Evaluación de la implementación de la iniciativa HEARTS en una comunidad rural de Venezuela, 2023 / Evaluation of Implementation of the HEARTS Initiative in a Rural Community in Venezuela, 2023 / Avaliação da implementação da iniciativa HEARTS em uma comunidade rural da Venezuela, 2023

[RESUMEN]. Objetivo. Evaluar la implementación de estrategias de la iniciativa HEARTS en una comunidad de la República Bolivariana de Venezuela. Métodos. Estudio cuasiexperimental, con la evaluación de la cascada de cuidado, factores impulsores e índices de madurez y desempeño cuatro meses después de la implementación de la iniciativa HEARTS en la comunidad La Marroquina en 52 pacientes con hipertensión (HTA). Los datos se procesaron en el programa SPSS® versión 25.0. Se aplicaron las pruebas t-Student y de ji cuadrado para determinar la significancia estadística. Resultados. Completaron los cuatro meses de seguimiento 50 pacientes, 63,5% con baja escolaridad y estrato socioeconómico bajo o muy bajo. Al inicio, 11,5% estaba controlado, y 40,4% inició con monoterapia. Al cuarto mes, 100% de las personas hipertensas recibieron el diagnóstico, 92% recibió tratamiento y 52% alcanzó la meta de control de HTA. El 72% recibía terapia combinada. De las personas hipertensas, 70% mantenía cifras de presión arterial <140/90 mmHg. El índice de madurez alcanzó nivel 4 de 5, y el índice de desempeño se clasificó en incipiente. Conclusión. Este trabajo muestra, en un corto tiempo, un buen índice de madurez en la implementación de un protocolo estandarizado de diagnóstico, tratamiento y seguimiento de la HTA en una población rural, por parte de personal médico y no médico supervisado, que mejora las tasas de diagnóstico, tratamiento y control en los hipertensos, y empieza a mostrar su desempeño. El mantenimiento de esta iniciativa tendrá un gran impacto en la salud de esta población. Se recomienda su implementación como política de salud pública nacional.

[ABSTRACT]. Objective. To evaluate the implementation of HEARTS strategies in a community in the Bolivarian Republic of Venezuela. Methods. Quasi-experimental study evaluating the cascade of care, driving factors, and maturity and performance indicators four months after implementation of the HEARTS initiative in 52 patients with high blood pressure (BP) in the community of La Marroquina. The data were processed using SPSS® Statistics, version 25.0. Student's t-distribution and chi-square tests were applied to determine statistical significance. Results. Fifty patients, 63.5% of them with a low educational level and low or very low socioeconomic status, completed the four-month monitoring period. At baseline, 11.5% had controlled BP and 40.4% initiated monotherapy. By the fourth month, 100% of patients with high BP had been diagnosed, 92% had received treatment, and 52% had achieved control of their BP. Seventy-two percent were receiving combined therapy. Seventy percent of the hypertensive individuals maintained blood pressure levels <140/90 mmHg. The maturity index score was 4 of 5, and the performance index was classified as incipient. Conclusion. This work shows that, in a short time, a good maturity index was achieved through the implementation, by medical and supervised non-medical personnel, of a standardized protocol for diagnosis, treatment, and monitoring of high blood pressure in a rural population. Rates of diagnosis, treatment, and BP control improved, with incipient performance results. Sustaining this initiative will have a major impact on the health of this population. Its implementation as a national public health policy is recommended.

