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1.
Int J STD AIDS ; 33(6): 559-569, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35333101

RESUMO

BACKGROUND: A mixed method systematic review was undertaken to address the research question, Do young Australian Aboriginal people barriers in accessing public sexual health services? Aboriginal people are disproportionally affected by significantly higher incidence rates of sexually transmissible infections (STIs), compared to the rest of the Australian population. This problem is particularly acute for young people under 30 years of age who suffer from the consequences of STIs due to the number of sexual partners and challenges faced in accessing healthcare. METHODS: The study inclusion criteria were: papers published between January 1999 and September 2019 inclusive; published in any language, discussed healthcare barriers and facilitators; included people under 30 years of age; contained research with one or more of the following terms; Aboriginal, Health, Access, Barriers and Sexual Health; was published or discussed Australia research. Articles were extracted from MEDLINE, Embase, PsychINFO, Proquest Social Sciences, Open Grey and NLM Bookshelf. An initial search identified 770 articles; 23 duplicate articles were removed. 642 were excluded for not meeting inclusion criteria following a title and abstract review of articles. 60 articles underwent full text review by two reviewers and 15 articles were included in analysis. RESULTS: This review found that novel approaches to service delivery such as incorporating STI testing into other targeted initiatives, providing self-testing kits and achieving high levels of cultural competency were key facilitators to access. Whereas location of services, inconsistent service provision, shame and differing levels of knowledge about the effects of STIs were key barriers. CONCLUSIONS: This systematic review identified barriers and facilitators of access to sexual health services for Aboriginal young people. System level changes are needed to improve physical environments, service integration and consistent provision of culturally competent services. This review highlights the need for further research focussed on assessing the real-world pressures of young Aboriginal people and how healthcare providers can better offer a person-centred service.


Assuntos
Serviços de Saúde do Indígena , Saúde Sexual , Doenças Sexualmente Transmissíveis , Adolescente , Austrália/epidemiologia , Acesso aos Serviços de Saúde , Humanos , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/epidemiologia , Doenças Sexualmente Transmissíveis/prevenção & controle
2.
Health Promot Int ; 37(1)2022 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-34125199

RESUMO

Despite high prevalence of hepatitis C virus (HCV), linkage to care and treatment for Indigenous people is low. In an Indigenous community in Saskatchewan, Canada a retrospective review identified 200 individuals (∼12% prevalence) had HCV antibodies though majority lacked ribonucleic acid (RNA) testing, and few received treatment despite availability of an effective cure. Following Indigenous oral traditions, focus group discussions were held with key community members and leadership. Participants emphasized the need for a community-based screening and treatment programme. A team of community members, peers and healthcare professionals developed a streamlined screening pathway termed 'liver health event' (LHE) to reduce stigma, reach undiagnosed, re-engage previously diagnosed, and ensure rapid linkage to care/treatment. LHEs began December 2016. Statistics were tracked for each event. As of July 2019, there were 10 LHEs with 540 participants, 227 hepatitis C tests and 346 FibroScans completed. This represented 294 unique individuals, of which 64.3% were tested, and of those, 40.8% were Ab positive. Among those positive for antibodies, 41.7% had active hepatitis C infections, and among these, 90% were linked to care, and 14 new positive individuals were identified. Following the success of LHEs, these were adapted and implemented in 10 other communities in this region, resulting in 17 additional LHEs. This intervention is reaching the undiagnosed and linking clients to care through a low-barrier and de-stigmatizing approach. It has facilitated collaboration, knowledge exchange and mentorship between Indigenous communities, significantly impacting health outcomes of Indigenous people in this region.


Individuals residing in geographically isolated Indigenous communities often face multiple barriers trying to access healthcare services in Saskatchewan Canada. Consequently, many individuals who have HCV antibody (Ab), often lack confirmatory RNA test and experience delays in linkage to HCV treatment. A collective decision was made by pertinent stakeholders including community members, peers, community healthcare staff, Chief and leadership to improve access to screening and linkage to HCV treatment in community. A streamlined HCV screening pathway referred to as LHEs was developed by an Indigenous community. Since implementation in December 2016, 10 LHEs were delivered in community, with 540 participant visits, 227 hepatitis C tests conducted, and 346 FibroScans completed. Out of 294 unique individuals who attended, 64.3% were tested, and of those, 40.8% were Ab positive. Among those positive for antibodies, 41.7% had active hepatitis C infections, and among these, 90% were linked to care, and 14 new positive individuals were identified. Following the success of the LHEs in reaching the undiagnosed, this screening pathway has been adapted and implemented in at least 10 additional Indigenous communities in Saskatchewan, Canada.


