSION: Consumption of antidepressants from pharmacy retail outlets increased even within a context of economic crisis, which may be a reflection of the disease burden in Brazil. Health budget cuts due to the economic crisis may be directing users to out-of-pocket expenses, deepening social inequalities.

Demographics, Socioeconomic Status, Social Distancing, Psychosocial Factors and Psychological Well-Being among Undergraduate Students during the COVID-19 Pandemic.

The COVID-19 pandemic impacted on academic routine because of the social distancing measures. This study examined the relationships of sociodemographic characteristics, social distancing aspects and psychosocial factors on psychosocial well-being among undergraduate students during the social distancing period due to COVID-19. A web-based survey was conducted of undergraduate students at a public university in Brazil (n = 620). Demographics, socioeconomic status (SES), social distancing factors, negative affectivity (DASS-21), sense of coherence (SOC-13), social support and psychosocial well-being (GHQ-12) were measured. The direct and indirect links between was variables was tested using structural equation modelling. The estimated model showed that greater social support, higher sense of coherence and lower negative affectivity were directly associated with better psychological well-being. Female gender, higher SES, not working during the social distancing period and availability of online modules were indirectly associated with psychological well-being through psychosocial factors. Working during the social distancing period and availability of online modules mediated the link of age, gender, SES with psychological well-being. Our findings suggest the need to provide psychological support, online teaching and financial aid to undergraduate students during the social distancing period due to COVID-19 pandemic to improve their psychological well-being.

An ontology of Pharmaceutical Services in the pages of Journal Ciência & Saúde Coletiva. / Uma proposta de ontologia para a Assistência Farmacêutica a partir das páginas da Revista Ciência & Saúde Coletiva.

Pharmaceutical Services (PS) is a growing field which has established itself over the last 25 years in Brazil through scientific publications. This work investigates the evolution of the field in the Brazilian periodical Journal Ciência & Saúde Coletiva. We conducted a scoping review of relevant literature produced in four separate periods (1996-2003, 2004-2010, 2011-2015, and 2016-2019). A search for articles that contained one or more of the pre-established key words in the title was performed by separate pairs of reviewers. The search resulted in 307 articles, 260 of which were included. The findings show that the number of publications increased steadily over the study period. The papers were predominantly open-topic and original articles and written in Portuguese. Most of the lead authors were from the South and Southeastern regions of Brazil and from public universities and Fiocruz. The predominant primary theme was medicine utilization (161 articles), followed by management (56), and tangential aspects of the PM cycle (43). An ontology of PS was created based on the classification of the articles. The findings show that the field of PS encompasses public policy and management and frontline activities involved in the delivery of health care to the population. It is hoped that the diverse range of interrelations in the field of PS will be increasingly addressed in future publications.

A Assistência Farmacêutica (AF) é um campo em expansão no Brasil e nos últimos 25 anos vem se consolidando também através da publicação científica. O objetivo deste trabalho foi investigar a evolução da AF como campo na Revista Ciência & Saúde Coletiva. Uma revisão de escopo, em quatro períodos, 1996-2003, 2004-2010, 2011-2015, 2016-2019, foi realizada por duplas de pesquisadores, buscando palavras e termos de busca nos títulos. As inclusões foram totalizadas por ano de publicação, suas características descritas quanto ao tipo de artigo, idioma, local e instituição de origem do primeiro autor e classificadas por temáticas principais, secundárias e especificidades. Foram resgatados 307 artigos e incluídos 260. Os resultados refletiram aumento de publicações ao longo do tempo, participação majoritária de artigos de tema livre e originais, em português, de autores das regiões Sul e Sudeste, de universidades públicas e da Fiocruz. Os temas principais foram Utilização de Medicamentos (161 artigos), Gestão (56) e Temas Tangenciais ao Ciclo da AF (43). A partir da classificação foi elaborada uma ontologia própria da AF. O campo reúne política pública a atividades gerenciais e de cuidados em saúde à população. Espera-se que essa variada gama de interrelações venha a se expressar cada vez mais na publicação científica.

