Factors associated with loss to follow up among HIV-exposed children: a historical cohort study from 2000 to 2017, in Porto Alegre, Brazil.

BACKGROUND: There are many inequalities in terms of prevention and treatment for pregnant women with HIV and exposed children in low and middle-income countries. The Brazilian protocol for prenatal care includes rapid diagnostic testing for HIV, compulsory notification, and monitoring by the epidemiological surveillance of children exposed to HIV until 18 months after delivery. The case is closed after HIV serology results are obtained. Lost to follow-up is defined as a child who was not located at the end of the case, and, therefore, did not have a laboratory diagnosis. Lost to follow-up is a current problem and has been documented in other countries. This study analyzed factors associated with loss to follow-up among HIV-exposed children, including sociodemographic, behavioral, and health variables of mothers of children lost to follow-up. METHODS: This historical cohort study included information on mothers of children exposed to HIV, born in Porto Alegre, from 2000 to 2017. The research outcome was the classification at the end of the child's follow-up (lost to follow-up or not). Factors associated with loss to follow-up were investigated using the Poisson regression model. Relative Risk calculations were performed. The significance level of 5% was adopted for variables in the adjusted model. RESULTS: Of 6,836 children exposed to HIV, 1,763 (25.8%) were classified as lost to follow-up. The factors associated were: maternal age of up to 22 years (aRR 1.25, 95% CI: 1.09-1.43), the mother's self-declared race/color being black or mixed (aRR 1.13, 95% CI: 1.03-1.25), up to three years of schooling (aRR 1.45, 95% CI: 1.26-1.67), between four and seven years of schooling (aRR 1.14, 95% CI: 1.02-1.28), intravenous drug use (aRR 1.29, 95% CI: 1.12-1.50), and HIV diagnosis during prenatal care or at delivery (aRR 1.37, 95% CI: 1.24-1.52). CONCLUSION: Variables related to individual vulnerability, such as race, age, schooling, and variables related to social and programmatic vulnerability, remain central to reducing loss to follow-up among HIV-exposed children.

Experience report on nutritional care in an outpatient clinic for trans and non-binary people: reflection of the university approach on the subject / Relato de experiência sobre atendimento nutricional em um ambulatório de atendimento de pessoas trans e não binárias: reflexão da abordagem universitária sobre o assunto

Trans people face social ills and difficult access to basic rights, such as education, work and health. In this way, specialized outpatient clinics for the care of the trans population, as is the case mentioned in this study, are necessary to guarantee a humanized health service, in addition to providing access to the transsexualization process by the Unified Health System. The nutritionist has a lot to offer to the individual's health, because hormone therapy can bring physiological changes not desired by the patient, such as changes in the lipid profile and weight gain. This topic has gained the attention of some researchers recently, however, little is said about the nutritional care of this population. The current study, in addition to having the objective of reporting the nutritional care of trans and non-binary people, aims to investigate the presence of the theme in curriculum matrices of the Bachelor's Degree in Nutrition in public universities in Brazil. The experience report model was used to detail the nutritional care performed, and search for keywords in the models of lesson plans, which characterized the theme of the health of the trans or LGBTQIA+ population in public universities. In the outpatient clinic, the author noticed a great interest of the population in providing nutritional care. However, this theme is rarely described in nutrition courses, suggesting the inclusion of a discipline, even if optional, on the inclusion and importance of serving various minority groups.

Pessoas trans enfrentam mazelas sociais e dificuldade de acesso a direitos básicos, como a educação, trabalho e saúde. Deste modo, os ambulatórios especializados para o atendimento de população trans, como é o caso do citado neste estudo, são necessários para garantir um serviço de saúde humanizado, além de prover acesso ao processo transsexualizador pelo Sistema Único de Saúde. O nutricionista tem muito a oferecer para a saúde do indivíduo, pois, a terapia hormonal pode trazer alterações fisiológicas não desejadas pelo paciente, como mudanças do perfil lipídico e ganho de peso. Este tema tem ganhado a atenção de alguns pesquisadores recentemente, no entanto, pouco se fala sobre o atendimento nutricional desta população. O estudo atual, além de ter como objetivo relatar o atendimento nutricional de pessoas trans e não binárias, visa investigar a presença do tema em matrizes curriculares do curso de bacharelado de Nutrição em universidades públicas do Brasil. Foi utilizado o modelo de relato de experiência para detalhar o atendimento nutricional realizado, e pesquisa por palavras-chave nos modelos de planos componentes de aulas, que caracterizassem o tema da saúde da população trans ou LGBTQIA+ nas universidades públicas. No ambulatório, a autora percebeu um grande interesse da população em realizar atendimento nutricional. No entanto, esta temática raramente encontra-se descrita nos cursos de nutrição, sugerindo-se então, a inclusão de uma disciplina, ainda que optativa, sobre a inclusão e importância do atendimento de vários grupos minoritários. 

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.

Survival and predictors of death in tuberculosis/HIV coinfection cases in Porto Alegre, Brazil: A historical cohort from 2009 to 2013.