Assuntos
Hepacivirus , Hepatite C , Hepacivirus/genética , Hepatite C/diagnóstico , Hepatite C/epidemiologia , Anticorpos Anti-Hepatite C , Humanos , Programas de Rastreamento/métodos , Saskatchewan
3.
Rural Remote Health ; 22(1): 6803, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35184569

RESUMO

INTRODUCTION: In 2018 in the Australian town of Lismore, New South Wales, 175 children were overdue for scheduled vaccinations, 11% of them being Aboriginal and/or Torres Strait Islander (2018). This study aimed to gain a deeper understanding of the reasons for low coverage. METHODS: Aboriginal and non-Aboriginal parents, carers and health service providers were invited to take part in semi-structured interviews and focus groups. Open-ended questions were asked about immunisation barriers and enablers, and what strategies may be effective in improving coverage in Lismore. RESULTS: A total of 35 participants took part. Six themes were developed: childhood immunisation in Lismore is limited by access barriers to health services, some families may need additional support to access vaccination services, health services need to ensure that Aboriginal families feel safe and comfortable when accessing their service, parents and carers value reminders and recalls to keep their children's vaccinations up to date, parents' and carers' views influence their decisions to immunise their children, and reliable information about immunisation needs to be available in ways that are meaningful and appropriate for parents and carers. CONCLUSION: Access barriers and vaccine hesitancy have been contributing to children falling behind in their scheduled vaccinations in Lismore. More flexible health services, culturally safe and appropriate care and more practical support can help overcome structural barriers to health services. Tailored health messages for both Aboriginal and non-Aboriginal parents and carers can assist parents in making wise immunisation choices. More consistent analysis and reporting of routinely available data can identify pockets of low coverage. Publicly funded health services and Aboriginal Community Controlled Health Services are well placed to provide flexible vaccination services for those families who may struggle with access barriers.


Assuntos
Serviços de Saúde do Indígena , Austrália , Criança , Humanos , Imunização , New South Wales , Vacinação
4.
Rev. cienc. cuidad ; 19(1): 31-41, 2022.
Artigo em Espanhol, Português | LILACS, BDENF - Enfermagem, COLNAL | ID: biblio-1362457

RESUMO

Introducción: El dengue es una enfermedad viral documentada por enfoques biomédicos y epidemiológicos, los cuales instituyen la práctica de la enfermería. Sin embargo, hace algunas décadas se plantea la necesidad de crear puentes entre el conocimiento científico y los saberes indígenas para potenciar otras rutas de atención con mayor impacto en la salud humana. Objetivo: Explorar los saberes sobre el dengue que tiene una comunidad indígena, radicada en el municipio de Momil (Córdoba, Colombia). Materiales y métodos: Estudio exploratorio cualitativo con enfoque micro etnográfico, desarrollado entre octubre de 2020 y marzo de 2021. La muestra la conformaron 20 miembros de un cabildo indígena de Momil. Los par-ticipantes se seleccionaron por conveniencia, aplicándoseles una entrevista semiestructurada hasta alcanzar el nivel de saturación teórica; estos datos fueron organizados y categorizados bajo la técnica del análisis de contenido de Bardin, empleándose los postulados de Leininger. Resultados: Los indígenas tienen conocimientos atribuidos a la perspectiva universal del cuidado sobre los sitios de cría, síntomas y percepción del riesgo de morir por dengue; sin embargo, presentaron deficiencias vinculadas con el modo de transmisión y ecología del vector Aedes aegypti. Asimismo, se registra la perspectiva del cuidado diverso en el empleo de plantas medicinales como el matarratón, nin, albahaca y orégano para el control del vector y de los síntomas del dengue; resaltan especialmente la visión de ofrecer el cuidado familiar en las primeras fases de la enfermedad. Conclusión: La enfermería transcultural se enuncia como el puente entre el reconocimiento de este tipo de saberes y los conocimientos científi-cos; no obstante, los entes gubernamentales han de atender las necesidades indígenas que se constituyen en detonantes de las enfermedades