Uma proposta de ontologia para a Assistência Farmacêutica a partir das páginas da Revista Ciência & Saúde Coletiva / An ontology of Pharmaceutical Services in the pages of Journal Ciência & Saúde Coletiva

Resumo A Assistência Farmacêutica (AF) é um campo em expansão no Brasil e nos últimos 25 anos vem se consolidando também através da publicação científica. O objetivo deste trabalho foi investigar a evolução da AF como campo na Revista Ciência & Saúde Coletiva. Uma revisão de escopo, em quatro períodos, 1996-2003, 2004-2010, 2011-2015, 2016-2019, foi realizada por duplas de pesquisadores, buscando palavras e termos de busca nos títulos. As inclusões foram totalizadas por ano de publicação, suas características descritas quanto ao tipo de artigo, idioma, local e instituição de origem do primeiro autor e classificadas por temáticas principais, secundárias e especificidades. Foram resgatados 307 artigos e incluídos 260. Os resultados refletiram aumento de publicações ao longo do tempo, participação majoritária de artigos de tema livre e originais, em português, de autores das regiões Sul e Sudeste, de universidades públicas e da Fiocruz. Os temas principais foram Utilização de Medicamentos (161 artigos), Gestão (56) e Temas Tangenciais ao Ciclo da AF (43). A partir da classificação foi elaborada uma ontologia própria da AF. O campo reúne política pública a atividades gerenciais e de cuidados em saúde à população. Espera-se que essa variada gama de interrelações venha a se expressar cada vez mais na publicação científica.

Abstract Pharmaceutical Services (PS) is a growing field which has established itself over the last 25 years in Brazil through scientific publications. This work investigates the evolution of the field in the Brazilian periodical Journal Ciência & Saúde Coletiva. We conducted a scoping review of relevant literature produced in four separate periods (1996-2003, 2004-2010, 2011-2015, and 2016-2019). A search for articles that contained one or more of the pre-established key words in the title was performed by separate pairs of reviewers. The search resulted in 307 articles, 260 of which were included. The findings show that the number of publications increased steadily over the study period. The papers were predominantly open-topic and original articles and written in Portuguese. Most of the lead authors were from the South and Southeastern regions of Brazil and from public universities and Fiocruz. The predominant primary theme was medicine utilization (161 articles), followed by management (56), and tangential aspects of the PM cycle (43). An ontology of PS was created based on the classification of the articles. The findings show that the field of PS encompasses public policy and management and frontline activities involved in the delivery of health care to the population. It is hoped that the diverse range of interrelations in the field of PS will be increasingly addressed in future publications.

Neurological Development, Epilepsy, and the Pharmacotherapy Approach in Children with Congenital Zika Syndrome: Results from a Two-Year Follow-up Study.

Clinical outcomes related to congenital Zika syndrome (CZS) include microcephaly accompanied by specific brain injuries. Among several CZS outcomes that have been described, epilepsy and motor impairments are present in most cases. Pharmacological treatment for seizures resulting from epilepsy is performed with anticonvulsant drugs, which in the long term are related to impairments in the child's neuropsychomotor development. Here, we describe the results from a two-year follow-up of a cohort of children diagnosed with CZS related to the growth of the head circumference and some neurological and motor outcomes, including the pharmacological approach, and its results in the treatment of epileptic seizures. This paper is part of a prospective cohort study carried out in the state of Mato Grosso Sul, Brazil, based on a Zika virus (ZIKV)-exposed child population. Our data were focused on the assessment of head circumference growth and some neurological and motor findings, including the description of seizure conditions and pharmacological management in two periods. Among the 11 children evaluated, 8 had severe microcephaly associated with motor impairment and/or epilepsy. Seven children were diagnosed with epilepsy. Of these, 3 had West syndrome. In four children with other forms of epilepsy, there was no pharmacological control.

Health demands and care of children with congenital Zika syndrome and their mothers in a Brazilian state.

BACKGROUND: A Zika virus (ZIKV) infection outbreak occurred in Brazil in 2015, accompanied by a marked increase in the number of newborns presenting with microcephaly and other neurological disorders. This characteristic set of birth defects was later termed congenital Zika syndrome (CZS). The therapeutic itinerary of mothers and children infected by ZIKV can be determined by several factors, including the relationship established with existing healthcare services. Here, we aimed to describe and analyze the extent to which children with CZS, born from 2015 to 2018 in the state of Mato Grosso do Sul, Brazil, and their mothers were treated according to the guidelines established by the Brazilian Ministry of Health. METHODS: This was a descriptive cross-sectional study that considered all children (and respective mothers) with confirmed or suspected CZS born in Mato Grosso do Sul. Children and their mothers were identified based on all suspected or confirmed cases of congenital anomalies in Mato Grosso do Sul that were reported to the Registry of Public Health Events. We analyzed data on the epidemiological profile of mother-child pairs and the care received by them. Data were summarized using statistical descriptive analysis. RESULTS: We showed that most mothers were white women (57%) with low income. Among pregnant women, 73% had a diagnosis of fever caused by ZIKV infection at a primary health care institution (PHCI), but only 36% received the necessary information regarding the risk of CZS. Over a third (36%) of the mothers did not receive guidance about childcare follow-up and 73% did not receive guidance regarding the availability of social support after childbirth. Gaps in medical care were observed mainly in pregnant women treated at a PHCI. Specialized assistance for children was adequate in most cases. Psychosocial support was not made available to women throughout their therapeutic itineraries. CONCLUSIONS: Here, we identified gaps in the care of families and children with disabilities, which can have an important impact on their quality of life. Beyond protocols, practical interventions must cover all the needs that arise throughout the therapeutic itineraries not only of children but also of pregnant women and mothers.

