Factors Associated with HIV and Vulnerability Contexts for Women in Brazil.

The purpose of this study was to identify factors associated with HIV and vulnerability contexts for women in Porto Alegre, Brazil. The participants were 1326 women recruited by complex sampling design, divided into two groups: 640 women with HIV (WLH) and 686 women who did not have HIV (WNLH). Gross and weighted statistical analyses were performed. Logistic regression models were used to estimate the odds ratio (OR) for 12 variables. The main results demonstrated that WLH had lower income (p < .001) and poorer education (p = .038), and few used condoms during their first sexual intercourse (p < .001). The occurrence of HIV was higher among the black population (p < .001). Sex in exchange for money (p < .001) and sexually transmitted infections (p < .001) were more frequent among WLH than among WNLH. The age of sexual debut and age difference from the partner at first sexual intercourse (FSI) were not associated with the outcome. The high percentage of non-use of condoms during the FSI shows how vulnerable individuals are right at the beginning of their sexual lives. More effective prevention strategies can be developed by nurses in view of the contexts of vulnerability surrounding women.

Fatores associados às perdas de seguimento de crianças expostas ao HIV: um estudo no município de Porto Alegre / Factors associated with losses to follow-up in HIV-exposed children: a study in the city of Porto Alegre

Introdução: Apesar das condutas disponíveis para evitar a transmissão vertical do HIV, existem cenários como Porto Alegre, que permanecem com elevadas taxas. Perda de seguimento é aquela criança que foi exposta ao HIV, e que no momento do encerramento do caso, não foi localizada na rede de saúde para a realização de diagnóstico laboratorial. Objetivo: Analisar as "perdas de seguimentos" de crianças expostas à transmissão vertical do HIV e os fatores associados, no município de Porto Alegre. Métodos: Trata-se de um estudo de coorte histórica, no período de 2000 a 2017. Os dados foram coletados do Sistema de Informação de Agravos de Notificação. Foram investigadas informações relativas à mãe e a criança. Comparações foram realizadas por meio do teste de homogeneidade de proporções baseado na estatística de qui-quadrado de Pearson. Preditores foram investigados por modelo de regressão de Poisson com variação robusta. Resultados: Entre as 8.520 crianças expostas ao HIV, 1.762 (25,9%) foram classificadas como perda de seguimento. O perfil demográfico das mães de crianças perda de seguimento é de mulheres entre 21 a 35 anos (71,1%), predominantemente com 4 a 7 anos de estudo (49,9%), e brancas (53,9%). Em 78,4% dos casos o pré-natal não foi iniciado no primeiro trimestre (p<0,001). Estiveram associados à perda de seguimento os seguintes fatores socioeconômicos, comportamentais e de saúde das gestantes: ter até 20 anos de idade (OR = 1,47, IC95%: 1,17-1,84) ou 21 a 35 anos (OR = 1,34, IC95%: 1,09-1,64); se autodeclarar como preta (OR = 1,11, IC95% 1,01-1,24); fazer uso de drogas injetáveis (OR = 1,21, IC95%: 1,04-1,42), diagnóstico de HIV durante o pré-natal ou parto (OR = 1,32, IC95%: 1,19-1,47), e iniciar o pré-natal após o primeiro trimestre (OR = 1,22, IC95%: 1,08-1,39). Conclusão: Um expressivo percentual de gestante apresentou início tardio de pré-natal. Os preditores da perda de seguimento, que foram: idade mais jovem, autodeclarar raça/cor preta, uso de drogas injetáveis, diagnóstico de HIV no pré-natal ou parto e início tardio do pré-natal, remetem aos contextos de vulnerabilidade individual, social e programático que as gestantes estão inseridas.

