Coformulated Bictegravir/Emtricitabine/Tenofovir Alafenamide for Postexposure Prophylaxis After Sexual Assault: A Retrospective Real-World Study.

We report the experience of bictegravir/emtricitabine/tenofovir alafenamide for nonoccupational postexposure prophylaxis in sexual assault cases. Between June 2021 and October 2023, 39 individuals completed the 28-day follow-up; 41% experienced some side effects, and 1 person discontinued the drug because of a rash. No individuals seroconverted to HIV during the follow-up period.

Telemedicine in Post-Exposure Prophylaxis to Biological Material During the COVID-19 Pandemic: Impact on Care and Outcome Indicators.

Introduction: The restrictions on face-to-face care for exposure to biological material during the COVID-19 pandemic required alternatives to maintain outpatient assistance. This study evaluated the impact of telemedicine on care and outcome indicators of a reference service for exposure to biological material during the COVID-19 pandemic. Methods: This pre- and post-study compared the effectiveness of telemedicine in the Hospital Correia Picanço in Recife (Pernambuco, Brazil) before (August 2018 to January 2019 [P1]) and during the COVID-19 pandemic (August 2020 to January 2021 [P2]). Individuals above 18 years old exposed to biological material who sought the service during P1 or P2 were included in the study. Results: A total of 4,494 cases were assessed (1,997 in P1 and 2,497 in P2), mostly because of sexual exposure (62.3%). The mean age was 32.2 ± 9.2 years, most individuals were male (64.9%), originated from Recife (56.6%), and the education level was up to 12 years (53.7%). P2 presented 43% more attendances and shorter intervals between the exposure and first attendance (51%), first testing (28%), and discharge (10%) than P1 (p < 0.05), and cases had no difference in discharge rate (p = 0.339). Cases of sexual exposure had the highest dropout rate in both periods. Conclusion: Telemedicine maintained similar outcomes to face-to-face care and improved the indicators, increasing the mean monthly attendance and reducing the time between exposure and follow-up.

Community-Based Intervention for Active Detection and Provision of Single-Dose Rifampicin Post-Exposure Prophylaxis to Household Contacts of Leprosy in Bolivia.

BACKGROUND: To achieve zero leprosy cases in Santa Cruz, Bolivia, we designed a community-based active detection and provision of single-dose rifampicin post-exposure prophylaxis (SDR-PEP) to household contacts with new leprosy patients. METHODS: From July to August 2021, we assessed the current knowledge, attitude, and practices through structured interviews and focus group discussions with community representatives and health staff. This was followed by sensitization sessions, the training of health staff, and the reinforcement of referral mechanisms. Teams, including health staff and community volunteers, visited all new leprosy patients detected in 2021-2023 and household contacts. RESULTS: Among 115 community representatives, knowledge about leprosy etiology was attributed to non-biological factors (74%); fear accounted for 77%, and access to care was perceived as weak (74%), but the outlook was improved by SDR-PEP (80%). Among the 217 health staff interviewed, the programmatic barriers identified were a lack of referral feedback (67%), limited supplies for diagnosis and prevention, and ineffective training (64%). We visited 70 new patients and 258 household contacts. The median age in household contacts was 25 years old; 49% were women, 98% were eligible for SDR-PEP, and all who were eligible accepted it. Those who were non-eligible included one tuberculosis patient and six newly detected leprosy patients (23‱). CONCLUSIONS: A community-based intervention was successful in Santa Cruz, Bolivia. Misbeliefs and a lack of knowledge were identified as barriers. Programmatic components should be reinforced for SDR-PEP extension.

Awareness, willingness to use pre-exposure prophylaxis, and use of post-exposure prophylaxis for HIV prevention among men who have sex with men in Mexico.

BACKGROUND: Little is known about awareness and willingness to use or purchase HIV pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in Mexico. METHODS: MSM in Mexico were recruited via advertisements on online social venues to participate in Encuesta de Sexo Entre Hombres, an online behavioral survey. Awareness of PrEP, willingness to take PrEP if available for free, willingness to purchase PrEP, awareness of post-exposure prophylaxis (PEP), and ever PEP use were assessed in descriptive and multivariate analyses. RESULTS: Overall, 54.8% (4588/8376) of participants were aware of PrEP. Of those aware, 77.6% were willing to use PrEP if free and 52.6% were willing to purchase PrEP, generally at a maximum monthly cost of $500MXP. Both awareness of and willingness to use PrEP if free or for purchase were significantly greater among MSM who were younger, and varied by demographic, recent healthcare use, and behavioral risk factors. Only 8.2% had ever used PEP, which was highly associated with healthcare utilization. CONCLUSIONS: About half of Mexican MSM were aware of PrEP. The majority of those aware were willing to use PrEP if available for free and many were willing to purchase PrEP at low cost. Leveraging demographic, recent healthcare use, and behavioral risk characteristics associated with awareness and willingness to use PrEP could be useful in designing future PrEP programs for MSM in Mexico. Expanding healthcare settings in which PEP is available may also support identifying candidates for PrEP and scaling up PrEP implementation.

Efficacy of antibiotic prophylaxis to preventing brucellosis in accidental exposure: A systematic review.

