[A national network of molecular tests to detect Chlamydia trachomatis and Neisseria gonorrhoeae: a pilot implementation experience in Brazil]. / Rede nacional de testes moleculares para detecção de Chlamydia trachomatis e Neisseria gonorrhoeae: experiência de implantação-piloto no Brasil.

This study aimed to know the opinion of professionals participating in an experiment to implement a pilot for molecular tests to detect Chlamydia trachomatis and Neisseria gonorrhoeae at the Brazilian Unified National Health System (SUS). The detection rate of C. trachomatis and/or N. gonorrhoeae and the factors associated with infection were determined. The strategy included laboratories belonging to the HIV and viral hepatitis viral load network. Testing targeted people who are more vulnerable to sexually transmitted infections and collected urine samples and/or vaginal, endocervical, and/or male urethral swabs. Questionnaires were sent to state managers and laboratory professionals about the implementation of the pilot. Reviews were overall positive. Weaknesses included difficulties changing work processes, lack of human resources, poorly sensitized care professionals, and absence of primary urine tubes, the only input not provided. Strengths included the centralized acquisition of tests, sharing of equipment, and storage of samples at room temperature. Of the 16,177 people who were tested, 1,004 (6.21%) were positive for C. trachomatis; 1,036 (6.4%), for N. gonorrhoeae; and 239 (1.48%), for C. trachomatis/N. gonorrhoeae . Detection of any infection occurred more frequently in young people (≤ 24 vs. > 24 years) (adjOR = 2.65; 95%CI: 2.38-2.96), men (adjOR = 1.95; 95%CI: 1.72-2.21), brown/black individuals (adjOR = 1.06; 95%CI: 1.05-1.11), those in Southeastern Brazil (adjOR = 1.08; 95%CI: 1.02-1.13), and in urethral secretion samples (adjOR = 1.46; 95%CI: 1.41-1.52). Results show the importance of making testing available nationwide, which supported the implementation of a definitive network to detection C. trachomatis/N. gonorrhoeae in SUS.

O objetivo deste estudo foi conhecer a opinião dos profissionais participantes da implantação-piloto de testes moleculares para detecção de Chlamydia trachomatis e Neisseria gonorrhoeae no Sistema Único de Saúde (SUS). Determinou-se a taxa de detecção de C. trachomatis e/ou N. gonorrhoeae e os fatores associados à infecção. A estratégia contou com laboratórios pertencentes à rede de carga viral de HIV e hepatites virais. A testagem teve como público-alvo pessoas mais vulnerabilizadas às infecções sexualmente transmissíveis, com coleta de amostras de urina e/ou swabs vaginal, endocervical e/ou uretral masculino. Questionários foram enviados aos gestores estaduais e profissionais de laboratório sobre a implantação-piloto. De maneira geral, as avaliações foram positivas. Entre as fraquezas, citou-se dificuldades na mudança do processo de trabalho, carência de recursos humanos, pouca sensibilidade de profissionais da assistência e ausência de tubo primário de urina, único insumo não fornecido. Como fortaleza, destaca-se aquisição centralizada de testes, compartilhamento de equipamentos e armazenamento de amostras à temperatura ambiente. Das 16.177 pessoas testadas, 1.004 (6,21%) foram positivas para C. trachomatis, 1.036 (6,4%) para N. gonorrhoeae e 239 (1,48%) para C. trachomatis/N. gonorrhoeae. A detecção de infecção ocorreu mais em pessoas jovens (≤ 24 vs. > 24 anos) (aOR = 2,65; IC95%: 2,38-2,96), do sexo masculino (aOR = 1,95; IC95%: 1,72-2,21), pardas/pretas (aOR = 1,06; IC95%: 1,05-1,11), na Região Sudeste (aOR = 1,08; IC95%: 1,02-1,13) e em amostras de secreção uretral (aOR = 1,46; IC95%: 1,41-1,52). Os resultados deste estudo demonstraram a importância da disponibilização da testagem em âmbito nacional, os quais subsidiaram a implantação da rede definitiva para detecção de C. trachomatis/N. gonorrhoeae no SUS.

El objetivo de este estudio fue conocer la opinión de los profesionales participantes de la implantación piloto de pruebas moleculares para la detección de Chlamydia trachomatis y Neisseria gonorrhoeae en el Sistema Único de Salud brasileño (SUS). Se determinó la tasa de detección de C. trachomatis y/o N. gonorrhoeae y los factores asociados con la infección. En la estrategia participaron laboratorios pertenecientes a la red de carga viral de VIH y hepatitis virales. La prueba tuvo como público objetivo a personas más vulnerables a las infecciones de transmisión sexual, con recolección de muestras de orina y/o swabs vaginal, endocervicales y/o uretral masculino. Se enviaron cuestionarios a los gestores estatales y a los profesionales de laboratorio sobre la implementación piloto. En general, las evaluaciones fueron positivas. Entre las debilidades, se citó las dificultades en el cambio del proceso de trabajo, la falta de recursos humanos, los profesionales de la asistencia poco sensibilizados y la ausencia del contenedor de orina primaria, el único insumo no suministrado. Como fortalezas, se destaca la adquisición centralizada de pruebas, el intercambio de equipos y el almacenamiento de muestras a temperatura ambiente. De las 16.177 personas evaluadas, 1.004 (6,21%) fueron positivas para C. trachomatis, 1.036 (6,4%) para N. gonorrhoeae y 239 (1,48%) para C. trachomatis/N. gonorrhoeae. La detección de alguna infección ocurrió más en personas jóvenes (≤ 24 vs. > 24 años) (aOR = 2,65; IC95%: 2,38-2,96), del sexo masculino (aOR = 1,95; IC95%: 1,72-2,21), parda/negra (aOR = 1,06; IC95%: 1,05-1,11), localizadas en la región Sudeste (aOR = 1,08; IC95%: 1,02-1,13) y en muestras de secreción uretral (aOR = 1,46; IC95%: 1,41-1,52). Los resultados de este estudio demostraron la importancia de la disponibilidad de la prueba a nivel nacional, los cuales subsidiaron la implantación de la red definitiva para detección de C. trachomatis/N. gonorrhoeae en el SUS.