[RESUMO]. Objetivo. Avaliar a implementação das estratégias da iniciativa HEARTS em uma comunidade da República Bolivariana da Venezuela. Métodos. Estudo quase-experimental que avaliou a cascata de cuidados, fatores determinantes e índices de maturidade e desempenho quatro meses após a implementação da iniciativa HEARTS na comunidade de La Marroquina, Venezuela. Foram avaliados 52 pacientes com hipertensão arterial. A análise estatística foi realizada no software SPSS®, versão 25.0. O teste t de Student e o teste qui-quadrado foram usados para determinar a significância estatística. Resultados. Cinquenta pacientes completaram o acompanhamento de quatro meses. Desses, 63,5% tinham baixa escolaridade e nível socioeconômico baixo ou muito baixo. No início do estudo, 11,5% apresentavam doença controlada e 40,4% estavam em monoterapia. No quarto mês, 100% dos pacientes com hipertensão arterial haviam sido diagnosticados, 92% haviam recebido tratamento, 52% haviam atingido a meta de controle da hipertensão e 72% estavam recebendo terapia combinada. Dos pacientes com hipertensão, 70% mantinham níveis pressóricos <140 × 90 mmHg. O índice de maturidade foi avaliado como nível 4 (de 5), e o desempenho foi classificado como incipiente. Conclusão. Este estudo demonstra, após pouco tempo, um bom índice de maturidade na implementação de um protocolo padronizado de diagnóstico, tratamento e acompanhamento da hipertensão arterial em uma população rural atendida por pessoal médico e não médico supervisionado. Observa-se melhoria das taxas de diagnóstico, tratamento e controle dos pacientes com hipertensão, demonstrando de forma incipiente seu desempenho. Dar continuidade a essa iniciativa terá uma repercussão importante na saúde dessa população. Recomendando-se que a iniciativa seja implementada como política nacional de saúde pública.

Quality of life of Venezuelan migrants in Brazil during the COVID-19 pandemic.

The economic, social, and health crisis in Venezuela has resulted in the largest forced migration in recent Latin American history. The general scenario in host countries influence migrants' self-perception of quality of life, which can be understood as an indicator of their level of integration. The COVID-19 pandemic has exacerbated socioeconomic and health vulnerabilities, especially for forced migrants. We hypothesized that the adverse circumstances faced by Venezuelan migrants during the pandemic have deepened their vulnerability, which may have influenced their perception of quality of life. This study aims to evaluate the quality of life of Venezuelan migrants in Brazil during the COVID-19 pandemic. We assessed the quality of life of 312 adult Venezuelan migrants living in Brazil using the World Health Organization WHOQOL-BREF quality of life assessment, which was self-administered online from October 20, 2020, to May 10, 2021. The associations of quality of life and its domains with participants' characteristics were analyzed via multiple linear regression models. Mean quality of life score was 44.7 (±21.8) on a scale of 0 to 100. The best recorded mean was in the physical domain (66.2±17.8) and the worst in the environmental domain (51.1±14.6). The worst quality of life was associated with being a woman, not living with a partner, lower household income, and discrimination based on nationality. Factors associated with overall quality of life and respective domains, especially income and discrimination, were also observed in other studies as obstacles to Venezuelan migrants. The unsatisfactory quality of life among Venezuelans living in Brazil may have been worsened by the pandemic during the study period.

Self-rated health and sociodemographic inequalities among Venezuelan adults: a study based on the National Survey of Living Conditions (ENCOVI 2021).

Self-rated health is an indicator that can be easily identified in health surveys, widely used to measure physical, social, mental, and health aspects of the population, and predict premature mortality. In Venezuela, this information only began to be collected recently, in the National Survey of Living Conditions (ENCOVI). In this context, our study aims to analyze the demographic and socioeconomic factors associated with non-positive self-rated health among Venezuelan adults. The ENCOVI 2021 (n = 16,803) was used as a data source, assessing a probability stratified sample with questions about health, education, emigration, and other social and economic aspects. Crude and adjusted prevalence ratio analyses were performed using Poisson regression models with robust variance. The prevalence of fair/bad self-rated health among Venezuelans was 17.8%. The results indicated a strong association between outcome prevalence and age group, 3.81 times higher (95%CI: 3.29-4.41) among individuals aged 60 or more when compared to individuals aged 18 to 29 years. Also, participants experiencing severe food insecurity had a prevalence 2 times higher (95%CI: 1.61-2.47) than those who did not have any level of food insecurity. Factors such as poverty, education, recent emigration of family members, and sex also showed a significant influence, also when analyzed independently. The results show that special attention should be dedicated to the health of individuals facing hunger and of the older people.