Introdução: a dengue é uma doença viral documentada pela perspectiva biomédica e epidemiológica, que institui a pratica de enfermagem. Entretanto, faz algumas décadas planteia-se a necessidade de criar pontes entre o conhecimento cientifico e o saber empírico indígena para fortalecer outras guias de atendimento com maior impacto na saúde humana. Objetivo: explorar o saber sobre a dengue que tem uma comunidade indígena, radicada no município de Momil (Córdoba, Colômbia). Materiais e métodos: estudo exploratório qualitativo, micro etnográfico, desenvolvido entre outubro de 2020 e março de 2021. A amostra foi integrada por 20 membros do grupo indígena de Momil. Os participantes selecionaram-se por conveniência, aplicando uma entrevista semiestruturada até conseguir o nível de saturação teórica; esses dados foram organizados e categorizados pela técnica de analise de conteúdo de Bardin, empregando-se a teoria de Leininger. Resultados: os indígenas tem conhecimentos atribuídos à pespetiva universal do cuidado sobre os sítios de criação, sintomas e percepções do risco de morrer por dengue; entretanto, presentaram deficiências vinculadas com o mecanismo de transmissão e ecologia do vector Aedes aegypti. Além disso, registou-se a perspectiva do cuidado diverso no uso de plantas medicinais conhecidas como mata-rato, nin, manjericão e orégano para o controle do vector e os sintomas da dengue; destacando especialmente, a visão de oferecer o cuidado familiar nas primeiras fases da doença. Conclusão: a enfermagem transcultural é enunciada como a ponte entre o reconhecimento desse tipo de saberes e os conhecimentos científicos; entretanto, os entes governamentais precisam atender as necessidades dos indígenas que constituem detonantes das doenças.


Assuntos
Enfermagem Transcultural , Conhecimento , Dengue , Povos Indígenas
6.
CMAJ ; 193(43): E1652-E1659, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34725112

RESUMO

BACKGROUND: Active screening for tuberculosis (TB) involves systematic detection of previously undiagnosed TB disease or latent TB infection (LTBI). It may be an important step toward elimination of TB among Inuit in Canada. We aimed to evaluate the cost-effectiveness of community-wide active screening for TB infection and disease in 2 Inuit communities in Nunavik. METHODS: We incorporated screening data from the 2 communities into a decision analysis model. We predicted TB-related health outcomes over a 20-year time frame, beginning in 2019. We assessed the cost-effectiveness of active screening in the presence of varying outbreak frequency and intensity. We also considered scenarios involving variation in timing, impact and uptake of screening programs. RESULTS: Given a single large outbreak in 2019, we estimated that 1 round of active screening reduced TB disease by 13% (95% uncertainty range -3% to 27%) and was cost saving compared with no screening, over 20 years. In the presence of simulated large outbreaks every 3 years thereafter, a single round of active screening was cost saving, as was biennial active screening. Compared with a single round, we also determined that biennial active screening reduced TB disease by 59% (95% uncertainty range 52% to 63%) and was estimated to cost Can$6430 (95% uncertainty range -$29 131 to $13 658 in 2019 Can$) per additional active TB case prevented. With smaller outbreaks or improved rates of treatment initiation and completion for people with LTBI, we determined that biennial active screening remained reasonably cost-effective compared with no active screening. INTERPRETATION: Active screening is a potentially cost-saving approach to reducing disease burden in Inuit communities that have frequent TB outbreaks.


Assuntos
Análise Custo-Benefício , Custos de Cuidados de Saúde/estatística & dados numéricos , Serviços de Saúde do Indígena/economia , Inuítes , Programas de Rastreamento/métodos , Tuberculose/diagnóstico , Tuberculose/etnologia , Antituberculosos/uso terapêutico , Efeitos Psicossociais da Doença , Árvores de Decisões , Surtos de Doenças , Serviços de Saúde do Indígena/organização & administração , Humanos , Incidência , Programas de Rastreamento/economia , Programas de Rastreamento/organização & administração , Quebeque/epidemiologia , Tuberculose/economia , Tuberculose/terapia
8.
Washington, D.C.; PAHO; 2021-11-16.
Não convencional em Inglês | PAHO-IRIS | ID: phr-55194

RESUMO

This regional report on the situation of tuberculosis (TB) in the Americas contains information from 2019, provided by the countries of the Region through the World Health Organization TB data collection system. These data have been consolidated and analyzed at the regional level. In addition to presenting the epidemiological and programmatic situation of TB in the Americas, the report aims to raise awareness and to motivate and encourage all stakeholders in the prevention and control of this disease, to accelerate efforts towards TB elimination in the Region, and to achieve the targets of the End TB Strategy. The report records the Region's achievements, but also the gaps in the work being carried out in diagnosis, treatment, comorbidities, vulnerable populations, risk factors, and funding, among other issues. Based on the information presented, specific recommendations are provided for further progress.