Introduction: Despite the available conducts to prevent mother-to-child transmission of HIV, there are scenarios, such as Porto Alegre, that remain with high rates. Loss to follow-up is a child exposed to HIV who, at the time of case closure, was not located in the health network for laboratory diagnosis. Objective: To analyze the "loss to follow-up" of children exposed to mother-to-child transmission of HIV and the associated factors in the municipality of Porto Alegre. Methods: This is a historical cohort study from 2000 to 2017. Data were collected from the Notifiable Diseases Information System. Information regarding the mother and the child were investigated. Comparisons were made using the homogeneity of proportions test based on Pearson's chi-square statistic. Predictors were investigated using the Poisson's regression model with robust variation. Results: Among the 8,520 children exposed to HIV, 1,762 (25.9%) were classified as loss to follow-up. The demographic profile of mothers of children lost to follow-up is of women aged 21 to 35 years (71.1%), predominantly with 4 to 7 years of education (49.9%), and white (53.9%). In 78.4% of the cases, prenatal care was not started in the first trimester (p<0.001). The following socioeconomic, behavioral, and health factors were associated with loss to follow-up: being up to 20 years old (aRR 1.47; 95% CI 1,17-1,84) or 21 to 35 years old (aRR 1.34; 95% CI 1,09-1,64); self-reporting as black (aRR 1.11; 95% CI 1,01-1,24); using injective drugs (aRR 1.21; 95% CI 1,04-1,42); HIV diagnosis during prenatal care or childbirth (aRR 1.32; 95% CI 1,19-1,47); and late entry into prenatal care (aRR 1.22; 95% CI 1,08-1,39). Conclusion: A significant percentage of pregnant women had delayed prenatal care. The predictors of loss to follow-up, which were: younger age, self-reporting black race/color, use of injectable drugs, HIV diagnosis during prenatal care or childbirth, and late initiation of prenatal care, refer to the contexts of individual, social, and programmatic vulnerability in which pregnant women are inserted.

Factors associated with directly observed treatment in tuberculosis/HIV coinfection cases in Porto Alegre, 2009-2013: A retrospective cohort.

BACKGROUND: TB/HIV coinfection is a serious public health issue in Brazil, and patients with coinfection have difficulty adhering to treatments. Directly observed treatment (DOT) has been recommended by the World Health Organization, considering the vulnerability of those affected. The purpose is to investigate the occurrence of DOT and associated factors compared to conventional treatment in Porto Alegre, Brazil. METHODS: A retrospective cohort study was carried out with all patients with coinfection from 2009 to 2013 in the city of Porto Alegre, Brazil, the state capital with the highest rate of coinfection in Brazil. The data came from national health information systems. The dependent variable was the performance of DOT. Bivariate and multivariable models were used to determine factors associated with DOT. The percentage of cure and death was verified in a period of two years, comparing patients who received and did not receive DOT. RESULTS: 2,400 cases of coinfection were reported, with 1,574 males and 826 females and a mean age of 38 years ± 9.91 years. The occurrence of DOT was 16.9%. In the multivariable analysis, factors independently associated to DOT were the year (with greater chances of being received in 2012 and 2013), place of origin, non-white race (OR = 1.29, 95% CI = 1.08-1.54), cases of relapse (OR = 1.33; 95% CI = 1.03-1.73), readmission after abandonment (OR = 1.48, 95% CI = 1.20-1.83), transfer (OR = 2.04; 95% CI = 1.40-2.98), acid-fast bacilli (AFB) test with positive result in first sample (OR = 1.73, 95% CI = 1.24-2.42), alcohol abuse (OR = 1.39; 95% CI = 1.16-1.67), and mental disorders (OR = 1.83; 95% CI = 1.38-2.44.) Of the 532 cases of death, occurring in two years, 10.2% were in patients who underwent DOT and 89.8% in patients who did not undergo DOT (p<0.001). O percentual de óbitos em pessoas que receberam DOT foi de 13% e o percentual de óbitos para pessoas que receberam tratamento convencional foi de 24%. CONCLUSIONS: There was an increase in the percentage of DOT over the years in the scenario studied, and the predictors for DOT were related to social vulnerability. In relation to death within two years, a lower proportion was found in patients who underwent DOT, suggesting a protective effect of the strategy.

Atenção à Saúde dos Usuários com Hipertensão Arterial Sistêmica, no Rio Grande Do Sul e Nas Demais Unidades Federativas do Brasil, Na Atenção Básica / Care For Users With Systemic Arterial Hypertension, In The Rio Grande do Sul And In Other Federal Units Of Brazil, In The Primary Health Care