Using Respondent-Driven Sampling (RDS) to Identify the Healthcare Needs among Women of Reproductive Age Who Migrated from Venezuela to Brazil, 2018-2021.

In 2021, an RDS survey was conducted among Venezuelan migrant women of reproductive age who migrated to two Brazilian cities (Manaus and Boa Vista) from 2018 to 2021. To start the RDS recruitment, we chose seeds non-randomly in both cities. The study variables were age, educational level, self-rated health, pregnancy, migratory status and use of health services. We estimated the prevalence, confidence intervals and homophily effects by variable category. We used a multivariate logistic regression model to identify the main factors associated with healthcare use. A total of 761 women were recruited in Manaus and 1268 in Boa Vista. Manaus showed more irregular migrants than Boa Vista. The main reasons for using health services were as follows: illness, disease prevention and prenatal care. The logistic regression model showed the use of health services was associated with educational level and healthcare needs but not with migratory status. The social inclusion of Venezuelan migrants is extremely relevant, although many challenges must be overcome. The strategy of the Brazilian Federal Government for providing humanitarian assistance to Venezuelan migrants should be expanded to include and facilitate their integration into labor markets, access to healthcare and education, benefiting both migrants and the Brazilian people by reducing social inequality.

Comparing Mediators and Moderators of Mental Health Outcomes from the Implementation of Group Problem Management Plus (PM+) among Venezuelan Refugees and Migrants and Colombian Returnees in Northern Colombia.

Colombia hosts the largest number of refugees and migrants fleeing the humanitarian emergency in Venezuela, many of whom experience high levels of displacement-related trauma and adversity. Yet, Colombian mental health services do not meet the needs of this population. Scalable, task-sharing interventions, such as Group Problem Management Plus (Group PM+), have the potential to bridge this gap by utilizing lay workers to provide the intervention. However, the current literature lacks a comprehensive understanding of how and for whom Group PM+ is most effective. This mixed methods study utilized data from a randomized effectiveness-implementation trial to examine the mediators and moderators of Group PM+ on mental health outcomes. One hundred twenty-eight migrant and refugee women in northern Colombia participated in Group PM+ delivered by trained community members. Patterns in moderation effects showed that participants in more stable, less marginalized positions improved the most. Results from linear regression models showed that Group PM+-related skill acquisition was not a significant mediator of the association between session attendance and mental health outcomes. Participants and facilitators reported additional possible mediators and community-level moderators that warrant future research. Further studies are needed to examine mediators and moderators contributing to the effectiveness of task-shared, scalable, psychological interventions in diverse contexts.

The Venezuelan Humanitarian Crisis, Out-Migration, and Household Change Among Venezuelans in Venezuela and Abroad.

International migration is increasingly characterized by the need to evade threats to survival. Nevertheless, demographic understandings of how families-rather than individuals alone-decide to migrate or separate in response to threats remain limited. Focusing on the recent humanitarian crisis in Venezuela, we analyze 2012-2016 data on Venezuelans in Venezuela and 2018-2020 data on UNHCR (United Nations High Commissioner for Refugees)-registered Venezuelans in nine receiving countries to illuminate the evolution of threats Venezuelans sought to evade, how threat evasion transformed households away from previous norms, the selection of migrants into different receiving countries and household structures, and demographic disparities in migrants' odds of reporting changes to their household because of specific migration-related processes (e.g., leaving someone in Venezuela, leaving someone in another country). Results underscore a simultaneous escalation of economic, safety, and political concerns that informed Venezuelans' increasing intentions to out-migrate. Where Venezuelans migrated and who ended up in their households abroad varied by demographic background and migration experiences. Among UNHCR-registered Venezuelans, 43% left family members in Venezuela, and more than 10% left or were left behind by members in another country. Such household separations, however, were unevenly distributed across factors such as age, gender, and country of reception.