Corrigendum: Implementing a provisional overarching intervention for COVID-19 monitoring and control in the Brazil-Colombia-Peru frontier.

[This corrects the article DOI: 10.3389/fpubh.2023.1330347.].

The leading role of expert safety knowledge in supporting the mission of caring for patients during man-made and natural disasters: state of emergency medicine in Ethiopia, Myanmar, and Ukraine.

Preparedness to endure extreme situations such as natural disasters or military conflicts is not commonplace in healthcare training programs. Moreover, multidisciplinary teams in health services rarely (if ever) include experts in security. However, when emergency situations occur, prevailing healthcare demands do not cease to exist, and unexpected demands often surge due to the shortage of other services and supplies or as a consequence of the emergency condition itself.With services in 45 countries, AIDS Healthcare Foundation (AHF) has operated in several conflict zones, facing broad and challenging security demands. Since 2017 AHF has implemented the Global Department of Safety and Security (GDSS), a dedicated intelligence and safety program that had a key role in the security monitoring, preparedness, and defense responses, assisting staff members and clients during recent conflicts.In this manuscript, we describe the experience of AHF's GDSS in three recent military conflicts in Ethiopia, Myanmar, and Ukraine, and provide insights into steps that can be taken to assure staff safety and support the mission of caring for patients throughout catastrophic events.

Rede nacional de testes moleculares para detecção de Chlamydia trachomatis e Neisseria gonorrhoeae: experiência de implantação-piloto no Brasil / A national network of molecular tests to detect Chlamydia trachomatis and Neisseria gonorrhoeae: a pilot implementation experience in Brazil / Red nacional de pruebas moleculares para la detección de Chlamydia trachomatis y Neisseria gonorrhoeae: experiencia de implantación piloto en Brasil

Resumo: O objetivo deste estudo foi conhecer a opinião dos profissionais participantes da implantação-piloto de testes moleculares para detecção de Chlamydia trachomatis e Neisseria gonorrhoeae no Sistema Único de Saúde (SUS). Determinou-se a taxa de detecção de C. trachomatis e/ou N. gonorrhoeae e os fatores associados à infecção. A estratégia contou com laboratórios pertencentes à rede de carga viral de HIV e hepatites virais. A testagem teve como público-alvo pessoas mais vulnerabilizadas às infecções sexualmente transmissíveis, com coleta de amostras de urina e/ou swabs vaginal, endocervical e/ou uretral masculino. Questionários foram enviados aos gestores estaduais e profissionais de laboratório sobre a implantação-piloto. De maneira geral, as avaliações foram positivas. Entre as fraquezas, citou-se dificuldades na mudança do processo de trabalho, carência de recursos humanos, pouca sensibilidade de profissionais da assistência e ausência de tubo primário de urina, único insumo não fornecido. Como fortaleza, destaca-se aquisição centralizada de testes, compartilhamento de equipamentos e armazenamento de amostras à temperatura ambiente. Das 16.177 pessoas testadas, 1.004 (6,21%) foram positivas para C. trachomatis, 1.036 (6,4%) para N. gonorrhoeae e 239 (1,48%) para C. trachomatis/N. gonorrhoeae. A detecção de infecção ocorreu mais em pessoas jovens (≤ 24 vs. > 24 anos) (aOR = 2,65; IC95%: 2,38-2,96), do sexo masculino (aOR = 1,95; IC95%: 1,72-2,21), pardas/pretas (aOR = 1,06; IC95%: 1,05-1,11), na Região Sudeste (aOR = 1,08; IC95%: 1,02-1,13) e em amostras de secreção uretral (aOR = 1,46; IC95%: 1,41-1,52). Os resultados deste estudo demonstraram a importância da disponibilização da testagem em âmbito nacional, os quais subsidiaram a implantação da rede definitiva para detecção de C. trachomatis/N. gonorrhoeae no SUS.

Abstract: This study aimed to know the opinion of professionals participating in an experiment to implement a pilot for molecular tests to detect Chlamydia trachomatis and Neisseria gonorrhoeae at the Brazilian Unified National Health System (SUS). The detection rate of C. trachomatis and/or N. gonorrhoeae and the factors associated with infection were determined. The strategy included laboratories belonging to the HIV and viral hepatitis viral load network. Testing targeted people who are more vulnerable to sexually transmitted infections and collected urine samples and/or vaginal, endocervical, and/or male urethral swabs. Questionnaires were sent to state managers and laboratory professionals about the implementation of the pilot. Reviews were overall positive. Weaknesses included difficulties changing work processes, lack of human resources, poorly sensitized care professionals, and absence of primary urine tubes, the only input not provided. Strengths included the centralized acquisition of tests, sharing of equipment, and storage of samples at room temperature. Of the 16,177 people who were tested, 1,004 (6.21%) were positive for C. trachomatis; 1,036 (6.4%), for N. gonorrhoeae; and 239 (1.48%), for C. trachomatis/N. gonorrhoeae . Detection of any infection occurred more frequently in young people (≤ 24 vs. > 24 years) (adjOR = 2.65; 95%CI: 2.38-2.96), men (adjOR = 1.95; 95%CI: 1.72-2.21), brown/black individuals (adjOR = 1.06; 95%CI: 1.05-1.11), those in Southeastern Brazil (adjOR = 1.08; 95%CI: 1.02-1.13), and in urethral secretion samples (adjOR = 1.46; 95%CI: 1.41-1.52). Results show the importance of making testing available nationwide, which supported the implementation of a definitive network to detection C. trachomatis/N. gonorrhoeae in SUS.