Falhas na gestão da Assistência Farmacêutica para Medicamentos Judicializados, em 16 municípios da região Sudeste brasileira / Failures in Pharmaceutical Services management for Judicialized Medicines, in 16 municipalities of the Brazilian Southeast

RESUMO Desde a década de 1990, as solicitações de medicamentos por via judicial vêm se intensificando. Vários estudos têm traçado o panorama destas demandas. Buscou-se descrever a existência de organização própria da gestão da Assistência Farmacêutica (AF) Municipal para o atendimento de medicamentos demandados judicialmente. Um conjunto de 16 municípios incluiu 4 de cada estado da região Sudeste brasileira. Para a descrição do perfil da gestão da AF, foi estruturada uma matriz de indicadores que contemplou suas dimensões de recursos humanos, financeiros e suas atividades. Em nove municípios, a gestão dos medicamentos solicitados por via judicial coube ao gestor local da AF. Os indicadores com os piores desempenhos em todas as respostas foram aqueles que versaram sobre as despesas com Medicamentos Judicializados. Somente seis gestores informaram que realizavam análise técnica das prescrições e contato regular com o judiciário. Em sete municípios, os gestores não souberam especificar a modalidade de aquisição dos medicamentos demandados. A gestão municipal tem papel preponderante sobre a gestão da AF e precisa ser revista, havendo a necessidade de amplo questionamento a respeito do seu papel e de eventuais mudanças pelas quais possa passar.

ABSTRACT Since the 1990s, judicial demands for medicines have intensified. Several studies have outlined these demands. We describe the organization of the management of Municipal Pharmaceutical Services (PS) for the provision of medicines demanded through litigation. The sample included 16 municipalities, four for each state in the Brazilian Southeast. To describe the management profile of PS, a matrix of indicators was developed including dimensions of human and financial resources, and PS activities. In nine municipalities, management of medicines acquired through litigation was the responsibility of the local manager of PS. Indicators on expenditures with litigated medicines were the ones with the worst performance. Only six managers informed using technical analysis of prescriptions and regular contact with the judiciary. In seven municipalities, managers were unable to specify the modality of acquisition of medicines. Municipal management plays a major role in the management of PS and must be reviewed, with the need for a thorough questioning regarding its role and possible changes it needs to implement.

Factors influencing pharmaceutical pricing - a scoping review of academic literature in health science.

INTRODUCTION: Pharmaceutical pricing has only recently gained space in mainstream health science literature. OBJECTIVES: Bibliometric and content description of health science academic literature and ad hoc analysis of grey literature on factors influencing pharmaceutical pricing on databases commonly accessed by healthcare professionals. METHODS: Scoping study with no time limits performed in Medline, Scopus and Scielo, and relevant sites and databases for grey literature, using search terms with database-appropriate keywords. RESULTS: Two hundred four articles were published in 103 peer-reviewed journals between 1981 and 2016 (last search year). In grey literature 78 documents were retrieved in the final selection. Five key thematic clusters for analysing pharmaceutical pricing emerged: market dynamics, segmented into (i) supply-related, (ii) consumer-related and (iii) product-related; (iv) trading strategies, either buyer's or seller's and (v) regulatory approach. In peer-reviewed literature there is an overall dominance of themes referring to trading strategies and regulatory approaches and a wide thematic cluster scope. Over half of this literature was produced after the year 2010. International agency technical papers make up the most significant contributions of grey literature, with a clear focus on regulatory approaches to pricing and wider consideration of emerging countries. Research lags in the literature on factors affecting pharmaceutical pricing include impacts of financing schemes, market liberalization, internet trading and biosimilars on prices, with insufficient discussion identified for the effects of discounts/rebates, profits and price transparency. CONCLUSIONS: Interest in pharmaceutical pricing literature is increasing. Robust evidence-producing study designs for pricing interventions will be a welcome development.