Eviction-driven infanticide and sexually selected adoption and infanticide in a neotropical parrot.

Infanticide and adoption have been attributed to sexual selection, where an individual later reproduces with the parent whose offspring it killed or adopted. While sexually selected infanticide is well known, evidence for sexually selected adoption is anecdotal. We report on both behaviors at 346 nests over 27 y in green-rumped parrotlets (Forpus passerinus) in Venezuela. Parrotlets are monogamous with long-term pair bonds, exhibit a strongly male-biased adult sex ratio, and nest in cavities that are in short supply, creating intense competition for nest sites and mates. Infanticide attacks occurred at 256 nests in two distinct contexts: 1) Attacks were primarily committed by nonbreeding pairs (69%) attempting to evict parents from the cavity. Infanticide attacks per nest were positively correlated with population size and evicting pairs never adopted abandoned offspring. Competition for limited nest sites was a primary cause of eviction-driven infanticide, and 2) attacks occurred less frequently at nests where one mate died (31%), was perpetrated primarily by stepparents of both sexes, and was independent of population size. Thus, within a single species and mating system, infanticide occurred in multiple contexts due to multiple drivers. Nevertheless, 48% of stepparents of both sexes adopted offspring, and another 23% of stepfathers exhibited both infanticide and long-term care. Stepfathers were often young males who subsequently nested with widows, reaching earlier ages of first breeding than competitors and demonstrating sexually selected adoption. Adoption and infanticide conferred similar fitness benefits to stepfathers and appeared to be equivalent strategies driven by limited breeding opportunities, male-biased sex ratios, and long-term monogamy.

Violence suffered by Venezuelan immigrant female sex workers: an intersectional view.

OBJECTIVE: To characterize and analyze violence committed against Venezuelan immigrant female sex workers, from the perspective of an intersectional look at social class, gender and race-ethnicity. METHOD: Exploratory study with a qualitative approach. Data sources: interviews with 15 Venezuelan immigrant women sex workers and 37 Brazilian online media reports that addressed the topic. Data were submitted to thematic content analysis, with the support of Qualitative Data Analysis (WebQDA) software. RESULTS: Thematic analysis of data from reports and interviews allowed the emergence of three empirical categories: Structural violence and reasons that led to prostitution: a question of social class; Among the forms of violence, the most feared: physical violence; Violence based on gender and race-ethnicity. CONCLUSION: The study made it possible to recognize that Venezuelan immigrant women who are sex workers in Brazil are subject to different types of violence and exploitation. This scenario is due to a reality of life and work that is based on the exploitation of female workers who experience the consequences of the interweaving of subalternities characteristic of their social insertion of class, gender and race-ethnicity.

Some trematodes including three new species from freshwater fishes of Venezuela.

The present paper comprises a systematic survey of trematodes found in 13 species of freshwater fishes in Venezuela collected in 1992, 1996 and 2001. The following 15 trematode species were recorded: Adults: Genarchella venezuelaensis sp. n., Thometrema dissimilis sp. n., Megacoelium spinicavum Thatcher et Varella, 1981, Doradamphistoma bacuense Thatcher, 1999, Crassicutis cichlasomae Manter, 1936, Parspina carapo Ostrowski de Núñez, Arredonto et Gil de Pertierra, 2011, Phyllodistomoides hoplerythrini sp. n. Larvae (metacercariae): Clinostomatopsis sorbens (Braun, 1899), Clinostomum marginatum (Rudolphi, 1819), C. detruncatum Braun, 1899, Ithyoclinostomum dimorphum (Diesing, 1850), Odhneriotrema microcephala (Travassos, 1922), Tylodelphys sp., Posthodiplostomum sp., Sphincterodiplostomum sp. All these parasites are reported from Venezuela for the first time and many of these findings represent new host records. The new species G. venezuelaensis sp. n., T. dissimilis sp. n. and P. hoplerythrini sp. n. were collected from the accessory respiratory organ of Loricariichthys brunneus (Hancock) (Loricariidae), from the stomach of Hoplerythrinus unitaeniatus (Spix et Agassiz) (Erythrinidae) and from the intestine of H. unitaeniatus, respectively. All parasites are briefly described and illustrated and problems concerning their morphology, taxonomy, hosts and geographical distribution are discussed. Megacoelium spinispecum Thatcher et Varella, 1981 is considered a junior synonym of M. spinicavum Thatcher et Varella, 1981, and Crassicutis opisthoseminis Bravo-Hollis et Arroyo, 1962 as a junior synonym of C. cichlasomae Manter, 1936.