BACKGROUND: Antibiotic prophylaxis to prevent brucellosis after accidental exposure to Brucella is an important topic in public health. This study aimed to systematically review the efficacy of antibiotic prophylaxis following accidental exposure to Brucella in preventing human brucellosis disease. METHODS: The study protocol was registered in PROSPERO (CRD42023456812). The outcomes included the incidence of brucellosis disease, adverse events rate, and antibiotic prophylaxis adherence. A comprehensive literature search, conducted until 20 November, 2023, involved Medline, Embase, Cochrane Library, and LILACS databases. Descriptive analysis and meta-analysis using R software were performed, risk of bias was assessed using JBI Critical appraisal tools, and certainty of evidence was assessed using the GRADE tool. RESULTS: Among 3102 initially identified records, eight studies involving 97 individuals accidentally exposed, all focused on high-risk accidental exposure to Brucella in laboratory settings, were included in the review. All studies reported the prophylactic treatment comprising doxycycline at a dosage of 100 mg twice daily, combined with rifampicin at 600 mg, both administered over 21 days. Prophylaxis adherence was reported in 86% of cases, and incidence of brucellosis post-treatment was 0.01. Adverse events, mainly gastrointestinal, occurred in 26% of cases. Critical appraisal revealed limitations in reporting demographics and clinical information. The certainty of evidence was rated as 'very low,' emphasising the need for caution in interpreting the observed outcomes due to study design constraints and the absence of comparative groups. CONCLUSIONS: PEP is an alternative practice reported in the literature, used in accidents with high-risk exposure to Brucella. The currently available evidence of the efficacy of antibiotic prophylaxis is insufficient to support a recommendation for or against the widespread use of antibiotic prophylaxis, so caution is needed in interpreting results due to the very low certainty of evidence, primarily stemming from case series and lack of comparative groups.

Prescription of HIV Post-Exposure Prophylaxis in emergency care units and return for follow-up appointments in specialized services in Salvador, Brazil, 2018: a cross-sectional study / Prescripción de Profilaxis Post Exposición al VIH en unidades de emergencia y consulta de control en unidades de seguimiento y de acompañamiento, Salvador, 2018: un estudio transversal / Prescrição da profilaxia pós-exposição ao HIV em unidades de urgência e retorno às consultas de acompanhamento em serviços especializados, Salvador, 2018: um estudo transversal

Abstract Objective: To analyze HIV Post-Exposure Prophylaxis (PEP) prescription and return for follow-up appointments. Methods: This was a descriptive cross-sectional study using data on people who sought PEP in emergency care units (UPAs) and specialized medical services in Salvador, BA, Brazil, between January-December/2018. Results: Of the 1,525 people who sought PEP at UPAs, 1,273 (83.5%) met PEP eligibility criteria, while 252 (16.5%) did not; of the eligible group, 1,166 (91.6%) had antiretrovirals prescribed, while 107 (8.4%) eligible people did not; of the total number of people with PEP prescriptions, only 226 (19.4%) returned for the first follow-up appointment, 115 (9.9%) for the second, and 33 (2.8%) for the third in order to complete the protocol. Conclusion: We found a significant proportion of eligible users who did not have PEP prescribed at UPAs and a significant loss of return for specialized service follow-up appointments.

Resumen Objetivo: Analizar la prescripción de Profilaxis Post Exposición (PPE) al Virus de la Inmunodeficiencia Humana (VIH) y la concurrencia a las consultas de control y seguimiento. Método: Estudio de datos descriptivo transversal de personas que solicitaron la PPE en Unidades de Atención de Emergencia (UPA) y servicios médicos especializados en Salvador, BA, Brasil, durante los meses de enero a diciembre de 2018. Resultados: De las 1.525 personas que consultaron por PEP en las unidades hospitalarias de emergencia, 1.273 (83,5%) cumplieron criterios de elegibilidad para profilaxis y 252 (16,5%) no los cumplieron; entre los elegibles, a 1.166 (91,6%) personas se les recetaron antirretrovirales (ARVs), pero 107 (8,4%) no los recibieron. Del total de personas que recibieron prescripción de PPE, solamente 226 (19,4%) regresaron a la primera consulta; 115 (9,9%) a la segunda consulta y 33 (2,8%) a la tercera consulta para completar el protocolo. Conclusión: Hubo una proporción significativa de usuarios elegibles que no recibieron prescripción de PEP en las Unidades de Atención de Emergencia y una pérdida significativa en las consultas de control al servicio especializado.

Resumo Objetivo: Analisar a prescrição da profilaxia pós-exposição (PEP) ao vírus da imunodeficiência humana (HIV) e o retorno às consultas de acompanhamento. Métodos: Estudo transversal descritivo, sobre dados de pessoas que buscaram a PEP em unidades de pronto atendimento (UPAs) e serviço médico de atenção especializada em Salvador, BA, Brasil, entre janeiro e dezembro/2018. Resultados: Das 1.525 pessoas que buscaram a PEP nas UPAs, 1.273 (83,5%) apresentaram critérios de elegibilidade à profilaxia e 252 (16,5%) não os apresentaram; entre os elegíveis, 1.166 (91,6%) pessoas tiveram prescrição dos antirretrovirais (ARVs), mas 107 (8,4%) não os receberam; do total de pessoas com prescrição de PEP, apenas 226 (19,4%) retornaram à primeira consulta, 115 (9,9%) à segunda consulta e 33 (2,8%) à terceira consulta para conclusão do protocolo. Conclusão: Observou-se proporção importante de usuários elegíveis que não receberam prescrição de PEP nas UPAs e perda significativa nas consultas de retorno ao serviço especializado.

Vivências pós-acidente com material biológico por profissionais de saúde de um serviço especializado em HIV/Aids: contribuições para Educação Permanente / Vivencias post accidente con material biológico por parte de profesionales de la salud de un servicio especializado en VIH/SIDA: Contribuciones para la educación permanente / Post-accident experiences with biological material by health professionals of a specialized HIV/Aids service: contributions to Continuing Education

O acidente de trabalho com material biológico de profissionais de saúde em serviços especializados em HIV/Aids é uma demanda complexa. O objetivo desta pesquisa foi compreender as vivências pós-acidente com material biológico por profissionais de saúde que trabalham em um serviço especializado em HIV/Aids. Realizou-se uma pesquisa qualitativa com sete profissionais de saúde que atuam nesse contexto, abordando as vivências dessa experiência por meio de entrevistas semiestruturadas. Os discursos foram categorizados pelo método de análise de conteúdo temática. Foram observados sentimentos de medo da infecção e do estigma perante o ocorrido. Demonstrou-se o impacto dessa experiência nas relações familiares, sociais e profissionais, além do insuficiente acolhimento e apoio emocional no serviço onde trabalhavam e foram atendidos. Evidencia-se a necessidade de repensar protocolos e processos de cuidado desses profissionais mediante a Educação Permanente, considerando a complexidade de suas vivências diante do acidente.(AU)

