Long chikungunya? An overview to immunopathology of persistent arthralgia.

Chikungunya fever (CF) is caused by an arbovirus whose manifestations are extremely diverse, and it has evolved with significant severity in recent years. The clinical signs triggered by the Chikungunya virus are similar to those of other arboviruses. Generally, fever starts abruptly and reaches high levels, followed by severe polyarthralgia and myalgia, as well as an erythematous or petechial maculopapular rash, varying in severity and extent. Around 40% to 60% of affected individuals report persistent arthralgia, which can last from months to years. The symptoms of CF mainly represent the tissue tropism of the virus rather than the immunopathogenesis triggered by the host's immune system. The main mechanisms associated with arthralgia have been linked to an increase in T helper type 17 cells and a consequent increase in receptor activator of nuclear factor kappa-Β ligand and bone resorption. This review suggests that persistent arthralgia results from the presence of viral antigens post-infection and the constant activation of signaling lymphocytic activation molecule family member 7 in synovial macrophages, leading to local infiltration of CD4+ T cells, which sustains the inflammatory process in the joints through the secretion of pro-inflammatory cytokines. The term "long chikungunya" was used in this review to refer to persistent arthralgia since, due to its manifestation over long periods after the end of the viral infection, this clinical condition seems to be characterized more as a sequel than as a symptom, given that there is no active infection involved.

Telehealth in community mental health centers during the COVID-19 pandemic in Peru: A qualitative study with key stakeholders.

Aim: To describe the perceptions and experiences of key stakeholders to understand the use of telehealth in community mental health centers (CMHCs) during the COVID-19 pandemic in Lima and Callao, Peru. Methods: A qualitative study was carried out in four CMHCs in Lima and Callao, Peru. Forty-nine individual semi-structured interviews were conducted between September 2021 and March 2022, considering CMHCs' users and their relatives, health and administrative workers, directors, as well as local and national policymakers. Data was analyzed using thematic analysis. Results: Regarding the transition from in-person care to telehealth, CMHCs' directors and workers identified some of the regulations issued by the Government during the pandemic, such as the continuity of care through telehealth, especially for pregnant women and for people with comorbidities related to COVID-19. Regarding benefits, workers and users indicated that it allowed better communication, such as constant follow-ups. Directors and workers recognized that Google Drive facilitated access to user information, since they did not have an electronic medical record. Additionally, workers said they used social media to share educational information on mental health, and explained that some new users began their treatment this way. Regarding difficulties, participants reported a lack of devices and poor internet connection in CMHCs. Users mentioned that scheduling an appointment was difficult because the phone lines were usually saturated, and they could not find available appointments. Conclusion: Although the pandemic forced an immediate and disruptive change towards telehealth, CMHCs were able to adapt most of their services. This study reports the adaptations made by CMHCs to move from in-person to remote care, identifying the benefits and challenges faced, information that can be used for the nationwide implementation of telehealth in CMHCs. We recommend ensuring technological equipment and internet connection and adapt the telehealth system to make it responsive to the routine practices of CMHCs.

A new noctuid genus and species (Lepidoptera, Noctuidae, Amphipyrinae, Psaphidini, Triocnemidina) from New Mexico and Texas, United States of America.

Pooleagen. nov. is described for two noctuid species from southwestern United States: Pooleagrandimacula Barnes & McDunnough, comb. nov., previously in Oxycnemis Grote, and Pooleapsaphidoidessp. nov.Poolea is compared to Oxycnemis (Amphipyrinae, Psaphidini, Triocnemidina) and is retained in the same subtribe. Adult moths and male and female genitalia of Poolea species are illustrated along with those of Oxycnemisadvena Grote, the genus type species. Pertinent recent taxonomic changes to Amphipyrinae classification are reviewed.

Caribbean Amphipoda (Crustacea) of Panama. Part II: parvorder Hadziidira.

Amphipods in the parvorder Hadziidira are typically associated with algae, sponges, or coral rubble. Members of the parvorder have a gnathopod 2 that is stouter than gnathopod 1, a pair of dorsal robust setae on urosomite 2, and a basofacial robust seta on the uropod 1 peduncle. Within the parvorder, six families are documented from Bocas del Toro, Panama, represented by 26 species. This research documents range extensions for all 26 species and an identification key to the species of Caribbean Hadziidira of Panama is provided.