Assuntos
Tuberculose , Epidemiologia , Mortalidade , HIV , Populações Vulneráveis , Povos Indígenas , Saúde de Populações Indígenas , Fatores de Risco , Adolescente , Saúde do Adolescente , Criança , Saúde da Criança , América
9.
Am J Public Health ; 111(11): 1939-1941, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34648378

RESUMO

Indigenous populations have been disproportionally affected by COVID-19, particularly those in rural and remote locations. Their unique environments and risk factors demand an equally unique public health response. Our rural Native American community experienced one of the highest prevalence outbreaks in the world, and we developed an aggressive management strategy that appears to have had a considerable effect on mortality reduction. The results have implications far beyond pandemic response, and have reframed how our community addresses several complicated health challenges. (Am J Public Health. 2021;111(11):1939-1941. https://doi.org/10.2105/AJPH.2021.306472).


Assuntos
COVID-19 , Busca de Comunicante , Povos Indígenas , População Rural , Idoso , Arizona/epidemiologia , COVID-19/epidemiologia , COVID-19/mortalidade , Feminino , Visita Domiciliar , Humanos , Comunicação Interdisciplinar , Masculino , Pessoa de Meia-Idade , Saúde Pública , Estados Unidos , United States Indian Health Service
10.
Proc Natl Acad Sci U S A ; 118(41)2021 10 12.
Artigo em Inglês | MEDLINE | ID: mdl-34607957

RESUMO

Morbidity and mortality rates from seasonal and pandemic influenza occur disproportionately in high-risk groups, including Indigenous people globally. Although vaccination against influenza is recommended for those most at risk, studies on immune responses elicited by seasonal vaccines in Indigenous populations are largely missing, with no data available for Indigenous Australians and only one report published on antibody responses in Indigenous Canadians. We recruited 78 Indigenous and 84 non-Indigenous Australians vaccinated with the quadrivalent influenza vaccine into the Looking into InFluenza T cell immunity - Vaccination cohort study and collected blood to define baseline, early (day 7), and memory (day 28) immune responses. We performed in-depth analyses of T and B cell activation, formation of memory B cells, and antibody profiles and investigated host factors that could contribute to vaccine responses. We found activation profiles of circulating T follicular helper type-1 cells at the early stage correlated strongly with the total change in antibody titers induced by vaccination. Formation of influenza-specific hemagglutinin-binding memory B cells was significantly higher in seroconverters compared with nonseroconverters. In-depth antibody characterization revealed a reduction in immunoglobulin G3 before and after vaccination in the Indigenous Australian population, potentially linked to the increased frequency of the G3m21* allotype. Overall, our data provide evidence that Indigenous populations elicit robust, broad, and prototypical immune responses following immunization with seasonal inactivated influenza vaccines. Our work strongly supports the recommendation of influenza vaccination to protect Indigenous populations from severe seasonal influenza virus infections and their subsequent complications.


Assuntos
Anticorpos Antivirais/sangue , Povos Indígenas/estatística & dados numéricos , Vacinas contra Influenza/imunologia , Influenza Humana/prevenção & controle , Ativação Linfocitária/imunologia , Austrália , Linfócitos B/imunologia , Humanos , Imunoglobulina G/sangue , Memória Imunológica/imunologia , Influenza Humana/imunologia , Influenza Humana/virologia , Contagem de Linfócitos , Vacinação em Massa , Risco , Células T Auxiliares Foliculares/imunologia , Linfócitos T/imunologia
11.
Rural Remote Health ; 21(4): 7043, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34619974

RESUMO

The COVID-19 pandemic has devastated communities throughout the world and has required rapid paradigm changes in the manner in which health care is administered. Previous health models and practices have been modified and changed at a rapid pace. This commentary provides the experiences of a regional Victorian Aboriginal Community Controlled Organisation in a COVID-19 vaccination program led and managed by Aboriginal Health Practitioners.


Assuntos
Vacinas contra COVID-19 , Serviços de Saúde Comunitária , Serviços de Saúde do Indígena , Papel do Médico , Vacinação , COVID-19/etnologia , COVID-19/prevenção & controle , Vacinas contra COVID-19/administração & dosagem , Serviços de Saúde Comunitária/organização & administração , Serviços de Saúde do Indígena/organização & administração , Humanos , Pandemias/prevenção & controle , Vacinação/estatística & dados numéricos , Vitória/epidemiologia
12.
Pediatr Infect Dis J ; 40(11): e427-e433, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34609109