Update of the geographic range of Humboldt's squirrel monkeys (Saimiri cassiquiarensis cassiquiarensis Lesson, 1840) using a model-based approach.

Saimiri cassiquiarensis cassiquiarensis (Cebidae) is a primate subspecies with a wide distribution in the Amazonian region of Brazil, Colombia, and Venezuela. However, the boundaries of its geographic range remain poorly defined. This study presents new occurrence localities for this subspecies and updates its distribution using a compiled data set of 140 occurrence records based on literature, specimens vouchered in scientific collections, and new field data to produce model-based range maps. After cleaning our data set, we updated the subspecies' extent of occurrence, which was used in model calibration. We then modeled the subspecies' range using a maximum entropy algorithm (MaxEnt). The final model was adjusted using a fixed threshold, and we revised this polygon based on known geographic barriers and parapatric congeneric ranges. Our findings indicate that this subspecies is strongly associated with lowland areas, with consistently high daily temperatures. We propose modifications to all range boundaries and estimate that 3% of the area of occupancy (AOO, as defined by IUCN) has already been lost due to deforestation, resulting in a current range of 224,469 km2. We also found that 54% of their AOO is currently covered by protected areas (PAs). Based on these results, we consider that this subspecies is currently properly classified as Least Concern, because it occupies an extensive range, which is relatively well covered by PAs, and is currently experiencing low rates of deforestation.

Saimiri cassiquiarensis cassiquiarensis (Cebidae) é uma subespécie de primata com ampla distribuição na região amazônica do Brasil, Colômbia e Venezuela. No entanto, os limites de sua distribuição geográfica permanecem mal definidos. Este estudo apresenta novas localidades de ocorrência para essa subespécie e atualiza sua distribuição usando 140 registros de ocorrência compilados com base na literatura, espécimes depositados em coleções científicas e novos registros de campo para produzir mapas de distribuição baseados em modelos. Após a limpeza do nosso banco de dados, atualizamos a extensão de ocorrência da subespécie, que foi usada na calibração do modelo. Em seguida, modelamos a área de distribuição da subespécie usando um algoritmo de entropia máxima (MaxEnt). O modelo final foi ajustado usando um limiar fixo e revisamos esse polígono com base em barreiras geográficas conhecidas e na distribuição de congêneres parapátricas. Nosso modelo sugere que a espécie é fortemente associada a áreas planas, com temperaturas diárias consistentemente altas. Propomos modificações em todos os limites da área de distribuição e estimamos que 3% da área de ocupação (AOO, conforme definida pela IUCN) da subespécie já foi perdida devido ao desmatamento, resultando em uma área de distribuição atual de 224,469 km2. Também estimamos que 54% de sua AOO encontra­se atualmente coberta por áreas protegidas. Com base nesses resultados, consideramos que a subespécie está apropriadamente classificada como Pouco Preocupante, pois ocupa uma área extensa, que é relativamente bem coberta por áreas protegidas e atualmente apresenta baixas taxas de desmatamento.

Understanding the factors associated with COVID-19 vaccine hesitancy in Venezuela.