ResumenLos anfípodos del parvorden Hadziidira suelen estar asociados con algas, esponjas o escombros de coral. Los miembros del parvorden tienen un gnatópodo 2 que es más robusto que el gnatópodo 1, un par de setas dorsales robustas en el urosomita 2 y una seta basofacial robusta en el pedúnculo del urópodo 1. Dentro del parvorden se documentan seis familias de Bocas del Toro, Panamá, representadas por 26 especies. Esta investigación documenta extensiones de rango para las 26 especies y se proporciona una clave de identificación para las especies de Hadziidira caribeña de Panamá.

Variability in life expectancy among people with HIV in Brazil by gender and sexual orientation.

INTRODUCTION: In Brazil, though Antiretroviral Therapy (ART) is available to all, the benefits may not be experienced uniformly. We projected Life Expectancy (LE) for People Living with HIV (PLHIV) in care as currently observed and estimated the impact of guideline-concordant care. METHODS: Using a microsimulation model, we projected LE for a cohort of PLHIV and for four population groups: cisgender Men who have Sex with Men (MSM), cisgender Men who have Sex with Women (MSW), Cisgender Women (CGW), and Transgender Women (TGW). Cohort data from Evandro Chagas National Institute of Infectious Diseases/Oswaldo Cruz Foundation (INI/Fiocruz) informed model parameters. We modeled five scenarios: 1) Current care: ART initiation, adherence, and retention in care as currently observed, 2) Guideline-concordant care: immediate ART initiation, full adherence to treatment, and consistent retention in care, 3) Immediate ART initiation with observed adherence to treatment and retention in care, 4) Full adherence to treatment with observed timing of ART initiation and retention in care, and 5) Consistent retention in care with observed timing of ART initiation and adherence. RESULTS: With current care, LE from age 15 would be 45.9, 44.4, 54.2, and 42.3 years, for MSM, MSW, CGW, and TGW. With guideline-concordant care, LE would be 54.2, 54.4, 63.1, and 53.2 years, for MSM, MSW, CGW and TGW, with TGW experiencing the greatest potential increase in LE (10.9 years). When investigating the components of care separately, MSW and CGW would gain most LE with immediate ART initiation, whereas for MSM and TGW consistent retention in care would be most impactful. CONCLUSIONS: In settings like INI/Fiocruz, MSW and CGW would benefit most from interventions focused on earlier diagnosis and linkage to care, whereas TGW and MSM would benefit from interventions to sustain engagement in care. Assessment of the HIV care continuum for specific populations should inform care priorities.

The ants of the genus Rhopalothrix Mayr, 1870 (Hymenoptera, Formicidae, Myrmicinae) in Colombia.

The ants of the genus Rhopalothrix are diverse in the Neotropical region, with 14 of the 16 described species. Based on museum material and recent fieldwork, Rhopalothrix ants in Colombia were reviewed. Morphological analysis of the workers allowed delimitation of six species, including two new species, Rhopalothrixmandibularis Guerrero & Grajales, sp. nov. and Rhopalothrixmariaemirae Tocora, Fiorentino & Fernández, sp. nov. A new combination Rhopalothrixamaticomb. nov. is proposed for Eurhopalothrixamati. A worker-based taxonomic key, high-definition images of the workers, and a distribution map of all Rhopalothrix species present in Colombia are provided.

New morphological and biological contributions to adults and immature forms of Pissonotusparaguayensis (Fulgoromorpha, Delphacidae) in wetlands of Argentina.

In the search for insects as biological control agents for the water primrose, the delphacid Pissonotusparaguayensis (Delphacidae) was found on Ludwigiagrandiflorasubsp.hexapetala (Onagraceae) in a wetland of Central East Argentina. The morphology of the unknown females (brachypterous and macropterous) and immature stages are described and illustrated. Adults and nymphs were collected in wetlands of Del Plata River Basin, from Buenos Aires to the northeastern part of Argentina. A rearing methodology was developed to perform biological studies. Both winged forms and structural features of the female genitalia are described for the first time at the genus level. Eggs and immature stages are described and keyed; fifth nymphal instars may be easily recognised by the yellowish colouration, blackish on dorsal of head, thorax and abdomen with conspicuous yellowish pits, ventrally only darkened on base of frons extended to lower level of eyes and dorsal surface of antennomeres I and II, and legs with distinctive black marks at femoro-tibial joint and apex. The geographical distribution is updated, expanding its range into Argentina, making Buenos Aires the southernmost limit of the genus in America. Biological information of the species is also reported here: life cycle, fecundity, oviposition behaviour, and host plant. Field observations showed that P.paraguayensis breeds, feeds, and causes damage to L.g.subsp.hexapetala. This delphacid presents a certain degree of specificity to the Ludwigia species in the Jussiaea section in host specificity tests. More studies are required to test this species as a potential biological control agent.