RESUMO

BACKGROUND: We assessed nasopharyngeal pneumococcal carriage in Andean Kichwa children, the largest Amerindian indigenous population in the Ecuadorian Andes. All children in our study had been vaccinated with the 10-valent pneumococcal vaccine (PCV10). METHODS: Nasopharyngeal swabs from 63 families, 100 children <10 years old including 38 children under 5 years and 63 adult caregivers, from 5 different communities, were cultivated for Streptococcus pneumoniae and isolates were serotyped and antibiotic susceptibility testing was performed. RESULTS: Respectively, 67% of the 38 children under 5 years old, 49% of the 62 children between 6 and 10 years old and 16% of the 100 adults were colonized with S. pneumoniae. Of these, 30.9% carried a vaccine serotype, 5.4% a serotype shared by the PCV10/13-valent pneumococcal vaccine (PCV13) vaccine and 25.5% a PCV13 serotype or PCV13 vaccine-related serotype, with 19A (10.9%) and 6C (10.9%) as the most prominent. Drug susceptibility testing revealed that 46% of the S. pneumoniae strains were susceptible to 6 tested antibiotics. However, 20.3% of the strains were multidrug-resistant or extensively drug-resistant strains, including 82% of the vaccine (-related) serotype 19A and 6C strains. CONCLUSIONS: Kichwa children, vaccinated with PCV10, were highly colonized with pneumococci and should be considered a high-risk group for pneumococcal disease. Twenty-five percent of the colonizing S. pneumoniae strains were PCV13-only vaccine-targeted serotypes, and in addition to that, most were multidrug-resistant or extensively drug-resistant strains. The vaccine benefits for this population possibly will significantly increase with the introduction of PCV13.


Assuntos
Portador Sadio/epidemiologia , Portador Sadio/microbiologia , Povos Indígenas/estatística & dados numéricos , Nasofaringe/microbiologia , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/administração & dosagem , Streptococcus pneumoniae/isolamento & purificação , Adolescente , Adulto , Antibacterianos/farmacologia , Cuidadores/estatística & dados numéricos , Criança , Pré-Escolar , Farmacorresistência Bacteriana Múltipla , Equador/epidemiologia , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Infecções Pneumocócicas/epidemiologia , Sorogrupo , Streptococcus pneumoniae/classificação , Streptococcus pneumoniae/efeitos dos fármacos , Vacinação , Adulto Jovem
13.
Intern Med J ; 51(11): 1806-1809, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34636469

RESUMO

The NSW Government has proposed a blanket lifting of COVID-19 restrictions when the proportion of fully vaccinated people rate reaches 70% of the adult population. If implemented, this would have devastating effects on Aboriginal populations. At the present time, vaccination rates in Aboriginal communities remain low. Once restrictions are lifted, unvaccinated people will be at high risk of infection. The risks of serious illness and death among Aboriginal people from a variety of medical conditions are significantly greater than for the wider population. This is also the case with COVID-19 in First Nations populations around the world. The vulnerability of Aboriginal people is an enduring consequence of colonialism and is exacerbated by the fact that many live in overcrowded and poorly maintained houses in communities with under-resourced health services. A current workforce crisis and the demographic structure of the population have further hindered the effectiveness of vaccination programmes. Aboriginal organisations have called on state and federal governments to delay any substantial easing of restrictions until full vaccination rates among Aboriginal and Torres Strait Islander populations aged 16 years and older reach 90-95%. They have also called for additional support in the form of supply of vaccines, enhancement of workforce capacity and appropriate incentives to address hesitancy. Australia remains burdened by the legacy of centuries of harm and damage to its First Nations people. Urgent steps must be taken to avoid a renewed assault on Aboriginal and Torres Strait Islander health.


Assuntos
COVID-19 , Serviços de Saúde do Indígena , Adulto , Austrália , Humanos , SARS-CoV-2 , Vacinação
14.
Washington, D.C.; OPS; 2021-10-18.
Não convencional em Espanhol | PAHO-IRIS | ID: phr-55047

RESUMO

El presente informe regional sobre la situación de la tuberculosis en las Américas contiene la información correspondiente al 2019, provista por los países de la Región a través del sistema de recolección de datos de TB de la OMS. Esta información ha sido consolidada y analizada a nivel regional. Su objetivo, además de presentar la situación epidemiológica y programática de la TB en las Américas, es sensibilizar, motivar e incentivar a todas las partes involucradas en la prevención y el control de esta enfermedad, para acelerar los esfuerzos hacia su eliminación en la Región y alcanzar las metas de la Estrategia Fin de la TB. En el informe se consignan los logros, pero también las brechas en el trabajo que se realiza en aspectos de diagnóstico, tratamiento, comorbilidades, poblaciones vulnerables, factores de riesgo y financiación, entre otros asuntos. A partir de la información presentada, se brindan unas recomendaciones concretas para seguir avanzando.