Resumen: El objetivo de este estudio fue conocer la opinión de los profesionales participantes de la implantación piloto de pruebas moleculares para la detección de Chlamydia trachomatis y Neisseria gonorrhoeae en el Sistema Único de Salud brasileño (SUS). Se determinó la tasa de detección de C. trachomatis y/o N. gonorrhoeae y los factores asociados con la infección. En la estrategia participaron laboratorios pertenecientes a la red de carga viral de VIH y hepatitis virales. La prueba tuvo como público objetivo a personas más vulnerables a las infecciones de transmisión sexual, con recolección de muestras de orina y/o swabs vaginal, endocervicales y/o uretral masculino. Se enviaron cuestionarios a los gestores estatales y a los profesionales de laboratorio sobre la implementación piloto. En general, las evaluaciones fueron positivas. Entre las debilidades, se citó las dificultades en el cambio del proceso de trabajo, la falta de recursos humanos, los profesionales de la asistencia poco sensibilizados y la ausencia del contenedor de orina primaria, el único insumo no suministrado. Como fortalezas, se destaca la adquisición centralizada de pruebas, el intercambio de equipos y el almacenamiento de muestras a temperatura ambiente. De las 16.177 personas evaluadas, 1.004 (6,21%) fueron positivas para C. trachomatis, 1.036 (6,4%) para N. gonorrhoeae y 239 (1,48%) para C. trachomatis/N. gonorrhoeae. La detección de alguna infección ocurrió más en personas jóvenes (≤ 24 vs. > 24 años) (aOR = 2,65; IC95%: 2,38-2,96), del sexo masculino (aOR = 1,95; IC95%: 1,72-2,21), parda/negra (aOR = 1,06; IC95%: 1,05-1,11), localizadas en la región Sudeste (aOR = 1,08; IC95%: 1,02-1,13) y en muestras de secreción uretral (aOR = 1,46; IC95%: 1,41-1,52). Los resultados de este estudio demostraron la importancia de la disponibilidad de la prueba a nivel nacional, los cuales subsidiaron la implantación de la red definitiva para detección de C. trachomatis/N. gonorrhoeae en el SUS.

Safeguarding HIV prevention and care services amidst military conflict: experiences from Ukraine.

Ukraine stands out among European countries concerning HIV epidemiological data. Since February 2022, the military conflict with Russian forces has posed unprecedented challenges to HIV prevention and care. AIDS Healthcare Foundation (AHF), a global non-profit organisation with operations in Ukraine since 2009, implemented a preparedness plan to protect staff members and support local facilities in the continuity of care throughout the war. In this manuscript, we describe the strategies adopted by AHF to anticipate the risk of military conflict, steps to implement a preparedness plan, main challenges faced by local staff members and managers, adaptations needed as the conflict evolved, and indicators of HIV care 1 year before and 1 year after the onset of the conflict. Our experience shows that safeguarding the organisation's human resources has been a prerequisite to sustain services throughout the war.

Brazilian Clinical Practice Guidelines for Sexually Transmitted Infections That Cause Urethral Discharge: Assessment According to the AGREE II and Critical Analysis Based on the WHO Recommendations.

BACKGROUND: Sexually transmitted infections (STI) can have severe consequences. In Brazil, case management is recommended by the Clinical Protocol and Therapeutical Guidelines for Comprehensive Care for People with STIs (PCDT-IST). This study assessed the quality of PCDT-IST (2021) and reviewed the main recommendations for the management of STI that cause urethral discharge compared with the World Health Organization (WHO) STI Guidelines. METHODS: The PCDT-IST (2021) quality was independently assessed by 4 appraisers using the Appraisal of Guidelines Research and Evaluation instrument, version II (AGREE II). The PCDT-IST (2021) and the WHO Guidelines for the Management of Symptomatic STI (2021) were compared considering 14 different assessment domains. RESULTS: The PCDT-IST (2021) scores in the AGREE II domains were: Rigor of Development (58%), Applicability (35%), Editorial Independence (38%), Scope and Purpose (78%), Stakeholder Involvement (74%), and Clarity and Presentation (82%). The overall score was 67%, and all appraisers recommended the Brazilian guideline. Regarding the PCDT-IST (2021) and the WHO STI Guidelines (2021) comparation, 10 domains would be relevant for further reviewing the Brazilian recommendations: Diagnostic tests; Etiological approach; Treatment for recurrent urethral discharge; Treatment for urethritis without etiological agent identification; Treatment for gonococcal urethritis; Treatment for chlamydial urethritis; Retreatment for gonococcal infections; Treatment for Mycoplasma genitalium urethritis; Treatment for Trichomonas vaginalis urethritis; 10. Flowcharts. CONCLUSIONS: The PCDT-IST (2021) has a reasonable degree of quality. However, the domains of Applicability, Rigor of Development, and Editorial Independence must be better ensured. The guidelines comparison will help to select key topics that should be addressed with priority in the following national STI guidelines updates.

Assessment of the Accuracy, Usability and Acceptability of a Rapid Test for the Simultaneous Diagnosis of Syphilis and HIV Infection in a Real-Life Scenario in the Amazon Region, Brazil.

We field-assessed the accuracy, acceptability, and feasibility of the SD BIOLINE HIV/Syphilis Duo rapid diagnostic test in three groups: pregnant women, female sex workers (FSW), and men who have sex with men (MSM). Venous blood samples collected in the field were compared with the respective gold standard methods: SD BIOLINE HIV/Syphilis Duo Treponemal Test versus FTA-abs (Wama brand) treponemal laboratory test for syphilis, and SD BIOLINE HIV/Syphilis Duo Test versus the fourth generation Genscreen Ultra HIV Ag-Ag (Bio-Rad brand) laboratory test for HIV. From a total of 529 participants, 397 (75.1%) were pregnant women, 76 (14.3%) FSW and 56 (10.6%) MSM. Sensitivity and specificity parameters of HIV were 100.0% (95% CI: 82.35-100.0%) and 100.0% (95% CI: 99.28-100.0%), respectively. Sensitivity and specificity parameters found for TP antibody detection were 95.00% (95% CI: 87.69-98.62%) and 100.0% (95% CI: 98.18-100.0%), respectively. The SD BIOLINE HIV/Syphilis Duo Test showed high acceptability among participants (85.87%) and health professionals (85.51%), as well as easy usability by professionals (91.06%). The usability of the SD BIOLINE HIV/Syphilis Duo Test kit would not be a barrier to accessing rapid testing, if the product were incorporated into the list of health service supplies.