Revision of the Neotropical genus Trigava O'Brien, 1999 (Hemiptera, Fulgoromorpha, Dictyopharidae, Nersiini), with descriptions of two new species from Peru and Brazil.

The Neotropical planthopper genus Trigava O'Brien, 1999 (Hemiptera, Fulgoromorpha, Dictyopharidae, Nersiini) is revised. Four species are included: T.brachycephala (Melichar, 1912) (the type species, from Peru), T.obrieni Song, Malenovský & Deckert, sp. nov. (from Brazil), T.peruensis Song, O'Brien & Bartlett, sp. nov. (from Peru), and T.recurva (Melichar, 1912) (from Bolivia and Peru). Lectotypes are designated for Igavabrachycephala Melichar, 1912 and Igavarecurva Melichar, 1912. All species are described, including habitus photographs and detailed illustrations of the male genitalia. Male and female genitalia are described for this genus for the first time. A key for identification of the species of Trigava and a distribution map are provided.

An update on the huntsman spider genus Uaiuara Rheims, 2013 (Araneae, Sparassidae, Sparianthinae)

The genus Uaiuara rheims is revisited. A new species is described, based on females from Iquitos, Peru and new distribution records for Uaiuara amazonica (Simon, 1880) and U. quyguaba rheims, 2013 are provided. In addition, an identification key and updated distribution maps are provided for all species.

Variability in life expectancy among people with HIV in Brazil by gender and sexual orientation

Abstract Introduction In Brazil, though Antiretroviral Therapy (ART) is available to all, the benefits may not be experienced uniformly. We projected Life Expectancy (LE) for People Living with HIV (PLHIV) in care as currently observed and estimated the impact of guideline-concordant care. Methods Using a microsimulation model, we projected LE for a cohort of PLHIV and for four population groups: cisgender Men who have Sex with Men (MSM), cisgender Men who have Sex with Women (MSW), Cisgender Women (CGW), and Transgender Women (TGW). Cohort data from Evandro Chagas National Institute of Infectious Diseases/Oswaldo Cruz Foundation (INI/Fiocruz) informed model parameters. We modeled five scenarios: 1) Current care: ART initiation, adherence, and retention in care as currently observed, 2) Guideline-concordant care: immediate ART initiation, full adherence to treatment, and consistent retention in care, 3) Immediate ART initiation with observed adherence to treatment and retention in care, 4) Full adherence to treatment with observed timing of ART initiation and retention in care, and 5) Consistent retention in care with observed timing of ART initiation and adherence. Results With current care, LE from age 15 would be 45.9, 44.4, 54.2, and 42.3 years, for MSM, MSW, CGW, and TGW. With guideline-concordant care, LE would be 54.2, 54.4, 63.1, and 53.2 years, for MSM, MSW, CGW and TGW, with TGW experiencing the greatest potential increase in LE (10.9 years). When investigating the components of care separately, MSW and CGW would gain most LE with immediate ART initiation, whereas for MSM and TGW consistent retention in care would be most impactful. Conclusions In settings like INI/Fiocruz, MSW and CGW would benefit most from interventions focused on earlier diagnosis and linkage to care, whereas TGW and MSM would benefit from interventions to sustain engagement in care. Assessment of the HIV care continuum for specific populations should inform care priorities.

Barriers and facilitators to scaling up access to HIV pre-exposure prophylaxis among key populations: A qualitative study of the incentive-based PrEP Seguro program in Mexico.