Assuntos
Tuberculose , Epidemiologia , Mortalidade , HIV , Populações Vulneráveis , Fatores de Risco , Saúde de Populações Indígenas , Povos Indígenas , Adolescente , Criança , Saúde da Criança , Saúde do Adolescente , América
15.
Washington, D.C.; PAHO; 2021-10-08.
em Inglês | PAHO-IRIS | ID: phr-54973

RESUMO

Tuberculosis continues to represent a severe public health problem in the Region of the Americas, even more so in the case of indigenous peoples, whose TB incidence is much higher than that of the general population. To achieve tuberculosis control in these communities, it is necessary to respond to communities’ diverse needs from an intercultural perspective that allows the application of a holistic approach—from a standpoint of equality and mutual respect—and considers the value of their cultural practices. In the Region of the Americas, although there has been progress toward recognizing the need for an intercultural approach to health services, obstacles rooted in discrimination, racism, and the exclusion of indigenous peoples and other ethnic groups persist. To respond to this situation, the Pan American Health Organization (PAHO) prepared this guidance which––based on an intercultural approach in accordance with the priority lines of the current PAHO Policy on Ethnicity and Health and its practical development in the Region’s indigenous populations––represent a support tool for implementing the End TB Strategy. This publication integrates PAHO’s accumulated experience and best practices developed by its Member States in recent years, including discussions and experiences shared in regional meetings on the issue, and emphasizes innovation and social inclusion. This requires an urgent shift away from traditional paradigms, taking specific actions that gradually reduce TB incidence and moving toward effective multisectoral actions that have proven effective in quickly containing the epidemic.


Assuntos
Doenças Transmissíveis , Tuberculose , Povos Indígenas , Educação da População , Grupos Étnicos , Origem Étnica e Saúde , Epidemias , América
16.
BMJ Open ; 11(8): e047890, 2021 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-34344679

RESUMO

INTRODUCTION: Aboriginal and Torres Strait Islander women experience a higher burden of cervical cancer than non-Indigenous women in Australia. Cervical cancer is preventable partly through human papillomavirus (HPV) vaccination; in Australia, this is delivered through the national school-based immunisation programme. While HPV vaccination uptake is high among Australian adolescents, there remain gaps in uptake and completion among Aboriginal and Torres Strait Islander adolescents. This study aims to gain a comprehensive understanding of the barriers and facilitators to HPV vaccination uptake and completion among Aboriginal and Torres Strait Islander adolescents in Queensland, Australia. METHODS AND ANALYSIS: The study will be guided by an Indigenist research approach and an ecological model for health promotion. Yarning, a qualitative Indigenous research method, will be conducted in up to 10 schools. Participants will include Year 7 (12/13 years old) Aboriginal and Torres Strait Islander adolescents; parents/caregivers; and local key informants and immunisation programme partners involved in the delivery of school-based HPV immunisation programme. Participants will be recruited through school representatives and investigator networks using purposive and snowball sampling and samples of convenience. Field notes, HPV vaccination clinic observations and sequential diagramming of the HPV vaccination process will be conducted. Thematic analysis of data will be led by Aboriginal and Torres Strait Islander researchers. Synthesised sequential diagrams of the process of HPV vaccination and qualitative themes summarising key findings will be produced. ETHICS AND DISSEMINATION: The Aboriginal Health and Medical Research Council of New South Wales Ethics Committee (1646/20), the Australian National University Human Research Ethics Committee (HREC, 2020/478), the HREC of the Northern Territory Department of Health and Menzies School of Health Research (19-3484) and the Townsville Hospital and Health Service HREC (HREC/QTHS/73789) have approved the study. Dissemination will occur via conferences and peer-reviewed publications. Further dissemination will be determined in partnership with the Aboriginal and Torres Strait Islander Steering Committee, including Youth Representatives and Consultation Network.