The work accident with biological material of health professionals in specialized services in HIV/Aids is a complex demand. This research objective was to understand the post-accident experiences with biological material by health professionals working in a service specialized in HIV/Aids. Qualitative research was conducted with seven health professionals who work in this context, approaching their experiences through semi-structured interviews. The discourses were categorized by thematic content analysis method. Feelings of fear of the infection and stigma were observed. The impact of this experience on family, social and professional relationships was demonstrated. There was lack of receptiveness and emotional support in the service where they worked and where they received care. There is an evident need to rethink protocols and care processes for these professionals, through Permanent Education, considering the complexity of their experiences in the face of the accident.(AU)

El accidente de trabajo con material biológico de profesionales de la salud en servicios especializados en VIH/SIDA es una demanda compleja. El objetivo de esta investigación fue comprender las vivencias post accidente con material biológico por parte de profesionales de la salud que trabajan en un servicio especializado en VIH/SIDA. Se realizó una encuesta cualitativa con siete profesionales de la salud que actúan en ese contexto, abordando las vivencias de esa experiencia por medio de entrevistas semiestructuradas. Los discursos se categorizaron por el método de análisis del contenido temático. Se observaron sentimientos de miedo de la infección y del estigma ante lo ocurrido. Se demostró el impacto de esa experiencia en las relaciones familiares, sociales y profesionales. Se constató la insuficiente acogida y el apoyo emocional en el servicio en donde trabajaban y fueron atendidos. Resulta evidente la necesidad de volver a pensar protocolos y procesos de cuidados de estos profesionales, por medio de la Educación Permanente, considerando la complejidad de sus vivencias ante el accidente.(AU)

Estupro e lei do minuto seguinte em Minas Gerais, Brasil: fatores sociodemográficos associados às profilaxias de emergência / Rape and the "minute-after" law in Minas Gerais, Brazil: socio-demographic factors associated with emergency prophylaxis

Resumo Esta pesquisa investigou a relação entre características sociodemográficas das meninas e mulheres vítimas de estupro em Minas Gerais, no período de 2013 a 2021, e a probabilidade de receberem tratamentos de emergência, conforme estabelecido na Lei nº 12.845/2013, conhecida como Lei do Minuto Seguinte. Utilizou-se os dados do Sistema de Informação de Agravos de Notificação (SINAN) para casos de estupro para estimação de modelos de escolhas binárias. Os resultados indicam que fatores sociodemográficos das vítimas, alinhados à teoria e à prática da interseccionalidade (raça, idade, local de residência dentro das regiões de saúde, relação com o agressor e ano do registro do crime) influenciam, negativamente, a probabilidade de receberem o tratamento de emergência. Em particular, vítimas indígenas, menores de idade, agredidas por conhecidos e residentes em determinadas regiões de saúde demonstraram ter menor probabilidade de receber cuidados médicos imediatos. após o estupro. Além disso, constatou-se que a implementação da política pública não resultou em melhoria, já que, desde a promulgação da Lei, em 2013, até o ano 2021, houve diminuição no número de atendimentos médicos realizados.

Abstract This research project investigated the relationship between sociodemographic characteristics of girls and women who were the victims of rape of in Minas Gerais between 2013 and 2021, and the likelihood of receiving emergency treatment as stipulated in Law No. 12,845/2013, known as the "Minute-After" (Minuto Seguinte) Law. Data from the Notifiable Diseases Information System (SINAN) for rape cases were used to estimate binary choice models. The results indicate that the sociodemographic factors of the victims, aligned with the theory and practice of intersectionality (race, age, place of residence within health regions, relationship with the perpetrator, and year of crime registration), negatively influence the probability of receiving emergency treatment. Specifically, indigenous victims, minors, those raped by acquaintances, and residents in certain health regions, were found to have a lower probability of receiving immediate medical care after rape. Furthermore, it was found that the implementation of public policy did not result in an improvement, as there has been a decrease in the number of medical appointments since the enactment of the law in 2013 through to the year 2021.

Uso profiláctico de antimicrobianos fuera de la práctica quirúrgica y de procedimientos invasivos: bases conceptuales y operativas / Prophylactic use of antimicrobials outside surgical and invasive-procedure settings: conceptual and operational basis

El uso preventivo de antimicrobianos es de larga data y no se restringe a antibacterianos. Lo más consensuado y estructurado es la profilaxis antimicrobiana perioperatoria y ante procedimientos invasivos. Fuera de este contexto hay gran cantidad de situaciones, menos caracterizadas, con riesgo de infecciones en que se usan ampliamente, muchas veces con menor sistematización. Esta presentación presenta las bases conceptuales y operativas de este segundo tipo de profilaxis. Conceptualmente la profilaxis primaria pretende evitar la infección por agente único conocido o variados, por exposición ambiental o susceptibilidad específica de ese hospedero y es implementable antes o después de la exposición. Producida esta infección la meta de la profilaxis secundaria intenta evitar la enfermedad y puede tomar dos modalidades, en infecciones sin evidencias de enfermedad clínica o daños, la profilaxis corresponde a "tratamiento de infección latente" y, si aún en ausencia de manifestaciones clínicas, hay elementos de laboratorio precoces premonitorios de progresión, la profilaxis se denomina "tratamiento anticipatorio". Se presentan operacionalmente y resumidas las situaciones en contexto médico no invasivo con uso potencial preventivo de antimicrobianos en base a agentes posibles, situaciones ambientales de riesgo, vulnerabilidad del hospedero, medicamentos a usar, su duración y efectividad con enfoque mayoritario en medicina de adultos.