Introduction: Daily oral pre-exposure prophylaxis (PrEP) is highly safe and effective for HIV prevention, yet barriers to PrEP access and adherence persist among key populations. In Mexico, incentive-based pilot programs have been effective in improving PrEP adherence among male sex workers. Understanding the experiences of providers and program implementers is critical to integrating PrEP adherence programs as part of standard care in Mexico and similar settings. Methods: We conducted 17 in-depth informational interviews with care providers and staff responsible for administering PrEP to key populations (men who have sex with men, male sex workers, transgender women) in Mexico City. Interviews explored successes and challenges surrounding current PrEP implementation, as well as adaptations that could facilitate national scale-up of PrEP programs in Mexico. Informant transcripts were analyzed using a hybrid inductive-deductive thematic analysis approach utilizing CFIR constructs for the initial codebook while allowing for inductive findings. Results: Three key themes emerged from informant interviews as important for promoting PrEP programs in Mexico: 1) increasing individual PrEP access, 2) strengthening quality of care, and 3) improving organizational and structural support. Conclusions: PrEP in Mexico is currently only available in a few clinics with high patient populations, and siloed HIV services, stigma, and a lack of inter-organizational collaboration remain persistent barriers to PrEP uptake. Promoting government collaboration and increasing financial support for community-based organizations is needed to expand PrEP access. Tailored, destigmatizing information about PrEP services needs to be diffused among both staff and patients to strengthen care quality.

Litterfall and nutrient transfer dynamics in a successional gradient of tropical dry forest in Colombia / Dinámica de la hojarasca y transferencia de nutrientes en un gradiente sucesional de bosque seco tropical en Colombia

Introduction: The litterfall production, foliar nutrient dynamics and decomposition are essential to maintain nutrient cycling, soil fertility, and carbon regulation in terrestrial ecosystems. With several studies addressing the variation of these processes, their dynamics in tropical dry forests (TDFs) remain unclear, due to its complex interaction of biotic and abiotic factors. Objective: To evaluate litterfall, nutrient potential return and use efficiency, and decomposition variation in a TDF successional gradient in Tolima, Colombia. Methods: We quantified litterfall from November 2017 to October 2019 in 12 plots distributed in four successional stages: initial, early, intermediate, and late forests. We identified key tree species in foliar litter production and characterized the foliar decomposition of these species. At the community level, we quantified the C, N and P potential return, the N and P use efficiency, and the C:N and N:P ratio. Subsequently, we analyze relationships between vegetation characteristics and some soil chemical properties with these ecological processes. Results: We found that total litterfall in late forests (8.46 Mg ha-1 y-1) was double that found in initial forests (4.45 Mg ha-1 y-1). Decomposition was higher in initial (k = 1.28) compared to intermediate (k = 0.97) and late forests (k = 0.87). The nutrient potential return didn't change along succession, but it did show differences between study sites. The structural development and species richness favored litterfall, while soil chemical conditions influenced nutrient returns and decomposition. Conclusions: TDFs could recover key ecosystem function related to litterfall and nutrient dynamics after disturbances cessation; however, the soil quality is fundamental in return and release of nutrients.

Introducción: La producción de hojarasca, la dinámica de nutrientes foliares y la descomposición son esenciales para mantener el ciclo de nutrientes, la fertilidad del suelo y la regulación del carbono en ecosistemas terrestres. Con diversos estudios que abordan estos procesos, su variación en los bosques secos tropicales (BSTs) permanece incierta, por su compleja interacción de factores bióticos y abióticos. Objetivo: Evaluar la caída de hojarasca, el retorno potencial de nutrientes y eficiencia de uso, y la variación en descomposición en un gradiente sucesional de un BST en Tolima, Colombia. Métodos: Cuantificamos la caída de hojarasca entre noviembre 2017 y octubre 2019 en 12 parcelas distribuidas en cuatro estados sucesionales: bosque inicial, temprano, intermedio y tardío. Identificamos las especies arbóreas clave en la producción de hojarasca y caracterizamos la descomposición foliar de estas especies. A nivel comunitario, cuantificamos el retorno potencial de C, N y P, la eficiencia de uso de N y P y la relación C:N y N:P. Posteriormente, analizamos las relaciones entre las características de la vegetación y algunas propiedades químicas del suelo con estos procesos ecológicos. Resultados: Encontramos que la caída total de hojarasca en los bosques tardíos (8.46 Mg ha-1 año-1) fue el doble de la hallada en bosques iniciales (4.45 Mg ha-1 año-1). La descomposición fue mayor en bosques iniciales (k = 1.28) en comparación con bosques intermedios (k = 0.97) y tardíos (k = 0.87). El retorno potencial de nutrientes no cambió con el avance de la sucesión vegetal, pero exhibió diferencias entre los sitios de estudio. El desarrollo estructural y la riqueza de especies favorecieron la caída de hojarasca, mientras que las condiciones químicas del suelo influyeron en el retorno de nutrientes y descomposición. Conclusiones: Los BSTs tienen la capacidad de recuperar la función ecosistémica de aporte de hojarasca fina, retorno y liberación de nutrientes después del cese de alteraciones antrópicas; sin embargo, la calidad del suelo es fundamental en el retorno y liberación de nutrientes.