Assuntos
Serviços de Saúde do Indígena , Adolescente , Feminino , Humanos , New South Wales , Northern Territory , Queensland , Vacinação
17.
Eur J Public Health ; 31(6): 1123-1128, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34405861

RESUMO

BACKGROUND: In 2012, the central government of Spain enacted Royal Decree-Law (RDL) 16/2012 and Royal Decree (RD) 1192/2012, which abolished universal healthcare coverage, thus limiting access to care for undocumented immigrants. Free health care was also no longer granted to anyone who has never been employed. In this context, this study investigated the prevalence of late HIV diagnoses (LHDs) among immigrants living in Spain vs. native-born Spaniards. METHODS: Data (n = 5943) from the 2010 to 2015 Cohort of the Spanish AIDs Research Network were used, including HIV-positive and antiretroviral therapy (ART)-naïve patients throughout Spain. Multivariate logistic models were fitted to compare the prevalence of LHD among the groups, adjusting for covariates. RESULTS: The prevalence of LHD in the total sample was 39.5%. Compared with native-born Spaniards (n = 4445), immigrants (n = 1488) were more likely to have LHD (37.4% vs. 45.7%, respectively; P < 0.001). Multivariate analysis showed that the prevalence ratio of LHD among immigrants vs. native-born Spaniards was 1.15 [95% confidence interval (CI), 1.02-1.28], after adjusting for covariates. This disparity widened from 2010 to 2011 (APR = 1.14, 95% CI, 1.02-1.29) to 2012-15 (APR = 1.28, 95% CI, 1.17-1.39), although the change was not statistically significant. CONCLUSIONS: Immigrants in Spain had a higher risk of LHD compared with native-born counterparts. LHD is an important healthcare marker due to the positive benefits of early HIV diagnosis, including prevention, improvements in health outcomes and decreases in overall cost of treatment. More research is needed on the causes of the disparity and potential social and policy interventions to reduce the prevalence of LHD among immigrants.


Assuntos
Emigrantes e Imigrantes , Infecções por HIV , Imigrantes Indocumentados , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Humanos , Povos Indígenas , Espanha/epidemiologia
18.
BMJ Open ; 11(7): e042545, 2021 07 08.
Artigo em Inglês | MEDLINE | ID: mdl-34244246

RESUMO

OBJECTIVES: This study examined associations between childhood maltreatment, colonial harms and sex/drug-related risks for HIV and hepatitis C virus (HCV) infection among young Indigenous people who use drugs. DESIGN: The Cedar Project is a cohort involving young Indigenous people who use drugs in British Columbia (BC), Canada. Indigenous collaborators, collectively known as the Cedar Project Partnership, govern the entire research process. SETTING: Vancouver is a large city on the traditional territory of the Coast Salish peoples. Prince George is a mid-sized city, on the traditional territory of Lheidli T'enneh First Nation. PARTICIPANTS: 420 participants completed the Childhood Trauma Questionnaire and returned for follow-up from 2003 to 2016. PRIMARY/SECONDARY OUTCOME MEASURES: Primary outcomes were HIV and HCV infection over the study period. Secondary outcomes included sex and substance use-related risks. RESULTS: Prevalence of childhood maltreatment was 92.6% experienced any maltreatment; 73.4% experienced emotional abuse; 62.6% experienced physical abuse; 60.3% experienced sexual abuse; 69.5% experienced emotional neglect and 79.1% experienced physical neglect. We observed significant associations between childhood maltreatment and apprehensions into residential schools and foster care. All maltreatment types were associated with higher odds of sex/substance use-related risks; sexual abuse was associated with higher odds of HCV infection (adjusted OR: 1.67; 95% CI 1.05 to 2.66; p=0.031). CONCLUSIONS: Findings reflect high prevalence of childhood maltreatment and their associations with HIV/HCV risk and HCV infection. Public health prevention and treatment initiatives must be trauma informed and culturally safe to support healing, health, and well-being.


Assuntos
Maus-Tratos Infantis , Infecções por HIV , Hepatite C , Índios Norte-Americanos , Preparações Farmacêuticas , Colúmbia Britânica/epidemiologia , Criança , Cidades , Estudos de Coortes , Infecções por HIV/epidemiologia , Hepatite C/epidemiologia , Humanos , Povos Indígenas
19.
JAMA Netw Open ; 4(6): e2115850, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34081135