BACKGROUND: Despite nearly a quarter of Venezuelans remaining unvaccinated against coronavirus disease 2019 (COVID-19), the factors contributing to vaccine hesitancy in the country have not been thoroughly investigated. METHODS: A cross-sectional study was conducted from October 15th to 30th, 2022, using a knowledge, attitudes, and practices (KAP) survey to identify factors associated with COVID-19 vaccine hesitancy. RESULTS: The study analyzed data from 1,930 participants from all 24 states of Venezuela. The majority (93.4%) were vaccinated. The mean age was 40 years, predominantly female (67.3%), and held a university degree (70.6%). The mean KAP score was significantly higher among vaccinated individuals compared to unvaccinated ones (7.79 vs. 3.94 points for knowledge, 40 vs. 24 points for attitudes, and 16 vs. 10 points for practices, all p < 0.001). Increases in the scores for KAP were associated with increased odds of being vaccinated (84.6%, 25.6%, and 33% respectively for each one-point increase, all p < 0.001). Certain demographic factors such as marital status, occupation, religious beliefs, monthly income, and location influence COVID-19 vaccine knowledge. Higher income and certain occupations decrease the odds of low knowledge, while residing in specific states increases it. Attitudes towards the COVID-19 vaccine are influenced by age, health status, vaccination status, and location. Higher income and absence of certain health conditions decrease the odds of negative attitudes. Lastly, age, occupation, monthly income, and location affect vaccine practices. Advanced age and higher income decrease the odds of inappropriate practices, while residing in La Guaira state increases them. CONCLUSION: Factors such as age, education level, occupation, monthly income, and location were found to be associated with knowledge and attitudes towards COVID-19 vaccine among the surveyed Venezuelans.

A proposal to evaluate the management of tuberculosis programs: a qualitative, evaluability assessment in the border region of Brazil and Venezuela.

This study aims to analyze the feasibility of building an evaluative model for the management of the Tuberculosis Prevention and Control Program in the State of Roraima, located on the border between Brazil and Venezuela. This is an evaluability assessment, a type of study used as a pre-evaluation of the development and implementation stages of a program, as well as throughout its execution. The study was developed in stages comprising the: (i) definition of the intervention to be analyzed and its objectives and goals; (ii) construction of the intervention logical model; (iii) screening of parties interested in the evaluation; (iv) definition of the evaluative questions; and (v) design of the evaluation matrix. Four priority components were defined for the evaluation: management of the organization and implementation of tuberculosis (TB) prevention and control policy; epidemiological surveillance management; care network management; and management of expected/achieved results. In this model, and based on theoretical references, we defined the necessary resources, activities, outputs, outcomes, and the expected impact for each of the policy management components. The management of the TB control program is feasible for evaluation based on the design of its components, the definition of structure and process indicators, and relevant results for the analysis of the management of TB prevention and control actions, as well as its influence on compliance with the agreed indicators and targets aiming at eradicating the disease by 2035.

Migration process of Venezuelan women to Brazil: living conditions and use of health services in Manaus and Boa Vista, 2018-2021.

BACKGROUND: The last decade saw the emergence of a new significant migration corridor due to the mass migration of Venezuelans to neighboring countries in South America. Since 2018, Brazil became the third host country of Venezuelan displaced populations. Little is known about how migratory processes affect needs, access to social programs, and public health services of migrant women. The goal of this study is to shed light on the socio-economic profile, living conditions, and use of health services of Venezuelan migrant women in two main reception cities in Brazil. METHODS: A survey was conducted using respondent-driven sampling (RDS) in the cities of Boa Vista (Roraima), and Manaus (Amazonas). The study included 2012 Venezuelan migrant women aged between 15 and 49 years old who migrated from Venezuela to Brazil between 2018 and 2021. Relative prevalence was calculated, and the χ2 test was used to analyse the homogeneity of proportions. All analyses considered the complex sampling. RESULTS: The main reasons for migrating relate to difficulties obtaining food (54%) and accessing health services (37.8%) in their country of origin. They were young and mixed race (65.7%) and had high school education (69.9%). In Manaus, 3.7% of the interviewees declared that they had no family income in the last month, while in Boa Vista, it was higher (66.2%) (p-value < 0.001). Almost one-third of them sought health care in the last 15 days, and 95% of them received care. The residents of Boa Vista arrived more recently and family income and access to paid work improved with time of residence in Brazil. CONCLUSIONS: Given the increasing flow of Venezuelan migrants crossing to Brazil, a reception system was established for the provision of food, shelter, access to health services, and income transfer programs to migrants. This was the case despite high unemployment and poverty levels and income inequality, particularly in the city of Boa Vista. However, the majority had legal migrant status and had access to the public and universal healthcare system in Brazil (SUS). The use of the SUS was similar in both cities, acting as a buffer for the differences in opportunities offered.