Taxonomy and phylogeny of the genus Ganoderma (Polyporales, Basidiomycota) in Costa Rica.

Ganoderma species are well recognised by their significant role in the recycling of nutrients in ecosystems and by their production of secondary metabolites of medical and biotechnological importance. Ganoderma spp. are characterised by laccate and non-laccate, woody basidiocarps, polypore hymenophores and double-walled basidiospores generally with truncate apex. Despite the importance of this genus, its taxonomy is unclear and it includes several species' complexes with few circumscribed species and incorrect geographic distributions. The aim of this work was to provide detailed morphological descriptions together with phylogenetic analyses using ITS sequences to confirm the presence of seven species of Ganoderma in Costa Rica: G.amazonense, G.applanatum s.l., G.australe, G.curtisii, G.ecuadorense, G.oerstedii and G.parvulum. This is the first study that integrates morphological and phylogenetic data of Ganoderma from Central America and a key of the neotropical species. Besides, the distribution range of G.curtisii, previously reported from North America and G.ecuadorense from South America, is expanded to Central America.

Localized Donor Area Acute Telogen Effluvium following Follicular Unit Extraction: Key Trichoscopic Findings.

Introduction: Telogen effluvium is a form of non-scarring alopecia characterized by an increased hair shedding rate induced by mechanical or inflammatory factors. Case Report: A 27-year-old healthy male patient presented with several itchy alopecic patches in the occipital region. The patient had undergone a follicular unit extraction 6 weeks before with complete recovery after 1 week. Upon trichoscopy, we found empty follicular openings, short regrowing hairs, and coudability hairs. A diagnosis of acute telogen effluvium was made, and the patient was started on betamethasone lotion for daily use as a means to treat pruritus. After 1 month, the patient presented an almost complete response. Conclusion: While acute telogen effluvium is commonly seen in the receptor area after a hair transplant, the incidence of the donor region as a presentation is unknown. Common trichoscopic findings in telogen effluvium include empty follicular openings, short regrowing hairs, and lack of other signs usually seen in other types of alopecia. This description was consistent with what we found in our patient. Trichoscopic findings can help in the diagnosis, and understanding its natural course, physicians can reassure the patient about the self-resolutive outcome of this condition.

Machine learning algorithms accurately identify free-living marine nematode species.

Background: Identifying species, particularly small metazoans, remains a daunting challenge and the phylum Nematoda is no exception. Typically, nematode species are differentiated based on morphometry and the presence or absence of certain characters. However, recent advances in artificial intelligence, particularly machine learning (ML) algorithms, offer promising solutions for automating species identification, mostly in taxonomically complex groups. By training ML models with extensive datasets of accurately identified specimens, the models can learn to recognize patterns in nematodes' morphological and morphometric features. This enables them to make precise identifications of newly encountered individuals. Implementing ML algorithms can improve the speed and accuracy of species identification and allow researchers to efficiently process vast amounts of data. Furthermore, it empowers non-taxonomists to make reliable identifications. The objective of this study is to evaluate the performance of ML algorithms in identifying species of free-living marine nematodes, focusing on two well-known genera: Acantholaimus Allgén, 1933 and Sabatieria Rouville, 1903. Methods: A total of 40 species of Acantholaimus and 60 species of Sabatieria were considered. The measurements and identifications were obtained from the original publications of species for both genera, this compilation included information regarding the presence or absence of specific characters, as well as morphometric data. To assess the performance of the species identification four ML algorithms were employed: Random Forest (RF), Stochastic Gradient Boosting (SGBoost), Support Vector Machine (SVM) with both linear and radial kernels, and K-nearest neighbor (KNN) algorithms. Results: For both genera, the random forest (RF) algorithm demonstrated the highest accuracy in correctly classifying specimens into their respective species, achieving an accuracy rate of 93% for Acantholaimus and 100% for Sabatieria, only a single individual from Acantholaimus of the test data was misclassified. Conclusion: These results highlight the overall effectiveness of ML algorithms in species identification. Moreover, it demonstrates that the identification of marine nematodes can be automated, optimizing biodiversity and ecological studies, as well as turning species identification more accessible, efficient, and scalable. Ultimately it will contribute to our understanding and conservation of biodiversity.