BACKGROUND: Tuberculosis is a curable disease, which remains the leading cause of death among infectious diseases worldwide, and it is the leading cause of death in people living with HIV. The purpose is to examine survival and predictors of death in Tuberculosis/HIV coinfection cases from 2009 to 2013. METHODS: We estimated the survival of 2,417 TB/HIV coinfection cases in Porto Alegre, from diagnosis up to 85 months of follow-up. We estimated hazard ratios and survival curves. RESULTS: The adjusted risk ratio (aRR) for death, by age, hospitalization, and Directly Observed Treatment was 4.58 for new cases (95% CI: 1.14-18.4), 4.51 for recurrence (95% CI: 1.11-18.4) and 4.53 for return after abandonment (95% CI: 1.12-18.4). The average survival time was 72.56 ± 1.57 months for those who underwent Directly Observed Treatment and 62.61 ± 0.77 for those who did not. CONCLUSIONS: Case classification, age, and hospitalization are predictors of death. The occurrence of Directly Observed Treatment was a protective factor that increased the probability of survival. Policies aimed at reducing the mortality of patients with TB/HIV coinfection are needed.

O impacto das atividades da instrução individual básica no estado nutricional dos soldados em treinamento / The impact of basic individual instruction activities on the nutritional status of soldiers in training

Introdução: Segundo o Ministério da Defesa, atualmente no Brasil existem mais de 323 mil militares na ativa, sendo uma coletividade representativa de trabalhadores no país. Considerando que os militares são os responsáveis pela soberania nacional, esse estudo é importante para averiguar se o programa de treinamento realizado para a incorporação dos soldados pode ter impacto no estado nutricional, influenciando na saúde dessa população. Objetivo: Avaliar o impacto do Programa Padrão de Instrução Individual Básica no estado nutricional dos militares. Metodologia: Trata-se de um estudo epidemiológico, observacional, analítico e longitudinal. A amostragem se deu por conveniência. A população-alvo são os soldados, incorporados no ano corrente de 2019, que realizaram o Programa. O cálculo do tamanho da amostra considerou um nível de significância de 5%, obteve-se um total mínimo de 32 militares. Porém, foram coletados os dados de 65 soldados que cumpriam todos os requisitos e aceitaram participar da pesquisa. Para aferição das medidas antropométricas foi utilizada balança de bioimpedância, as demais variáveis foram coletadas através de questionários auto aplicados desenvolvidos para essa pesquisa. Esse trabalho respeitou os preceitos éticos, foi submetido e aprovado pelo Comitê de Ética da Universidade Federal do Rio Grande do Sul. Resultados: A idade média foi de 18,7±0,5 anos. O peso dos soldados nos períodos de pré e pós-imediato, não apresentaram diferença estatisticamente significativa. Porém, no período pós-tardio houve um aumento de peso representativo (77,6±11,4bkg, p<0,001). O período com menor percentual de gordura (%G) 19,7±4,5a% e o maior percentual de massa magra (%M) 43,1±4,2b% foi o pós-campo imediato (p<0,001). A idade metabólica (IM), apresentou a tendência estatística inversa do %M, sendo assim no pós-campo imediato foi possível observar a menor IM 27,7±13,4a anos. Os militares tiveram gasto energético aumentado no período de pós-imediato (1815 ± 142c kcal). Conclusões: concluímos que os militares tiveram uma melhora na composição corporal no período de pós-campo imediato, e não tiveram prejuízos a sua saúde nutricional.

Introduction: According to the Ministry of Defense, currently in Brazil there are more than 323 thousand military personnel on active duty, being a representative group of workers in the country. Considering that the military is responsible for national sovereignty, this study is important to ascertain whether the training program carried out for the incorporation of soldiers can have an impact on the nutritional status, influencing the health of this population. Objective: To assess the impact of the Standard Basic Instruction Program on the nutritional status of the military. Methodology: This is an epidemiological, observational, analytical and longitudinal study. Sampling was done for convenience. The target population is the soldiers, incorporated in the current year of 2019, who carried out the Program. The calculation of the sample size considered a significance level of 5%, a minimum total of 32 soldiers was obtained. However, data were collected from 65 soldiers who met all requirements and agreed to participate in the research. To measure anthropometric measurements, a bioimpedance scale was used, the other variables were collected through self-applied questionnaires developed for this research. This work respected the ethical precepts, was submitted and approved by the Ethics Committee of the Federal University of Rio Grande do Sul. Results: The average age was 18,7±0,5 years. The weight of soldiers in the pre and post-immediate periods did not show a statistically significant difference. However, in the post-late period there was a significant increase in weight (77,6±11,4bkg, p<0,001). The period with the lowest percentage of fat (%G) 19,7±4.5a% and the highest percentage of lean mass (%M) 43,1±4.2b% was the immediate post-field (p<0,001). Metabolic age (IM) showed the inverse statistical trend of %M, so in the immediate post-field it was possible to observe the lowest IM 27,7±13.4ayears. The military had increased energy expenditure in the postimmediate period (1815±142ckcal). Conclusions: we concluded that the military had an improvement in their body composition in the immediate post-field period, and had no damage to their nutritional health.