Antimicrobial use with preventive purpose probably began shortly after its therapeutic use, especially antibiotics. More consensus and sistematization exist with perioperative and invasive procedures prophylaxis. However, beyond that context, there is great number of non invasive medical situations with high risk of secondary infections either by acquisition of pathogens or activation of latent ones, in which antimicrobials are routinely used with preventive purpose, albeit with less sistematization and consensus. This presentation aims to lay down the conceptual and operational basis for antimicrobial prophylaxis in these settings, whose objective is preventing an infection (primary prophylaxis) by a known or a variety of pathogens, either by person to person transmission, enviromental exposure or particular susceptibility of the host, and can be implemented before or after exposure. If already infected, the antimicrobial prophylaxis goal is to avoid progression to disease (secondary prevention) and may take two conceptual approaches; first, without clinical disease but significant risk of progression, the modality can be called "treatment of latent infection". In the second, also clinically asymptomatic, but with premonitory laboratoy signs of impending progression present, early use of antimicrobial is called "preemptive treatment". This presentation will describe the most frequent medical situations where preventive use of antimicrobials is employed, together with the medications most consensually used, according to the host, the agent(s) and medical situation, with emphasis in adults.

Adherence to HIV post-exposure prophylaxis in a specialized service in São Paulo, Brazil.

INTRODUCTION: The effectiveness of human immunodeficiency virus (HIV) post-exposure prophylaxis (PEP) depends on adherence to the protocol, which includes taking antiretrovirals (ARVs) and attending visits. We examined the adherence rate to antiretroviral agents and follow-up visits identifying the associated characteristics of adherence and the reasons for not attending HIV PEP consultations in a specialized service in São Paulo, Brazil. METHODOLOGY: This was a cross-sectional study with health service users who had an indication for PEP due to sexual exposure in an HIV/AIDS service from April to October 2019. The health service users were followed-up throughout the prophylaxis cycle. Adherence was determined through self-reports on antiretroviral agent use and attendance to follow-up consultations. RESULTS: Association measures were employed to identify adherence-related characteristics. The sample analyzed included 91 users. The mean age was 32.5 years old (SD = 9.8). The largest share was white-skinned (49.5%), men who have sex with other men (62.2%), male (86.8%), and undergraduate/graduate students (65.9%). Adherence totaled 56.7% and health insurance was the associated characteristic (p = 0.039). Work (55.9%), using a private service (15.2%), forgetfulness (11.8%) and considering follow-up unnecessary (11.8%) were the main reasons for not attending the follow-up appointments. CONCLUSIONS: Few users do attend HIV PEP consultations. The users without health insurance had the highest adherence percentage whereas work was mentioned as a reason for not attending HIV PEP consultations.

Clinical-epidemiological characterization of women who received post-exposure HIV prophylaxis in a public hospital in Porto Alegre, Rio Grande do Sul / Caracterização clínico-epidemiológica de mulheres que receberam a profilaxia pós-exposição ao HIV em um hospital público de Porto Alegre, Rio Grande do Sul

Introduction: Prevention strategies are key to combating the epidemic of infections such as HIV and syphilis. The epidemiological scenario of Porto Alegre/RS for these infections shows the need for greater efforts in the area of prevention, seeking to characterize both the population that uses these strategies and the services involved in the care of exposed people. Objective: This study aimed to characterize the clinical and epidemiological profile of patients who received post-exposure prophylaxis (PEP) to HIV treated in a public hospital in Porto Alegre/RS. Methods: This is a retrospective, research, descriptive study based on the Clinical Protocol and Therapeutic Guidelines for PEP, updated in 2018 by the Ministry of Health. Prophylaxis request forms and medical records of patients treated were analyzed. Results: The population consisted of 87 women who received PEP from January to September 2019. There was a predominance of women aged between 20 and 29 years old (55.2%). The most frequent sexual exposure was consensual (69.0%) followed by sexual assault (31.0%). Porto Alegre was the place of residence of most patients (73.6%). The most frequently used therapeutic regimen was the combination of atazanavir, ritonavir, and tenofovir plus lamivudine. On the first visit, 8.0% of the patients showed reactive results for the treponemal syphilis test. Only 23.0% and 14.9% of patients returned for anti-HIV tests in the first and third months after exposure, respectively, and the results were non-reactive. Only 19 patients (21.8%) attended the consultations between 0 and 28 days after PEP. Conclusion: It was identified that a considerable percentage of women already had reactive serology for syphilis, most women did not return for follow-up within 28 and 90 days after the first consultation, more than half of the women were aged between 20 and 29 years old, and the most frequent sexual exposure was consensual. In this sense, efforts are needed, such as adequate counseling, adoption of interventions such as sending messages by cell phone, telephone calls, and preparation of educational materials, seeking to improve adherence to treatment and follow-up in the service, which is important given the scenario of epidemiology in Porto Alegre.Keywords: HIV. Sexually transmitted diseases. Post-exposure prophylaxis. Disease prevention