Implementing a provisional overarching intervention for COVID-19 monitoring and control in the Brazil-Colombia-Peru frontier.

Introduction: he challenge was to provide comprehensive health resources to a remote and underserved population living in the Brazil-Colombia-Peru border, amid the most disruptive global crisis of the century. Methods: In August 2021, Fundação Oswaldo Cruz Amazonia (FIOCRUZ Amazônia) and partner collaborators implemented an overarching provisional program for SARS-CoV-2 detection and lineages characterization, training of laboratory personnel and healthcare providers, donation of diagnostic supplies and personal protective equipment, and COVID-19 vaccination. The expedition was conducted at the Port of Tabatinga, a busy terminal with an intense flux of people arriving and departing in boats of all sizes, located in the Amazon River basin. Local government, non-profit organizations, private companies, and other stakeholders supported the intervention. Results: The expedition was accomplished in a convergence point, where migrant workers, traders, army personnel, people living in urban areas, and people from small villages living in riversides and indigenous territories are in close and frequent contact, with widespread cross-border movement. Using a boat as a provisional lab and storage facility, the intervention provided clinical and laboratory monitoring for 891 participants; vaccination for 536 individuals; personal protective equipment for 200 healthcare providers; diagnostic supplies for 1,000 COVID-19 rapid tests; training for 42 community health agents on personal protection, rapid test execution, and pulse oximeter management; and hands-on training for four lab technicians on molecular diagnosis. Discussion: Our experience demonstrates that multilateral initiatives can counterweigh the scarcity of health resources in underserved regions. Moreover, provisional programs can have a long-lasting effect if investments are also provided for local capacity building.

Estudo TransOdara: prevalência de HPV entre travestis e mulheres transexuais em situação de vulnerabilidade social em Manaus, Amazonas, Brasil / TransOdara study: HPV Prevalence among travestis and transsexual women in social vulnerability situation in Manaus, Amazonas, Brazil

Objetivo: Estimar a prevalência do papilomavírus humano (HPV) e avaliar a indicação e completude da vacinação contra o HPV entre travestis e mulheres transexuais (TrMT) em situação de vulnerabilidade social, participantes de estudo transversal multicêntrico (TransOdara), em Manaus, Amazonas (2020-2021). Métodos: O recrutamento ocorreu no Ambulatório de Diversidade Sexual e Gênero da Policlínica Pam/Codajás, utilizando Respondent-Driven Sampling. A variável dependente foi o resultado positivo para HPV, analisado por meio do resultado do swab anal e swab genital. Resultados: Participaram 39 TrMT. Cerca de 50% tinham entre 20 e 29 anos, com até Ensino Fundamental incompleto/completo e 81,6% identificaram-se como pretas/pardas. Um total de 97,4% apresentou infecção anal pelo HPV e 53,8%, infecção genital. As prevalências foram significativamente maiores entre as imigrantes (88,9%) e em situação de rua (72,7%) do que entre as privadas de liberdade (26,3%) (p = 0,003). Conclusão: Para reduzir a alta prevalência de HPV entre TrMT em situação de vulnerabilidade social, é importante aprimorar as políticas públicas vigentes e estabelecer estratégias de prevenção (ampliação da cobertura de imunização/diagnóstico precoce) e tratamento oportuno para melhor qualidade de vida.

Objective: To estimate the prevalence of human papillomavirus (HPV) and evaluate the indication and completeness of vaccination against HPV among 'travestis" and transsexual women (TrTW) in vulnerable social, participants of a multicenter cross-sectional study (TransOdara), in Manaus, Amazonas (2020-2021). Methods: Recruitment took place at the Sexual Diversity and Gender Outpatient Clinic of the Policlínica Pam/Codajás, using Respondent-Driven Sampling. The dependent variable was the positive result for HPV, analyzed through the result of the anal swab and genital swab. Results: 39 participated TrTW. About 50% were between 20 and 29 years old, with incomplete/complete Elementary School and 81.6% identified themselves as black/brown. A total of 97.4% had anal HPV infection and 53.8%, genital infection. Prevalences were significantly higher among immigrants (88.9%) and homeless (72.7%) than among those incarcerated (26.3%) (p = 0.003). Conclusion: To reduce the high prevalence of HPV among TrMT in socially vulnerable situations, it is important to improve current public policies and establish prevention strategies (expansion immunization coverage/early diagnosis) and timely treatment for better quality of life

Prevalência de hepatite B e hepatite C entre travestis e mulheres transexuais em situação de alta vulnerabilidade social participantes do estudo TransOdara - Manaus, Amazonas, 2020-2021 / Prevalence of hepatitis B and hepatitis C among travestis and transsexual women in vulnerable situation, participants of the TransOdara Study ­ Manaus, Amazonas, 2020-2021

Introdução: Travestis e mulheres transexuais (TrMT) apresentam taxas desproporcionalmente elevadas de IST em comparação com o restante da população. Este estudo objetiva estimar a prevalência de hepatites B e C (VHB e VHC ) entre TrMT de três subgrupos de alta vulnerabilidade social, advindas do estudo TransOdara, na cidade de Manaus, no período de novembro de 2020 a abril de 2021. Metodologia:O recrutamento ocorreu no Ambulatório de Diversidade Sexual e Gênero da Policlínica Pam/Codajás, utilizando-se Respondent-Drive Sampling. Resultados: Foram selecionadas 39 TrMT participantes, das quais 48,7% estavam em situação prisional, 28,2% em situação de área livre e 23,1% eram imigrantes. Apenas 2,5% das participantes foram diagnosticadas com VHB e 5,3% com VHC. Conclusão: Como as hepatites B e C são consideradas evitáveis, é necessário capacitar os profissionais da Rede Municipal de Saúde para reduzir o estigma e discriminação com que são tratadas e ampliar o acesso dessa população aos recursos de prevenção e tratamento disponíveis no Sistema Único de Saúde (SUS)