Tepuazines A-E: Phenazine Glycosides from a Venezuelan Quartz-Rich (Tepui) Cave Soil-Derived Streptomyces virginiae CMB-CA091.

Investigation of the secondary metabolites of Streptomyces virginiae CMB-CA091 isolated from the quartz-rich (tepui) soil of a cave in Venezuela yielded two new dimeric phenazine glycosides, tepuazines A and B (1 and 2); three new monomeric phenazine glycosides, tepuazines C-E (3-5); and a series of known analogues, baraphenazine G (6), phenazinolin D (7), izumiphenazine C (8), 4-methylaminobenzoyl-l-rhamnopyranoside (9), and 2-acetamidophenol (10). Structures were assigned to 1-10 on the basis of detailed spectroscopic analysis and biosynthetic considerations, with 1 and 2 featuring a rare 2-oxabicyclo[3.3.1]nonane-like ring C/D bridge shared with only a handful of known Streptomyces natural products. We propose a plausible convergent biosynthetic relationship linking all known members of this structure class that provides a rationale for the observed ring C/D configuration.

Leveraging limited data from wildlife monitoring in a conflict affected region in Venezuela.

Efficient monitoring of biodiversity-rich areas in conflict-affected areas with poor rule of law requires a combination of different analytical approaches to account for data biases and incompleteness. In the upland Amazon region of Venezuela, in Canaima National Park, we initiated biodiversity monitoring in 2015, but it was interrupted by the establishment of a large-scale mining development plan in 2016, compromising the temporal and geographical extent of monitoring and the security of researchers. We used a resource selection function model framework that considers imperfect detectability and supplemented detections from camera trap surveys with opportunistic off-camera records (including animal tracks and direct sighting) to (1) gain insight into the value of additional occurrence records to accurately predict wildlife resource use in the perturbated area (deforestation, fire, swidden agriculture, and human settlements vicinity), (2) when faced with security and budget constraints. Our approach maximized the use of available data and accounted for biases and data gaps. Adding data from poorly sampled areas had mixed results on estimates of resource use for restricted species, but improved predictions for widespread species. If budget or resources are limited, we recommend focusing on one location with both on-camera and off-camera records over two with cameras. Combining camera trap records with other field observations (28 mammals and 16 birds) allowed us to understand responses of 17 species to deforestation, 15 to fire, and 13 to swidden agriculture. Our study encourages the use of combinations of methods to support conservation in high-biodiversity sites, where access is restricted, researchers are vulnerable, and unequal sampling efforts exist.

Forced displacement and the health workforce crisis: Venezuelan healthcare workers in Peru.

The migration of health workforces tends to be economically based benefiting high-income countries, while draining lower-income countries of workers and skills However, national instability or civil conflict may also have the effect of forcing out health workers. However, few articles focus on the experiences of these types of migrants. Peru has become the second largest Latin American destination for Venezuelan forced displaced migrants, a number of which are health workers. While the exact numbers of these workers is unknown, it is estimated that 4000 and 3000 doctors and about 2500 nurses and health technicians from Venezuela reside in Peru. These workers find entry into the heath system difficult due to bureaucratic and costly registration and qualification validation procedures. However, during Covid-19 these conditions were relaxed, and a large number of these heath workers entered the heath workforce. These workers were primarily doctors and worked in urban medical facilities, though there was some distribution across the country's departments. This avenue to the health workforce allowed the mobilisation of dormant health skills and lifted workforce density numbers. Nonetheless, it is too early to see if there have been sustainable improvements, and it remains uncertain how these policies have contributed to the country's UHC goals. Peru's experiences raise the issue of how to mobilise dormant displaced health worker migrants.