Introdução: Estratégias de prevenção são fundamentais para o combate à epidemia de infecções como o vírus da imunodeficiência humana (HIV) e sífilis. O cenário epidemiológico de Porto Alegre/RS para essas infecções mostra a necessidade de maiores esforços na área de prevenção, buscando caracterizar tanto a população que utiliza essas estratégias quanto os serviços envolvidos no atendimento das pessoas expostas. Objetivo: Caracterizar o perfil clínico-epidemiológico das pacientes que receberam a profilaxia pós-exposição (PEP) ao HIV atendidas em um hospital público de Porto Alegre/RS. Métodos: Trata-se de um estudo retrospectivo, documental, descritivo e baseado no Protocolo Clínico e Diretrizes Terapêuticas para PEP, atualizado em 2021 pelo Ministério da Saúde. Foram analisados os formulários de solicitação da profilaxia e prontuários das pacientes atendidas. Resultados: A população foi composta de 87 mulheres que receberam a PEP no período de janeiro a setembro de 2019. Predominaram mulheres com idades entre 20 e 29 anos (55,2%). A exposição sexual mais frequente foi a consentida (69,0%), seguida pela violência sexual (31,0%). Porto Alegre foi o local de residência da maioria das pacientes (73,6%). O esquema terapêutico utilizado com maior frequência foi a combinação com atazanavir, ritonavir e tenofovir associado à lamivudina. No primeiro atendimento, 8,0% das pacientes demonstraram resultados reagentes para o teste treponêmico de sífilis. Retornaram para a realização dos testes anti-HIV no primeiro e terceiro mês após a exposição apenas 23,0 e 14,9% das pacientes, respectivamente, e os resultados foram não reagentes. Apenas 19 delas (21,8%) compareceram às consultas entre zero e 28 dias posteriores à PEP. Conclusão: Foi identificado que um percentual considerável de mulheres já apresentava sorologia reagente para sífilis, a maioria das mulheres não retornou para o seguimento no período de 28 e 90 dias após o primeiro atendimento, mais da metade delas tinha idade entre 20 e 29 anos e a exposição sexual mais frequente foi a consentida. Nesse sentido, são necessários esforços como aconselhamento adequado, adoção de intervenções como o envio de mensagens pelo celular, ligações telefônicas e elaboração de materiais educativos, buscando a melhoria da adesão ao tratamento e do acompanhamento no serviço, o que é importante diante do cenário epidemiológico de Porto Alegre.Palavras-chave: HIV. Infecções sexualmente transmissíveis. Profilaxia pós-exposição. Prevenção

Knowledge on post-exposure prophylaxis, sexual behavior, and vulnerabilities to HIV and other STIs among young adults in Brazil

Introduction: Post-exposure prophylaxis (PEP) is the use of antiretroviral drugs (ARVs) to reduce the risk of human immunodeficiency virus (HIV) infection after potential risk exposure. ARV-based interventions are recommended as part of combination HIV prevention, especially for key populations. Objective: The aim of this study was to measure knowledge about PEP among university students. Methods: A cross-sectional study was conducted on university students from the Health, Education, Exact, and Human Sciences Departments of the State University of Bahia, Brazil. Sociodemographic data, information on sexual behavior, and knowledge of PEP were collected through a standardized self-applied questionnaire. Results: We analyzed 1580 questionnaires, of which 66.7% (1024/1536) were from females, with a mean age of 23.9 (±6.5) years, and 35.4% (448/1264) reported irregular use of condoms and regular use was not associated with being students from the health area (p=0.44, OR 0.90, 95%CI 0.69­1.17). Regarding PEP, 28.5% (449/1578) had known about it and their knowledge was statistically associated with men who have sex with men (MSM) (p<0.01, OR 3.92, 95%CI 2.45­6.28). It was noted that 94.0% (1485/1579) did not know the time limit for starting PEP, 95.1% (1500/1578) did not know the duration of prophylaxis, and 91.1% (1437/1577) did not know where to get PEP. Finally, 0.4% (7/1578) referred to previous use and 96.6% (1488/1540) would not change their sexual behavior after knowing about PEP. Conclusion: PEP is a prevention strategy available for decades and is safe, effective, and cost-effective. However, it is underutilized and a lack of knowledge on PEP is one of the main obstacles to access. Among university students, there is a limited knowledge about PEP acting as a barrier in preventing new infections, which shows the need for interventions based on sexual-health education, stimulating the reduction of risk behaviors and disseminating information about combination prevention.

Introdução: A Profilaxia Pós-Exposição (PEP) é o uso de medicamentos antirretrovirais (ARVs) para reduzir o risco de infecção pelo vírus da imunodeficiência humana (HIV) após uma potencial exposição. Intervenções baseadas em ARV são recomendadas como parte da prevenção combinada do HIV, especialmente para populações-chave. Objetivo: O objetivo deste estudo foi medir o conhecimento sobre PEP entre estudantes universitários. Métodos: Estudo transversal realizado entre universitários dos Departamentos de Saúde, Educação, Ciências Exatas e Humanas da Universidade do Estado da Bahia, Brasil. Dados sociodemográficos, informações sobre comportamento sexual e conhecimento sobre PEP foram coletados por meio de um questionário autoaplicável padronizado. Resultados: Foram analisados 1.580 questionários, 66,7% (1024/1536) do sexo feminino, idade média de 23,9 (±6,5) anos, 35,4% (448/1264) relatam uso irregular de preservativo, e o uso regular não foi associado ao fato de ser estudante da área da saúde (p=0,44, OR 0,90, IC95% 0,69-1,17). Em relação à PEP, 28,5% (449/1578) já tinham ouvido falar, e seu conhecimento foi estatisticamente associado a homens que fazem sexo com homens (HSH) (p<0,01, OR 3,92, IC95% 2,45­6,28). Destaca-se que 94,0% (1485/1579) não sabiam o tempo limite para iniciar o PEP, 95,1% (1500/1578) não sabiam o tempo de duração da profilaxia e 91,1% (1437/1577) não sabiam onde conseguir o PEP. Por fim, 0,4% (7/1578) referiu uso anterior e 96,6% (1488/1540) não mudaria seu comportamento sexual após saber da PEP. Conclusão: A PEP é uma estratégia de prevenção disponível há décadas, segura, eficaz e de baixo custo, porém, é subutilizada e seu desconhecimento é um dos principais obstáculos ao acesso. Há um conhecimento limitado sobre PEP entre universitários, destacando-se como uma barreira na prevenção de novas infecções, o que evidencia a necessidade de intervenções baseadas na educação em saúde sexual, estimulando a redução de comportamentos de risco e disseminando informações sobre prevenção combinada.