Objetivo: comparar a atenção à saúde dos usuários com hipertensão arterial sistêmica ofertada no Rio Grande do Sul com aquela ofertada nas demais unidades federativas do país. Método: Trata-se de um estudo epidemiológico, observacional e analítico, de cunho ecológico, com dados oriundos do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB), ano 2012. A amostra nacional foi composta por 65.391 usuários, dos quais 36,5% possuía hipertensão arterial sistêmica. Comparações foram realizadas quanto à atenção a saúde dos 23.797 hipertensos residentes no Rio Grande do Sul (RS) e nas demais UFs. Resultados: A prevalência de HAS no RS foi de 35,9% (n = 1.156). Observou-se diferença estatística entre RS e demais UFs quanto à ocorrência de consulta nos últimos 6 meses (p<0,001), realização de exames (p<0,001), agendamento de consulta (p<0,001), e local de retirada de medicamentos (p<0,001). Conclusões: Apesar do RS ser apontado como uma das UFs com maior prevalência de HAS, as comparações apontam melhores resultados nas demais UFs quanto à atenção à saúde do hipertenso na atenção básica. Os resultados permitem discutir melhorias de acesso e qualidade da atenção básica. Sugere-se que o PMAQ-AB inclua questões relativas à adesão ao tratamento e questões sobre o tratamento não medicamentoso para a avaliação da qualidade da atenção à saúde do hipertenso.(AU)

Objective: To compare the health care provided for users who suffer from systemic arterial hypertension in Rio Grande do Sul and other states of Brazil. Method: This is an epidemiological, observational and analytic ecological study with data from the National Program for Access and Quality Improvement in Primary Care (PMAQAB) - 2012. The sample consisted of 65,391 users, 36.5% of whom suffered from systemic arterial hypertension (SAH) and answered questions regarding health care for hypertensive patients in primary care facilities. The service provided in Rio Grande do Sul was compared to that of other states. Results: The prevalence of SAH in the national sample was 36.5% (n = 23,797), whereas in Rio Grande do Sul it was 35.9% (n = 1,156). Statistical differences were found related to consultations in the last six months (p <0.001), medical examinations (p <0.001), appointments schedule (p <0.001) and medication deliverance sites (p <0.001). Conclusions: Although Rio Grande do Sul is regarded as one of the states with the highest prevalence rates of SAH, comparison shows other states have better results as far as care for hypertensive patients in primary health care is concerned. Results can support the debate about improving the quality of primary care, for which PMAQ was intended. It is suggested that PMAQ includes both adherence to treatment and non-drug treatments as factors to evaluate the quality of the care provided for hipertensive patients.(AU)

Disponibilidade do teste rápido para sífilis e anti-HIV nas Unidades de Atenção Básica do Brasil, no ano de 2012 / Availability of rapid tests for syphilis and HIV at Primary Health Care Units of Brasil in 2012

Objetivo: verificar e comparar a disponibilidade dos testes rápidos, nas cinco regiões do Brasil. Método: trata-se de um estudo epidemiológico ecológico, que analisou dados secundários provenientes do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica, coletados no ano de 2012. Resultados: em 96,6% e 86% dos estabelecimentos, respectivamente, o teste para sífilis e anti-HIV não estavam disponíveis. Teste para sífilis sempre disponível foi encontrado com maior frequência na região centro-oeste (6,1%; p<0,01) e teste anti-HIV na região sudeste (30,5%; p<0,01). Conclusões: foram evidenciadas desigualdades regionais na disponibilidade dos testes rápidos na atenção básica no Brasil. Considerando os elevados índices de sífilis e Aids no país, acredita-se que a disponibilidade dos testes rápidos constitui-se como uma relevante estratégia de enfrentamento. Portanto, frente às recentes recomendações das políticas públicas que incentivam a testagem na atenção básica, tornam-se necessárias ações de saúde para garantir que os testes rápidos estejam sempre disponíveis. (AU)

Objective: To check and compare the availability of rapid tests for syphilis and HIV in the five regions of Brazil. Method: This is an ecological epidemiological study, which analyzed secondary data from the National Program for Access and Quality Improvement in Primary Care (PMAQ-AB) - 2012. Results: Syphilis and HIV tests were not available in respectively 96.6% and 86% of the facilities. Syphilis tests were found more frequently in the Central-West Region (6.1%, p <0.01) and HIV tests in the Southeast Region (30.5%; p <0.01). Conclusions: Regional inequalities were evidenced in the availability of rapid tests in primary health care in Brazil. Given the high levels of syphilis and AIDS in Brazil, the availability of rapid tests constitutes a relevant coping strategy. Therefore, in the face of recent public policy recommendations that encourage testing in primary care, health actions are needed to ensure that rapid tests are always available. (AU)