The impact of the COVID-19 pandemic on people living with HIV: a cross-sectional study in Caracas, Venezuela.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has disrupted multiple health services, including human immunodeficiency virus (HIV) testing, care, and treatment services, jeopardizing the achievement of the Joint United Nations Programme on HIV/AIDS 90-90-90 global target. While there are limited studies assessing the impact of the COVID-19 pandemic on people living with HIV (PLHIV) in Latin America, there are none, to our knowledge, in Venezuela. This study aims to assess the impact of the COVID-19 pandemic among PLHIV seen at the outpatient clinic of a reference hospital in Venezuela. METHODS: We conducted a cross-sectional study among PLHIV aged 18 years and over seen at the Infectious Diseases Department of the University Hospital of Caracas, Venezuela between March 2021 and February 2022. RESULTS: A total of 238 PLHIV were included in the study. The median age was 43 (IQR 31-55) years, and the majority were male (68.9%). Most patients (88.2%, n = 210) came for routine check-ups, while 28 (11.3%) were newly diagnosed. The majority of patients (96.1%) were on antiretroviral therapy (ART), but only 67.8% had a viral load test, with almost all (95.6%) being undetectable. Among those who attended regular appointments, 11.9% reported missing at least one medical consultation, and 3.3% reported an interruption in their ART refill. More than half of the patients (55.5%) had received at least one dose of the COVID-19 vaccine, while the rest expressed hesitancy to get vaccinated. Most patients with COVID-19 vaccine hesitancy were male (65.1%), younger than 44 years (57.5%), employed (47.2%), and had been diagnosed with HIV for less than one year (33%). However, no statistically significant differences were found between vaccinated patients and those with COVID-19 vaccine hesitancy. Older age was a risk factor for missing consultations, while not having an alcoholic habit was identified as a protective factor against missing consultations. CONCLUSION: This study found that the COVID-19 pandemic had a limited impact on adherence to medical consultations and interruptions in ART among PLHIV seen at the University Hospital of Caracas, Venezuela.

Chagas Disease and Leishmaniasis, Sympatric Zoonoses Present in Human from Rural Communities of Venezuela.

PURPOSE: Trypanosoma cruzi and Leishmania spp. coexist in several endemic areas, and there are few studies of Chagas disease and leishmaniasis coinfection worldwide; for this reason, the objective of this work was to determine the Chagas disease and leishmaniasis coinfection in several rural communities co-endemic for these diseases. METHODS: A total of 1107 human samples from six co-endemic rural communities of Cojedes state, Venezuela, were analyzed. Serum samples were evaluated by ELISA, indirect hemagglutination, and indirect immunofluorescence for Chagas disease diagnosis, and individuals were evaluated for leishmaniasis by leishmanin skin test (LST). Approximately, 30% of the individuals were also analyzed by PCR (blood clot samples) for T. cruzi and for Leishmania spp. RESULTS: The 14.7% of the individuals were positive to Trypanosoma cruzi infection by serology, and 25.8% were positive to Leishmania spp. current or past infection by LST. Among the group with PCR results, 7.8% were positive for T. cruzi, and 9.4% for Leishmania spp. The coinfection T. cruzi/Leishmania spp. was 6.5%. The T. cruzi DTUs of the positive blood clot samples were TcI, revealed using the molecular markers: (i) intergenic region of the miniexon, (ii) D7 divergent domain of the 24Sα rDNA, (iii) size-variable domain of the 18S rDNA, and (iv) hsp60-PCR-RFLP (EcoRV). The Leishmania species identified were L. (Leishmania) mexicana and L. (Viannia) braziliensis. CONCLUSION: A high prevalence was found for T. cruzi and Leishmania spp. single and coinfections in almost all communities studied, being these results of relevance for the implementation of control programs in co-endemic areas.