Profile of human anti-rabies care and post-exposure prophylaxis in the state of São Paulo

ABSTRACT Background: Rabies is an anthropozoonosis that greatly impacts public health and is transmitted by infected mammals. Aggression by animals is notifiable and may result in anti-rabies post-exposure prophylaxis (PEP). This study aimed to characterize anti-rabies PEP notifications in São Paulo state, Brazil. Methods: A descriptive study was conducted using data provided by the SINAN between 2013 and 2017. Results: A total of 572,889 aggressions were recorded during the study period, characterized mostly by dogs (83.5%), single wounds (56.9%), superficial wounds (58.6%), and hands/feet (34.6%). Conclusions: Animal observation was the most frequent recommendation, even in cases of attacks from non-domestic animals.

Perfil epidemiológico dos usuários da profilaxia pós-exposição ao vírus da imunodeficência humana / Epidemiological profile of users of post-exposure prophylaxis to human immunodeficiency viruses / Perfil epidemiológico de usuarios de profilaxis post- exposición al virus de la inmunodeficiencia humana

A Profilaxia Pós-Exposição (PEP) ao Virus da Imunodeficiência Humana (HIV) trata-se de uma urgência médica que deve ser realizada durante 28 dias com medicamentos específicos em indivíduos que tiveram uma exposição com materiais biológicos e situações específicas considerados de risco no intervalo de até 72 horas em indivíduos não reagentes ao vírus do HIV. Objetivo: descrever o perfil epidemiológico dos usuários da PEP no município de Parnaíba, Piauí. Metodologia: Trata-se de um estudo transversal retrospectivo com abordagem quantitativa dos casos de pessoas residentes em Parnaíba, que utilizaram a PEP no período do estudo de 2017 a 2021 analisados por estatística descritiva. Resultados: Foram registrados 202 pacientes que utilizaram a PEP. Dentre estes a maioria foram homens cis com 129 (64%), na faixa etária de 30 a 59 anos foi de (49%) nos casos, a orientação sexual de héteros com (44%), a maioria dos pacientes possuíam o ensino médio (62%), a raça/cor foi maior em pardos (52%). O tipo de exposição mais ocorrente foi sexo consentido (79%), realizaram o tratamento sem intercorrência (84%) dos casos, 62% utilizaram álcool e/ou outras drogas e maioria dos pacientes (57%) referiam não conhecer a situação sorológica dos seus parceiros sexuais. Conclusão: A PEP tem sido uma das formas de prevenção combinada que minimiza as possibilidades de infecção pelo HIV. Percebeu-se que o aumento da população adulta-jovem tem buscado a prevenção, possivelmente devido as práticas consideradas de risco que apresentam maior ocorrência entre os casos.

Post-Exposure Prophylaxis (PEP) to the Human Immunodeficiency Virus (HIV) is a medical emergency that must be performed for 28 days with specific medications in individuals who have been exposed to biological materials and specific situations considered at risk in the interval up to 72 hours in HIV-negative individuals. Objective: to describe the epidemiological profile of PEP users in the city of Parnaíba, Piauí. Methodology: This is a retrospective cross-sectional study with a quantitative approach to the cases of people residing in Parnaíba, who used the PEP in the study period from 2017 to 2021, analyzed using descriptive statistics. Results: 202 patients who used PEP were registered. Among these, the majority were cis men with 129 (64%), in the age group of 30 to 59 years old (49%) in cases, the sexual orientation of heterosexuals with (44%), most patients had high school (62%), race/color was higher in pardos (52%). The most frequent type of exposure was consensual sex (79%), underwent treatment without intercurrence (84%) of cases, 62% used alcohol and/or other drugs and most patients (57%) reported not knowing the serological status of the their sexual partners. Conclusion: PEP has been one of the forms of combined prevention that minimizes the possibilities of HIV infection. It was noticed that the increase in the young adult population has sought prevention, possibly due to practices considered to be risky, with a higher occurrence among cases.

La Profilaxis Post-Exposición (PEP) al Virus de la Inmunodeficiencia Humana (VIH) es una emergencia médica que debe realizarse durante 28 días con medicamentos específicos en individuos que han estado expuestos a materiales biológicos y situaciones específicas consideradas de riesgo en el intervalo hasta 72 horas en personas VIH negativas. Objetivo: describir el perfil epidemiológico de los usuarios de PEP en la ciudad de Parnaíba, Piauí. Metodología: Se trata de un estudio transversal retrospectivo con abordaje cuantitativo de los casos de personas residentes en Parnaíba, que utilizaron el PEP en el período de estudio de 2017 a 2021, analizados mediante estadística descriptiva. Resultados: Se registraron 202 pacientes que usaron PEP. Entre estos, la mayoría eran hombres cis con 129 (64%), en el grupo de edad de 30 a 59 años (49%) en los casos, la orientación sexual de los heterosexuales con (44%), la mayoría de los pacientes tenían estudios secundarios (62 %), raza/color fue mayor en pardos (52%). El tipo de exposición más frecuente fue sexo consentido (79%), realizó tratamiento sin intercurrencia (84%) de los casos, 62% consumía alcohol y/u otras drogas y la mayoría de los pacientes (57%) refirieron no conocer el estado serológico de sus pacientes. parejas sexuales. Conclusión: La PEP ha sido una de las formas de prevención combinada que minimiza las posibilidades de infección por el VIH. Se percibió que el aumento de la población adulta joven ha buscado la prevención, posiblemente por prácticas consideradas de riesgo, con mayor ocurrencia entre los casos.

Prophylactic treatment abandonment in people bitten by suspected rabid animals, El Salvador, 2013-2017.