Sustainability of ARV provision in developing countries: challenging a framework based on program history.

The provision of ARVs is central to HIV/AIDS programs, because of its impact on the course of the disease and on quality of life. Although first-line treatments costs have declined, treatment-associated expenses are steeper each year. Sustainability is therefore an important variable for the success of treatment programs. A conceptual framework on sustainability of ARV provision was developed, followed by data collection instruments. The pilot study was undertaken in Brazil. Bolivia, Peru and Mozambique, were visited. Key informants were identified and interviewed. Investigation of sustainability related to ARV provision involved implementation and routinization events of provision schemes. Evidence of greater sustainability potential was observed in Peru, where provision is implemented and routinized by the National HIV/AIDS program and expenditures met by the government. In Mozambique, provision is dependent on donations and external aid, but the country displays a great effort to incorporate ARV provision and care in routine healthcare activities. Bolivia, in addition to external dependence on financing and management of drug supply, presents problems regarding implementation and routinization. The conceptual framework was useful in recognizing events that influence sustainable ARV provision in these countries.

Sustainability of ARV provision in developing countries: challenging a framework based on program history / Sustentabilidade da provisão de medicamentos ARV em países em desenvolvimento: modelo de avaliação com base na história do programa

Abstract The provision of ARVs is central to HIV/AIDS programs, because of its impact on the course of the disease and on quality of life. Although first-line treatments costs have declined, treatment-associated expenses are steeper each year. Sustainability is therefore an important variable for the success of treatment programs. A conceptual framework on sustainability of ARV provision was developed, followed by data collection instruments. The pilot study was undertaken in Brazil. Bolivia, Peru and Mozambique, were visited. Key informants were identified and interviewed. Investigation of sustainability related to ARV provision involved implementation and routinization events of provision schemes. Evidence of greater sustainability potential was observed in Peru, where provision is implemented and routinized by the National HIV/AIDS program and expenditures met by the government. In Mozambique, provision is dependent on donations and external aid, but the country displays a great effort to incorporate ARV provision and care in routine healthcare activities. Bolivia, in addition to external dependence on financing and management of drug supply, presents problems regarding implementation and routinization. The conceptual framework was useful in recognizing events that influence sustainable ARV provision in these countries.

Resumo A provisão de medicamentos ARV é central para programas de HIV/Aids, devido a seu impacto no curso da doença e na qualidade de vida. Embora os custos de tratamentos de primeira linha tenham diminuído, os gastos dos programas com os tratamentos tem aumentado a cada ano. A sustentabilidade torna-se fator fundamental para o sucesso dos programas. Um modelo conceitual para avaliação da sustentabilidade da provisão de ARV e instrumentos de coleta de dados foram desenvolvidos. Um estudo piloto foi realizado no Brasil e a pesquisa de campo cobriu Bolívia, Moçambique e Peru. Informantes-chaves foram identificados e entrevistados. Eventos críticos de implementação e rotinização foram investigados na história dos programas. Foi observado maior potencial para sustentabilidade no Peru, onde a provisão está implementada e rotinizada e os gastos são cobertos pelo governo nacional. Em Moçambique, o financiamento da provisão é quase totalmente dependente de ajuda internacional, mas há grandes esforços voltados à expansão da cobertura e rotinização do cuidado a PVH. Na Bolívia, além da dependência externa para o financiamento há problemas de implementação e gerenciamento da provisão. O modelo avaliativo mostrou-se útil na identificação de fatores que influenciam a capacidade para sustentabilidade dos programas nesses países.

[The "Farmácia Popular do Brasil" Program and aspects of public provision of medicines in Brazil]. / Quem acessa o Programa Farmácia Popular do Brasil? Aspectos do fornecimento público de medicamentos.

In 2004, the Federal Government introduced the "Farmácia Popular do Brasil" Program, which was an example of policy innovation, establishing a co-payment scheme as a strategy for access to medication. The study analyzed the original model of the Program. Data were obtained from interviews with key stakeholders, program documents and user prescriptions and registers. The results showed widespread expansion of the PFPB network and in the number of people attended. Despite the ever-increasing number of people attended with prescriptions from the private sector, a large demand from public sector users, namely the original focus of the program, was observed. From the standpoint of the federative pact, the program reinstates the centralized model of essential medication distribution which, in the decentralized public system is under state and municipal responsibility. The results point to the difficulty in compliance by states and municipalities with medication distribution responsibilities, mainly in the North and Northeast regions of Brazil. The study concludes that the population has been consistently turning to the PFPB for essential medication it has not been able to access in the public sector.