Introduction: Travestis and transgender women (TrTW) have disproportionately high STI rates compared to the general population. This study aims to estimate the prevalence of hepatitis B and C (HBV and HBC) among TrTW of three subgroups of high social vulnerability, resulting from the study TransOdara, in the city of Manaus, from November 2020 to April 2021. Methods: Recruitment took place at the Sexual Diversity and Gender Outpatient Clinic of the Pam/Codajás Polyclinic, using Respondent-Drive Sampling. Results: 39 TrTW participants were selected, from which 48.7% were incarcerated, 28.2% were homeless and 23.1% were immigrants. Only 2.5% of participants were diagnosed with HBV and 5.3% with HCV. Conclusion: Since Hepatitis B and C are considered preventable, it is necessary to train professionals in the City Health Network to reduce the stigma and discrimination with which they are treated and expand access to this population to prevention and treatment resources available in the Unified Health System (SUS)

Prevalência de sífilis entre travestis e mulheres transexuais em situação vulnerável, participantes do estudo TransOdara ­ Manaus, Amazonas, 2020-2021 / Prevalence of syphilis among travestis and transsexual women in vulnerable situation, participants in the TransOdara study ­ Manaus, Brazil, 2020-2021

Objetivo: Estimar a prevalência de sífilis entre travestis e mulheres transexuais (TrMT) em situação de vulnerabilidade social. Métodos: Foram selecionadas TrMT residentes em Manaus, em situação de rua, privadas de liberdade e imigrantes, participantes do projeto multicêntrico TransOdara ­ Estudo de Prevalência da Sífilis e outras Infecções Sexualmente Transmissíveis entre TrMT no Brasil: Cuidado e Prevenção. Resultados: Foram incluídas 39 TrMT. A prevalência de sífilis, segundo resultado de teste rápido e VDRL, foi 64,1% (25/39), sendo aparentemente maior entre as TrMT em situação de rua (72,7%), seguidas das privadas de liberdade (63,2%) e das imigrantes (55,6%), porém sem diferença estatística entre os subgrupos. Cerca de 80% tinham entre 20 e 39 anos e se autorreferiram pretas/pardas. Discussão: Apesar do pequeno tamanho amostral, destaca-se a especificidade deste trabalho, que incluiu população vulnerável. Conclusão: Foi alta a prevalência de sífilis na população estudada, sendo necessário ampliar os serviços capacitados para atender essa demanda

Objective: To estimate the prevalence of syphilis among travestis and transsexual women (TrTW) in situations of social vulnerability. Methods: TrTW residents in Manaus, homeless, incarcered and immigrants, participants of the multicenter project TransOdara - Prevalence Study of Syphilis and other Sexually Transmitted Infections among TrMT in Brazil: Care and Prevention were selected. Results: 39 TrMT were included. The prevalence of syphilis, according to the result of the rapid test and VDRL, was 64.1% (25/39), being apparently higher among homeless TrMT (72.7%), followed by those incarcereted (63.2 %) and immigrants (55.6%), but with no statistical difference between the subgroups. About 80% were between 20 and 39 years old and self-reported as black/brown. Discussion: Despite the small sample size, the specificity of this work stands out, which included a vulnerable population. Conclusion:The prevalence of syphilis in the studied population was high, and it is necessary to expand the services trained to meet this demand.

Prevalência de clamídia e gonorreia entre travestis e mulheres transexuais em situação vulnerável participantes do Estudo TransOdara ­ Manaus, Amazonas / Prevalence of Chlamydia and Gonorrhea among travestis and transsexual women in vulnerable situation, participants of the TransOdara Study ­ Manaus, Amazonas

Introdução: Infecções bacterianas por Chlamydia trachomatis (CT) e Neisseria gonorrhoeae (NG) estão entre as de transmissão sexual mais prevalentes no mundo. Objetivos: Estimar a prevalência de CT eNG edescrever características sociodemográficas de travestis e mulheres transexuais (TrMT), participantes do estudo multicêntrico TransOdara, de três subgrupos de vulnerabilidade social, residentes em Manaus, Amazonas (2020 a 2021). Metodologia:O recrutamento ocorreu no Ambulatório de Diversidade Sexual e Gênero da Policlínica Pam/Codajás, utilizando Respondent-Drive Sampling. A variável dependente foi o resultado reagente para CT eNG (urina e swab anal e orofaringe). Foram considerados casos positivos as que tiveram resultado positivo em pelo menos um dos três testes. As variáveis foram descritas por meio de frequências relativas e absolutas, estratificadas nos três subgrupos para CT e NG. O teste de hipótese utilizado foi o Qui quadrado de Pearson e o Exato de Fisher. Nível de significância adotado foi de 5%. Resultados: Participaram 39 TrMT [19 (48,7%) em situação prisional; 11 (28,2%) em situação de rua e 9 (23,0%) imigrantes]. 48,7% tinham entre 20 e 29 anos; 46,2%, ensino fundamental; e 81,6% eram pretas/pardas. As maiores proporções de casos confirmados para CT eNG foram entre as TrMT imigrantes (22,2% e 44,4%, respectivamente). Conclusão: Novas pesquisas com TrMT são necessárias para identificar estratégias de prevenção e práticas de rastreio mais efetivas para essas infecções.