Introduction: Around the world 60,000 people die from rabies each year. The main form of exposure to rabies is by the bite of animals infected with the virus. More than 20,000 cases of rabies-transmitting animal bites are reported each year, in El Salvador, a country located in Central America. People exposed should be managed with rabies prophylaxis. Objective: To determine the abandonment of post-exposure prophylaxis (PEP) cumulative incidence (CI) in humans bitten by suspected rabid animals in El Salvador from 2013 to 2017. Methodology: This is an ecological study based on the cases of bites by suspected rabid animals reported between 2013 and 2017 in the public health system of El Salvador. Descriptive and correlation analysis was performed using Statistical Package for the Social Sciences (SPSS) version 24. The municipality CI, expressed per 100,000 inhabitants. Results: The national CI of abandonment PEP in humans bitten by suspected rabid animals was 25.6 × 100,000 inhabitants. Simple bivariate correlation analysis shows that the departments with the highest CI of bites caused by cats, wild animals, and bites on the neck (R 2 = 0.99 P < 0.05) are mostly associated with dropping out of the PEP. Conclusion: In El Salvador, the abandonment CI of PEP is lower than other countries, however, bites by rabid suspected animal are frequent, this represents a public health problem due to the presence of the rabies virus in wild animals and the high lethality of the disease. Municipalities where head bites are common are the most related to the abandonment of PEP.

Trends in HIV post-exposure prophylaxis following sexual exposure in Brazil (2011-2019).

We examined trends in the prevalence of post-exposure prophylaxis following sexual exposure (PEPSE) per million population (2011-2019) and the proportion of repeated PEPSE within 365 days of the first PEPSE dispensing (2011-2018) in Brazil. We also compared the prevalence of repeated PEPSE according to patient and health services characteristics in 2018. The prevalence of PEPSE increased 55.5% from 2011 to 2019. Repeated PEPSE increased 11.8%, reaching 8.4% among people with their first dispensing in 2018. The prevalence of repeated PEPSE was higher in cis men or trans women (versus cisgender women); homosexuals (versus heterosexuals); and people aged 25-29 years (versus other age groups). We also observed greater prevalence of repeated PEPSE in HIV services in populous cities or services with elevated caseloads. Our findings highlight the need for strategies to reduce repeated PEPSE and promote other HIV-prevention technologies, particularly among young adults, cisgender men, transgender women, and homosexuals.

RESUMEN: Examinamos las tendencias de la prevalencia de uso de la profilaxis posterior a la exposición sexual (PEPSE) por millón de población (2011­2019) y la proporción de PEPSE repetida dentro de los 365 días de la primera dispensación de PEPSE (2011­2018) en Brasil. También comparamos la prevalencia de PEPSE repetida según las características del paciente y de los servicios de salud en 2018. La prevalencia de PEPSE aumentó un 55,5% de 2011 a 2019. La PEPSE repetida aumentó un 11,8%, alcanzando el 8,4% entre las personas con su primera dispensación en 2018. La prevalencia de PEPSE repetida fue mayor en hombres cis o mujeres trans (versus mujeres cisgénero); homosexuales (versus heterosexuales); y personas de 25 a 29 años (versus otros grupos de edad). También observamos una mayor prevalencia de repetición en los servicios de VIH de las ciudades más pobladas o con un elevado número de clientes. Nuestros hallazgos ponen de manifiesto la necesidad de estrategias para reducir la repetición de la PEPSE y promover otras tecnologías de prevención del VIH entre los adultos jóvenes, especialmente los hombres, las trans y los homosexuales.

Sexual Violence and Low Rates of HIV Post-exposure Prophylaxis Access Among Female Sex Workers in Brazil.

Female sex workers (FSW) are disproportionately affected by sexual violence (SV) and HIV. Social and structural barriers limit their access to post-exposure prophylaxis (PEP). Respondent-driven sampling survey in 12 Brazilian cities among 4188 FSW aimed to estimate the rates of SV and factors associated with access to PEP use among FSW who experienced SV. The prevalence of SV was 26.3% (1199). Of the 1199, 7.5% sought out healthcare and used PEP, 19% sought out healthcare, but did not use PEP, and 73.5% did not seek out healthcare after SV. Factors associated with PEP use included PEP awareness, participation in HIV/STI prevention workshops, and disclosure of FSW status in healthcare services. Although Brazil has a PEP program free of charge, it is not readily accessible, even for FSW who seek out healthcare. The development of effective strategies to link FSW to HIV preventive services is urgently needed.

RESUMEN: Mujeres trabajadoras sexuales (MTS) se ven afectadas de manera desproporcionada por la violencia sexual (VS) y el VIH. Las barreras sociales y estructurales limitan su acceso a la profilaxis posexposición (PEP). Encuesta de muestreo dirigida por encuestados en 12 ciudades brasileñas con 4188 MTS para estimar la prevalencia de VS y los factores asociados al uso de PEP entre MTS que experimentaron VS. La prevalencia de VS fue del 26.3% (1199). De essas, el 7.5% buscó atención médica y usó PEP, el 19% buscó atención médica pero no usó PEP y el 73.5% no buscó atención después del SV. Factores asociados con el uso de PEP: conciencia de PEP; participación en talleres educativos y divulgación del trabajo en los servicios de salud. Aunque Brasil tiene un programa de PEP gratuito, no es de fácil acceso. Es urgente el desarrollo de estrategias efectivas para vincular las MTS con servicios de prevención.

Awareness, knowledge, and attitudes related to HIV pre-exposure prophylaxis and other prevention strategies among physicians from Brazil and Mexico: cross-sectional web-based survey.