RESUMO

Importance: Contact tracing is a multistep process to limit SARS-CoV-2 transmission. Gaps in the process result in missed opportunities to prevent COVID-19. Objective: To quantify proportions of cases and their contacts reached by public health authorities and the amount of time needed to reach them and to compare the risk of a positive COVID-19 test result between contacts and the general public during 4-week assessment periods. Design, Setting, and Participants: This cross-sectional study took place at 13 health departments and 1 Indian Health Service Unit in 11 states and 1 tribal nation. Participants included all individuals with laboratory-confirmed COVID-19 and their named contacts. Local COVID-19 surveillance data were used to determine the numbers of persons reported to have laboratory-confirmed COVID-19 who were interviewed and named contacts between June and October 2020. Main Outcomes and Measures: For contacts, the numbers who were identified, notified of their exposure, and agreed to monitoring were calculated. The median time from index case specimen collection to contact notification was calculated, as were numbers of named contacts subsequently notified of their exposure and monitored. The prevalence of a positive SARS-CoV-2 test among named and tested contacts was compared with that jurisdiction's general population during the same 4 weeks. Results: The total number of cases reported was 74 185. Of these, 43 931 (59%) were interviewed, and 24 705 (33%) named any contacts. Among the 74 839 named contacts, 53 314 (71%) were notified of their exposure, and 34 345 (46%) agreed to monitoring. A mean of 0.7 contacts were reached by telephone by public health authorities, and only 0.5 contacts per case were monitored. In general, health departments reporting large case counts during the assessment (≥5000) conducted smaller proportions of case interviews and contact notifications. In 9 locations, the median time from specimen collection to contact notification was 6 days or less. In 6 of 8 locations with population comparison data, positive test prevalence was higher among named contacts than the general population. Conclusions and Relevance: In this cross-sectional study of US local COVID-19 surveillance data, testing named contacts was a high-yield activity for case finding. However, this assessment suggests that contact tracing had suboptimal impact on SARS-CoV-2 transmission, largely because 2 of 3 cases were either not reached for interview or named no contacts when interviewed. These findings are relevant to decisions regarding the allocation of public health resources among the various prevention strategies and for the prioritization of case investigations and contact tracing efforts.


Assuntos
COVID-19/prevenção & controle , Busca de Comunicante , Saúde Pública , COVID-19/complicações , COVID-19/diagnóstico , COVID-19/epidemiologia , Teste para COVID-19 , Busca de Comunicante/estatística & dados numéricos , Análise Custo-Benefício , Estudos Transversais , Revelação/estatística & dados numéricos , Serviços de Saúde do Indígena , Humanos , Incidência , Prevalência , SARS-CoV-2 , Telefone , Estados Unidos/epidemiologia
20.
PLoS Negl Trop Dis ; 15(6): e0009468, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34181663

RESUMO

BACKGROUND: Chikungunya fever (CHIKF) is a serious public health problem with a high rate of infection and chronic disabling manifestations that has affected more than 2 million people worldwide since 2005. In spite of this, epidemiological data on vulnerable groups such as Indigenous people are scarce, making it difficult to implement public policies in order to prevent this disease and assist these populations. OBJECTIVE: To describe the serological and epidemiological profile of chikungunya virus (CHIKV) in two Indigenous populations in Northeast Brazil, as well as in an urbanized control community, and to explore associations between CHIKV and anthropometric variables in these populations. METHODOLOGY/PRINCIPAL FINDINGS: This is a cross-sectional ancillary study of the Project of Atherosclerosis among Indigenous Populations (PAI) that included people 30 to 70 years old, recruited from two Indigenous tribes (the less urbanized Fulni-ô and the more urbanized Truká people) and an urbanized non-Indigenous control group from the same area. Subjects underwent clinical evaluation and were tested for anti-CHIKV IgG by enzyme-linked immunosorbent assay. Serological profile was described according to ethnicity, sex, and age. The study population included 433 individuals distributed as follows: 109 (25·2%) Truká, 272 (62·8%) Fulni-ô, and 52 (12%) from the non-Indigenous urbanized control group. Overall prevalence of CHIKV IgG in the study sample was 49.9% (216; 95% CI: 45·1-54·7). When the sample was stratified, positive CHIKV IgG was distributed as follows: no individuals in the Truká group, 78·3% (213/272; 95% CI: 72·9-83·1) in the Fulni-ô group, and 5.8% (3/52; 95% CI: 1.21-16) in the control group. CONCLUSIONS/SIGNIFICANCE: Positive tests for CHIKV showed a very high prevalence in a traditional Indigenous population, in contrast to the absence of anti-CHIKV serology in the Truká people, who are more urbanized with respect to physical landscape, socio-cultural, and historical aspects, as well as a low prevalence in the non-Indigenous control group, although all groups are located in the same area.


Assuntos
Anticorpos Antivirais/sangue , Febre de Chikungunya/sangue , Febre de Chikungunya/etnologia , Vírus Chikungunya/imunologia , Adulto , Idoso , Brasil/epidemiologia , Brasil/etnologia , Febre de Chikungunya/epidemiologia , Febre de Chikungunya/virologia , Vírus Chikungunya/isolamento & purificação , Estudos Transversais , Feminino , Humanos , Imunoglobulina G/sangue , Povos Indígenas/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Soroepidemiológicos
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