Introduction: Bacterial infections by Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are among the most prevalent sexually transmitted infections in the world. Objectives: To estimate the prevalence of CT and NG and to describe sociodemographic characteristics of travestis and transgender women (TrTW), participants of the multicenter study TransOdara, from three subgroups of social vulnerability, living in Manaus, Amazonas (2020 to 2021). Methods: Recruitment took place at the Sexual Diversity and Gender Outpatient Clinic of Policlínica Pam/Codajás, using Respondent-Drive Sampling. The dependent variable was the reagent result for CT and NG (urine and anal and oropharyngeal swab). Those with a positive result in at least one of the three tests were considered positive cases. Variables were described using relative and absolute frequencies, stratified into the three subgroups for CT and NG. The hypothesis test used was Pearson's Chi square and Fisher's Exact. The significance level adopted was 5%. Results: 39 TrMT participated. [19 (48.7%) in prison; 11 (28.2%) on the streets and 9 (23.0%) immigrants]. 48.7% were between 20 and 29 years old; 46.2% elementary school; 81.6% black/brown. The highest proportio ns of confirmed cases for CT and NG were among immigrant TrMT (22.2% and 44.4%, respectively). Conclusion: Further research with TrMT is needed to identify more effective prevention strategies and screening practices for these infections.

Prevalência de HIV entre travestis e mulheres transexuais em situação de vulnerabilidade social ­ Manaus, Amazonas, 2020-2021 / HIV prevalence among travestis and transsexual women in vulnerable situation ­ Manaus, Amazonas, 2020-2021

Introdução: É alta a prevalência de HIV entre travestis e mulheres transexuais (TrMT). Objetivo: Estimar a prevalência do HIV nessa população e descrever as características socioeconômicas de TrMT de três subgrupos com alta vulnerabilidade social. Metodologia: Estudo descritivo, com dados de participantes recrutadas em Manaus, de novembro de 2020 a abril de 2021, pelo estudo multicêntrico ­ TransOdara. Foram realizadas entrevistas estruturadas e teste rápido para HIV. As variáveis foram descritas em frequências absolutas e relativas. Resultados: Participaram 39 TrMT (48,7% em situação prisional; 28,2% em situação de rua; e 23,1% imigrantes). Cerca de 50% das participantes tinham entre 20 e 29 anos, com até 8 anos de estudo, e 81,6% eram pretas ou pardas. A prevalência de HIV foi 23,1% (9/39), sem diferença estatística entre os subgrupos analisados (p = 0,090). Conclusão: A alta prevalência de HIV entre as TrMT selecionadas requer o aprimoramento de estratégias direcionadas para ampliar o acesso dessa população à saúde.

Introduction: The prevalence of HIV among travestis and transgender women (TrTW) is high. Objective: To estimate the prevalence of HIV in this population and describe the socioeconomic characteristics of TrTW in three subgroups with high social vulnerability. Methods: Descriptive study, with data from participants recruited in Manaus, from November 2020 to April 2021, by the multicenter study - TransOdara. Structured interviews and a rapid HIV test were carried out. Variables were described in absolute and relative frequencies. Results: 39 TrMT participated (48.7% incarcereted, 28.2% in homeless, and 23.1% immigrants). About 50% of the participants were between 20 and 29 years old, with up to 8 years of study, and 81.6% were black or brown. HIV prevalence was 23.1% (9/39), with no statistical difference between the analyzed subgroups (p = 0.090). Conclusion: The high prevalence of HIV among the selected TrMT requires the improvement of targeted strategies to expand this population's access to health.

Behavioral factors associated with multiple-type HPV genital infections: data from a cross-sectional study in young women in Brazil.

OBJECTIVES: To investigate the pattern of multiple human papillomavirus (HPV) infections and associated factors in young women who access the Brazilian public health care system to better understand the characteristics of multiple HPV infections, a critical issue in this era of multivalent vaccines. METHODS: This was a cross-sectional, multicenter study with sexually active unvaccinated women (16-25 years old) from 119 primary Brazilian healthcare centers between September 2016 and November 2017. Cervical samples were collected by trained health professionals, and HPV detection was performed in a central laboratory by Linear Array. RESULTS: Of the 5268 women, 33.00% (95% CI 31.07-34.92) had multiple infections. At least one type of high-risk HPV was present in 85.50% of all multiple infections. All HPV types were detected more frequently in association with other types than alone. Young individuals who were single or in a casual relationship and those who had more than one sexual partner in the past year were more likely to have multiple infections. CONCLUSIONS: In this work, a high rate of multiple HPV infections among unvaccinated young adults tended to increase due to certain risk factors. Such data can provide insight for decision makers in the development of public policies regarding HPV prevention.

Understanding the characteristics of multiple infections is critical in the era of HPV multivalent vaccines for the prevention of cervical carcinomas. Therefore, in this cross-sectional study, we aimed to investigate the pattern of multiple HPV infections and associated factors in 5,268 sexually active unvaccinated women (16­25 years old) who access the Brazilian public health care system. Cervical samples were collected by trained health professionals, and HPV detection was performed in a central laboratory by Linear Array. A total of 33.00% (95% CI 31.07­34.92) had multiple infections (60.43% of the HPV-positive sample). The number of HPV types in a multiple infection ranged from 2 to 14 different types. The viral types more frequently identified were HPV 16 and 52. All HPV types were detected more frequently in association with other types than alone. The incidence of multiple infections was 1.29 times higher in single than in married or cohabitating participants. Women who had two or more partners in the last year also had higher rates of multiple infections than those who had fewer than two sexual partners. In conclusion, a high prevalence of multiple infections prior to the national HPV immunization program was observed, especially with the increase in less safe behavior factors.

Modeling the epidemiological impact of the UNAIDS 2025 targets to end AIDS as a public health threat by 2030.