High burden of sexually transmitted infections among under-resourced populations in the Dominican Republic.

Background: Sexually transmitted infections (STIs) are a major health issue, exacerbated by limited financial and infrastructural resources in developing countries. Methods: Prevalence of STIs was assessed in two urban centers of the Dominican Republic (DR) among populations at high risk for STIs: pregnant youth, men who have sex with men (MSM), trans women (TG), batey residents, female sex workers, and people living with human immunodeficiency virus (HIV). We conducted a cross-sectional survey and biological specimen collection to screen for Chlamydia trachomatis, Neisseria gonorrhea, Mycoplasma genitalium, Trichomonas vaginalis (trichomoniasis), Treponema pallidum (syphilis), HIV, hepatitis B and C, and human papillomavirus (HPV) among at-risk populations between 2015 and 2018. Ureaplasma urealyticum testing was also conducted even though it is not considered a STI. A non-probability community sample was recruited. Descriptive statistics examined the prevalence of STIs by population. Results: A total of 1991 subjects participated in the study. The median age was 26 years (range: 18-65). Most participants were female (65.3%), heterosexual (76.7%), and were not partnered (55.7%). Most of the participants reported unprotected vaginal sex in the last 6 months (54%); among MSM and TG almost half of the participants reported unprotected anal sex in the last 6 months and 17.6% reported drug use in the last 6 months. Almost half of the participants (49%) tested positive for one or more STIs. The most prevalent STI was Chlamydia trachomatis (12.8%), and human papillomavirus (11.9%). Among transgender women, 65.3% tested positive for an STI, 64.8% of female sex workers tested positive for an STI, and 53.8% of pregnant adolescents tested positive for an STI. Conclusion: There is a high prevalence of STIs among key and under resourced populations in the DR. Our findings highlight the need to conduct further research to optimize prevention and care strategies for structurally vulnerable and under resourced populations in the DR.

Using lessons learnt from key stakeholders to increase support for scaling the Reach Up Early Childhood Parenting program.

Introduction: Sustainable implementation of early childhood programs requires resources, materials and methods that are adaptable, scalable and feasible for delivery through multiple sectors. Additional or modified program resources may be required to meet emerging needs, as programs go to scale. An active and effective monitoring, evaluation and learning (MEL) process may enable programs to be responsive to demands. The Reach Up: Early Childhood Parenting program, is designed primarily for disadvantaged children under 4 years of age in low- and middle-income countries (LMICs) to promote their development through playful caregiver interactions. The curriculum, training manuals and other materials and resources support implementers in the adaptation of the intervention, implementation, workforce training, monitoring and evaluation. This paper reports on how data collected from key informants drove modifications to program processes, materials and resources. Methods: We conducted in-depth interviews with 14 key informants (including program managers, lead trainers, academics, consultants and workforce personnel) on their experiences with Reach Up across 15 LMICs where the program has been implemented. We also reviewed written records generated from (i) structured small group discussions at a Knowledge Exchange meeting of 31 Reach Up partners and (ii) notes from working groups formed at the meeting and tasked to continue working post-meeting to find solutions to support ongoing implementation. The transcripts from the in-depth interviews and the meeting records were analysed using thematic analysis with a mixture of pre-defined categories and data-driven sub-themes. Results: The main findings indicated that there was a need to: (i) develop advocacy and communication resources and materials to aid prospective implementers and other stakeholders, to make decisions for implementation, (ii) revise and/or add to the content and format of the curriculum and add content in the training and other supporting manuals and (iii) enhance the training process. Conclusion: The feedback from the key global partners informed the development of new knowledge materials, resources and processes and modifications to existing program materials and resources. These will help to support advocacy, ongoing implementations, and the process of transitioning the Reach Up early childhood intervention to scale.