BACKGROUND: In order to end the HIV epidemic by 2030, combination HIV prevention including pre-exposure prophylaxis (PrEP) should be widely available, especially for the most vulnerable populations. In Latin America and the Caribbean (LAC), only 14 out of 46 countries have access to PrEP. In Brazil and Mexico, PrEP has been provided at no cost through the Public Health System since 2017 and 2021, respectively. Thus, HIV physicians' perspectives about PrEP and other prevention strategies may differ. This study aimed to compare awareness, knowledge, and attitudes related to PrEP and other prevention strategies among HIV physicians from Brazil and Mexico. METHODS: Cross-sectional, web-based survey targeting physicians who prescribe antiretrovirals from both countries. Participants answered questions on socio-demographic, medical experience, awareness, knowledge, and attitudes towards PrEP and other HIV prevention strategies. We stratified all variables per country and compared frequencies using Chi-square, Fisher exact, and Wilcoxon-Mann-Whitney tests, as appropriate. RESULTS: From January-October 2020, 481 HIV physicians were included: 339(70.5%) from Brazil, 276(57.4%) male, and median age was 43 years (IQR = 36-53). Awareness of PrEP did not differ between Brazil and Mexico (84.6%), while awareness of other prevention strategies, including post-exposure prophylaxis and new PrEP technologies, was higher in Brazil. More Brazilians perceived U=U as completely accurate compared to Mexicans (74.0% vs. 62.0%, P < .001). Willingness to prescribe PrEP was 74.2%, higher among Brazilians (78.2%, P = .01). Overall, participants had concerns about consistent access to PrEP medication and the risk of antiretroviral resistance in case of acute HIV infection or seroconversion. The main barriers reported were assumptions that users could have low PrEP knowledge (62.0%) or limited capacity for adherence (59.0%). Compared to Brazilians, Mexicans reported more concerns and barriers to PrEP prescription (all; P ≤ .05), except for consistent access to PrEP medication and the lack of professionals to prescribe PrEP (both; P ≤ .01). CONCLUSIONS: Although awareness of PrEP was similar in Brazil and Mexico, differences in knowledge and attitudes may reflect the availability and stage of PrEP implementation in these countries. Strengthening and increasing information on PrEP technologies and other HIV prevention strategies among HIV physicians could improve their comfort to prescribe these strategies and facilitate their scale-up in LAC.

Predictors of knowledge of and access to biomedical prevention among MSM and transgender men in Latin America: Results from the Latin American internet survey.

INTRODUCTION: HIV is still a central public health issue in Latin America, disproportionally affecting key populations. Knowledge and access to biomedical prevention strategies, including treatment as prevention (TASP) or undetectable = untransmissible (U=U), pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), are the first steps to increasing uptake. We used data from the Latin American MSM Internet Survey (LAMIS) to describe knowledge and access to biomedical HIV prevention strategies among gay, bisexual, transgender and other men who have sex with men (MSM) living in 18 Latin American countries. METHODS: We compared LAMIS data across countries and according to age categories using frequencies and percentages. We also used multivariable models to explore whether age, gender identity, sexual identity, steady partnership, HIV status and education were independently associated with outcomes. RESULTS: In all, 55 924 participants were included. Most were cisgender (99%) and identified as gay/homosexual (77%) or bisexual (17%). Schooling levels were very high, with 89% reporting highest attained education as tertiary level, university or post-graduation. In total, 16% had been previously diagnosed with HIV; of those, rates of undetectable viral load varied from 60% in Venezuela to 83% in Brazil. Overall, 54%, 54% and 52% of participants already knew about PEP, PrEP and U=U, respectively. Participants from Brazil and those aged between 26 and 55 years, living with diagnosed HIV and having a gay/homosexual identity had greater levels of awareness about biomedical prevention strategies. CONCLUSIONS: Our study highlights gaps in HIV prevention campaigns directed to MSM in Latin America resulting in low uptake of biomedical prevention methods.

Human rabies post-exposure prophylaxis: a review of the treatment of accidents involving domestic cats / Profilaxia pós-exposição da raiva humana: uma revisão dos tratamentos envolvendo gatos domésticos

Rabies is an anthropozoonosis that presents approximately 100% lethality and expensive preventive assistance. Many human post-exposure anti-rabies treatments indicated for people at risk of exposure to rabies virus, usually due to some aggression by a mammalian animal, are instituted annually. This study aimed to evaluate the initial care of post-exposure prophylaxis of human rabies in Belo Horizonte between 2007 and 2016, involving accidents with domestic cats. It was found 71.1% agreement between the treatments instituted by health services and the protocol of the Ministry of Health. Treatments classified as insufficient totaled 18.3% and excessive, 10.6%. The animals were healthy in 68% and observable in 68.4% of the cases. Treatments involving the use of anti-rabies vaccine totaled 87.7%. The most frequent treatment adopted by the health services was observing the animals associated with the human anti-rabies vaccination in 56.7% of the cases. Imperfections in the filling of the notifications must be revised to enable improvements for future analyses. As for human prophylactic anti-rabies care, forming a multidisciplinary health team including veterinarians would be well on the way to improving the service offered.(AU)

A raiva é uma antropozoonose que apresenta aproximadamente 100% de letalidade e alto custo na assistência pre-ventiva. É instituído anualmente, um elevado número de tratamento antirrábico humano pós-exposição, o qual é indicado para pessoas que se encontram sob risco de exposição ao vírus rábico, geralmente devido a alguma agressão por animal mamí-fero. Este trabalho teve como objetivo avaliar o atendimento inicial da profilaxia pós-exposição da raiva humana, em Belo Horizonte, entre os anos de 2007 a 2016, envolvendo acidentes com gatos domésticos. Encontrou-se 71,1% de concordân-cia entre os tratamentos instituídos pelos serviços de saúde e o protocolo do Ministério da Saúde. Tratamentos classificados como insuficientes totalizaram 18,3% e excessivos 10,6%. Os animais eram sadios em 68% e observáveis em 68,4% dos casos. Tratamentos que envolviam o uso de vacina antirrábica totalizaram 87,7%. O tratamento adotado pelos serviços de saúde com maior frequência foi a observação do animal associada à vacinação antirrábica humana em 56,7% dos casos. É necessário que imperfeições no preenchimento das notificações sejam revistas de forma a possibilitar melhorias para análises futuras. Quanto ao atendimento antirrábico profilático humano, a formação de uma equipe multidisciplinar de saúde com inclusão de médi-cos veterinários seria uma forma de aprimorar o serviço oferecido.(AU)