BACKGROUND: UNAIDS has established new program targets for 2025 to achieve the goal of eliminating AIDS as a public health threat by 2030. This study reports on efforts to use mathematical models to estimate the impact of achieving those targets. METHODS AND FINDINGS: We simulated the impact of achieving the targets at country level using the Goals model, a mathematical simulation model of HIV epidemic dynamics that includes the impact of prevention and treatment interventions. For 77 high-burden countries, we fit the model to surveillance and survey data for 1970 to 2020 and then projected the impact of achieving the targets for the period 2019 to 2030. Results from these 77 countries were extrapolated to produce estimates for 96 others. Goals model results were checked by comparing against projections done with the Optima HIV model and the AIDS Epidemic Model (AEM) for selected countries. We included estimates of the impact of societal enablers (access to justice and law reform, stigma and discrimination elimination, and gender equality) and the impact of Coronavirus Disease 2019 (COVID-19). Results show that achieving the 2025 targets would reduce new annual infections by 83% (71% to 86% across regions) and AIDS-related deaths by 78% (67% to 81% across regions) by 2025 compared to 2010. Lack of progress on societal enablers could endanger these achievements and result in as many as 2.6 million (44%) cumulative additional new HIV infections and 440,000 (54%) more AIDS-related deaths between 2020 and 2030 compared to full achievement of all targets. COVID-19-related disruptions could increase new HIV infections and AIDS-related deaths by 10% in the next 2 years, but targets could still be achieved by 2025. Study limitations include the reliance on self-reports for most data on behaviors, the use of intervention effect sizes from published studies that may overstate intervention impacts outside of controlled study settings, and the use of proxy countries to estimate the impact in countries with fewer than 4,000 annual HIV infections. CONCLUSIONS: The new targets for 2025 build on the progress made since 2010 and represent ambitious short-term goals. Achieving these targets would bring us close to the goals of reducing new HIV infections and AIDS-related deaths by 90% between 2010 and 2030. By 2025, global new infections and AIDS deaths would drop to 4.4 and 3.9 per 100,000 population, and the number of people living with HIV (PLHIV) would be declining. There would be 32 million people on treatment, and they would need continuing support for their lifetime. Incidence for the total global population would be below 0.15% everywhere. The number of PLHIV would start declining by 2023.

Brazilian Protocol for Sexually Transmitted Infections 2020: acquired syphilis.

The Clinical Protocol and Therapeutic Guidelines for Comprehensive Care of People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020, includes updates concerning acquired syphilis. The document comprises rapid test use, safety and efficacy of benzathine benzylpenicillin, case follow-up, neurosyphilis clinical and laboratory management, approaching sex partners, assistance and monitoring of diagnosed pregnant women, and syphilis and HIV co-infection specificities, as well as a case notification summary. Health managers and professionals must be continuously trained so as to integrate care and surveillance, to strengthen actions for efficient control of syphilis, to broaden the search for sex partners, and to expand access of most vulnerable populations to health services. Most people with syphilis are asymptomatic; this contributes to the maintenance of the transmission chain. Without adequate treatment of pregnant women with syphilis, severe consequences can occur, such as miscarriage, prematurity, low birth weight, natimortality, and congenital syphilis.

[Brazilian Protocol for Sexually Transmitted Infections 2020: acquired syphilis]. / Protocolo Brasileiro para Infecções Sexualmente Transmissíveis 2020: sífilis adquirida.

The Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Ministry of Health of Brazil in 2020, includes the update on acquired syphilis. The document comprises rapid tests use, safety and efficacy of the administration of benzathine benzylpenicillin, follow-up of cases, clinical and laboratory management of neurosyphilis, approach to sexual partnerships, assistance and monitoring of diagnosed pregnant women, and specificities of syphilis and HIV co-infection, as well as a summary of the notification of cases. It is necessary to train health managers and professionals on a continuous basis, with a view to integrating care and surveillance, strengthening effective syphilis control actions, increasing the search for sexual partnerships, and expanding the access of the most vulnerable populations to health services.

O Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde do Brasil em 2020, contempla a atualização sobre sífilis adquirida. O documento apresenta a utilização de testes rápidos, a segurança e a eficácia da administração da benzilpenicilina benzatina, o seguimento dos casos, o manejo clínico e laboratorial da neurossífilis, a abordagem de parcerias sexuais, a assistência e o acompanhamento de gestantes diagnosticadas e as especificidades da coinfecção sífilis e HIV, além de uma síntese sobre a notificação dos casos. É necessário capacitar gestores e profissionais de saúde de forma contínua, com vistas à integração entre assistência e vigilância, ao fortalecimento de ações efetivas de controle da sífilis, à abrangência da busca de parcerias sexuais e ao amplo acesso de populações mais vulneráveis aos serviços de saúde.

El Protocolo Clínico y Directrices Terapéuticas para Atención Integral a las Personas con Infecciones de Transmisión Sexual, publicado por el Ministerio de Salud de Brasil en 2020, incluye la actualización sobre la sífilis adquirida. El documento comprende las pruebas rápidas, la seguridad y eficacia de la administración de bencilpenicilina benzatina, el seguimiento de casos, el manejo clínico y de laboratorio de la neurosífilis, el enfoque de las parejas sexuales, la asistencia y seguimiento de embarazadas diagnosticadas y las especificidades de la coinfección sífilis y VIH, bien como un resumen de la notificación de casos. Es necesario capacitar a los gestores y profesionales de la salud de manera continua, con miras a integrar la atención y la vigilancia, a fortalecer las acciones efectivas de control de la sífilis, a expandir la búsqueda de las parejas sexuales y a ampliar el acceso de las poblaciones más vulnerables a los servicios de salud.

Protocolo Brasileiro para Infecções Sexualmente Transmissíveis 2020: sífilis adquirida / Brazilian Protocol for Sexually Transmitted Infections 2020: acquired syphilis / Protocolo Brasileño para Infecciones de Transmisión Sexual 2020: sífilis adquirida

O Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde do Brasil em 2020, contempla a atualização sobre sífilis adquirida. O documento apresenta a utilização de testes rápidos, a segurança e a eficácia da administração da benzilpenicilina benzatina, o seguimento dos casos, o manejo clínico e laboratorial da neurossífilis, a abordagem de parcerias sexuais, a assistência e o acompanhamento de gestantes diagnosticadas e as especificidades da coinfecção sífilis e HIV, além de uma síntese sobre a notificação dos casos. É necessário capacitar gestores e profissionais de saúde de forma contínua, com vistas à integração entre assistência e vigilância, ao fortalecimento de ações efetivas de controle da sífilis, à abrangência da busca de parcerias sexuais e ao amplo acesso de populações mais vulneráveis aos serviços de saúde.

The Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Ministry of Health of Brazil in 2020, includes the update on acquired syphilis. The document comprises rapid tests use, safety and efficacy of the administration of benzathine benzylpenicillin, follow-up of cases, clinical and laboratory management of neurosyphilis, approach to sexual partnerships, assistance and monitoring of diagnosed pregnant women, and specificities of syphilis and HIV co-infection, as well as a summary of the notification of cases. It is necessary to train health managers and professionals on a continuous basis, with a view to integrating care and surveillance, strengthening effective syphilis control actions, increasing the search for sexual partnerships, and expanding the access of the most vulnerable populations to health services.

El Protocolo Clínico y Directrices Terapéuticas para Atención Integral a las Personas con Infecciones de Transmisión Sexual, publicado por el Ministerio de Salud de Brasil en 2020, incluye la actualización sobre la sífilis adquirida. El documento comprende las pruebas rápidas, la seguridad y eficacia de la administración de bencilpenicilina benzatina, el seguimiento de casos, el manejo clínico y de laboratorio de la neurosífilis, el enfoque de las parejas sexuales, la asistencia y seguimiento de embarazadas diagnosticadas y las especificidades de la coinfección sífilis y VIH, bien como un resumen de la notificación de casos. Es necesario capacitar a los gestores y profesionales de la salud de manera continua, con miras a integrar la atención y la vigilancia, a fortalecer las acciones efectivas de control de la sífilis, a expandir la búsqueda de las parejas sexuales y a ampliar el acceso de las poblaciones más vulnerables a los servicios de salud.

Protocolo Brasileiro para Infecções Sexualmente Transmissíveis 2020: sífilis adquirida / Brazilian Protocol for Sexually Transmitted Infections 2020: acquired syphilis / Protocolo Brasileño para Infecciones de Transmisión Sexual 2020: sífilis adquirida

Resumo O Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde do Brasil em 2020, contempla a atualização sobre sífilis adquirida. O documento apresenta a utilização de testes rápidos, a segurança e a eficácia da administração da benzilpenicilina benzatina, o seguimento dos casos, o manejo clínico e laboratorial da neurossífilis, a abordagem de parcerias sexuais, a assistência e o acompanhamento de gestantes diagnosticadas e as especificidades da coinfecção sífilis e HIV, além de uma síntese sobre a notificação dos casos. É necessário capacitar gestores e profissionais de saúde de forma contínua, com vistas à integração entre assistência e vigilância, ao fortalecimento de ações efetivas de controle da sífilis, à abrangência da busca de parcerias sexuais e ao amplo acesso de populações mais vulneráveis aos serviços de saúde.

Abstract The Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Ministry of Health of Brazil in 2020, includes the update on acquired syphilis. The document comprises rapid tests use, safety and efficacy of the administration of benzathine benzylpenicillin, follow-up of cases, clinical and laboratory management of neurosyphilis, approach to sexual partnerships, assistance and monitoring of diagnosed pregnant women, and specificities of syphilis and HIV co-infection, as well as a summary of the notification of cases. It is necessary to train health managers and professionals on a continuous basis, with a view to integrating care and surveillance, strengthening effective syphilis control actions, increasing the search for sexual partnerships, and expanding the access of the most vulnerable populations to health services.

Resumen El Protocolo Clínico y Directrices Terapéuticas para Atención Integral a las Personas con Infecciones de Transmisión Sexual, publicado por el Ministerio de Salud de Brasil en 2020, incluye la actualización sobre la sífilis adquirida. El documento comprende las pruebas rápidas, la seguridad y eficacia de la administración de bencilpenicilina benzatina, el seguimiento de casos, el manejo clínico y de laboratorio de la neurosífilis, el enfoque de las parejas sexuales, la asistencia y seguimiento de embarazadas diagnosticadas y las especificidades de la coinfección sífilis y VIH, bien como un resumen de la notificación de casos. Es necesario capacitar a los gestores y profesionales de la salud de manera continua, con miras a integrar la atención y la vigilancia, a fortalecer las acciones efectivas de control de la sífilis, a expandir la búsqueda de las parejas sexuales y a ampliar el acceso de las poblaciones más vulnerables a los servicios de salud.

Prevalence of HPV infection among sexually active adolescents and young adults in Brazil: The POP-Brazil Study.

For Brazil, there are no nationwide data on HPV prevalence against which the impact of the HPV immunization program can be measured in the future. Therefore, we aim to evaluate the prevalence of genital HPV infection among adolescents and young adults in Brazil. A cross-sectional, multicentric, nationwide survey was conducted between September 2016 and November 2017. Sexually active unvaccinated women and men aged 16 to 25 years old were recruited from 119 public primary care units, including all 26 state capitals and the Federal District. All participants answered a face-to-face interview and provided biological samples for genital HPV analysis. We used an automated DNA extraction method and HPV genotyping was performed using the Linear Array genotyping test (Roche). Of 7,694 participants, 53.6% (95% CI 51.4-55.8) were positive for any HPV type. The prevalence of high-risk HPV types was significantly higher in women (38.6% vs. 29.2%, P < 0·001). The HPV types included in the quadrivalent vaccine were detected in 1002 (14.8%) specimens, with a different pattern of HPV infection between sexes. Characteristics associated with overall HPV detection included female gender, self-declaration of race as brown/pardo, lower socioeconomic class, single or dating, current smoking and having 2 or more sex partners in the past year. We found a high prevalence of HPV, with significant differences between regions. Our data provide information that may be considered when developing HPV prevention policies and constitute a baseline against which the impact of the HPV immunization program in Brazil can be measured in future years.