Impact of pre-exposure prophylaxis uptake among gay, bisexual, and other men who have sex with men in urban centers in Brazil: a modeling study.

BACKGROUND: Men who have sex with men (MSM) in Brazil remain disproportionately affected by HIV. We estimated the potential incidence reduction by five years with increased uptake of publicly-funded, daily, oral tenofovir/emtricitabine (TDF/FTC) for HIV pre-exposure prophylaxis (PrEP) among MSM using the Cost Effectiveness of Preventing AIDS Complications microsimulation model. We used national data, local studies, and literature to inform model parameters for three cities: Rio de Janeiro, Salvador, and Manaus. RESULTS: In Rio de Janero, a PrEP intervention achieving 10% uptake within 60 months would decrease incidence by 2.3% whereas achieving 60% uptake within 24 months would decrease incidence by 29.7%; results were similar for Salvador and Manaus. In sensitivity analyses, decreasing mean age at PrEP initiation from 33 to 21 years increased incidence reduction by 34%; a discontinuation rate of 25% per year decreased it by 12%. CONCLUSION: Targeting PrEP to young MSM and minimizing discontinuation could substantially increase PrEP's impact.

Sexual exposure to HIV in Angolan men who have sex with men immigrants: A cross-sectional study in Portugal and Brazil.

BACKGROUND: In different contexts, international migrants are vulnerable to health disparities that increase the risk of HIV/AIDS exposure and continue to bear a significant burden of new virus infections in developed and developing countries. In this study, we sought to examine sexual practices and factors linked to HIV exposure among a sample of Angolan men who have sex with men (MSM) immigrants. METHODS: The study was conducted in two Portuguese-speaking countries, Brazil and Portugal, and involved 250 Angolan MSM immigrants between September 2020 and February 2021, using sampling methods to constitute the sample and the HIV Incidence Risk Index (HIRI) to define virus exposure risk. Odds ratio (OR) and adjusted odds ratio (aOR) were used to calculate the chances of higher HIRI index in the sample. RESULTS: Our results showed that 76.8% of participants presented a high HIRI index, influenced by the practice of chemsex (aOR: 4.26), having a known/repeated partner (aOR: 4.59), and engaging in passive sex without a condom in the last 30 days (aOR: 1.29) or 6 months (aOR: 1.98). CONCLUSIONS: It is crucial to focus on this vulnerable population and implement sexual health policies that integrate combined HIV prevention measures aimed at immigrant MSM.

Evaluation of the implementation progress through key performance indicators in a new multimorbidity patient-centered care model in Chile.

BACKGROUND: Complex health interventions involve deep organizational, structural, and cultural changes that challenge health teams and decision-makers. The explosion of chronic diseases has made the multimorbidity approach a global priority. The Centro de Innovación en Salud ANCORA UC implemented a Multimorbidity Patient-Centered Care Model in the Chilean public health system. OBJECTIVE: This study aims to evaluate the progress of the implementation of the Multimorbidity Patient-Centered Care Model in seven primary care centers through key performance indicators. METHODS: a set of indicators was designed to evaluate change management, operations, installation of new roles, and services and activities of the intervention strategy of the model. Key performance indicators were identified to monitor the implementation progress on minimal components for the model's sustainability. Each item was assigned against an expected minimum score of 67% of progress from the overall score. They were monitored twice in seven primary health centers in 2019 and 2020, which intervened 22,642 patients with the intervention. RESULTS: The results showed that six of the seven primary care centers reached the minimum implementation threshold. The main advances were in operational conditions, and those with minor progress in implementation were the clinical services. Population size, organization, coordination of the health care teams, additional training, and decision-makers support were key factors that determined the degree of progress in a complex intervention. CONCLUSION: It was possible to measure the progression of the implementation of a complex intervention through key performance indicators delivering relevant information for decision-makers that pursue a successful and faithful implementation. This study provides a valuable tool for the national scale-up of a similar model started in Chile by the Ministry of Health and other countries.