An Internet-Based HIV Self-Testing Program to Increase HIV Testing Uptake Among Men Who Have Sex With Men in Brazil: Descriptive Cross-Sectional Analysis.

BACKGROUND: Approximately 30% of people living with HIV worldwide are estimated to be unaware of their infection. HIV self-testing (HIVST) is a strategy recommended by the World Health Organization to increase access to and uptake of testing among key populations who are at high risk for HIV infection. OBJECTIVE: This study aimed to describe the development and feasibility of a free, anonymous, internet-based HIVST strategy designed for men who have sex with men in Curitiba, Brazil (electronic testing [e-testing]). METHODS: The project was developed under the scope of the "A Hora é Agora" (The Time is Now) program. Individuals aiming to request an HIVST package (two tests each) answered an anonymous 5-minute questionnaire regarding inclusion criteria and sexual risk behavior. Eligible individuals could receive one package every 6 months for free. Website analytics, response to online questionnaires, package distribution, and return of test results were monitored via a platform-integrated system. RESULTS: Between February 2015 and January 2016, the website documented 17,786 unique visitors and 3218 completed online questionnaires. Most individuals self-reported being white (77.0%), young (median age: 25 years, interquartile range: 22-31 years), educated (87.3% completed secondary education or more), and previously tested for HIV (62.5%). Overall, 2526 HIVST packages were delivered; of those, 542 (21.4%) reported a result online or by mail (23 reactive and 11 invalid). During the study period, 37 individuals who reported using e-testing visited the prespecified health facility for confirmatory testing (30 positive, 7 negative). CONCLUSIONS: E-testing proved highly feasible and acceptable in this study, thus supporting scale-up to additional centers for men who have sex with men in Brazil.

Transfer of sampling methods for studies on most-at-risk populations (MARPs) in Brazil.

The objective of this paper was to describe the process of transferring two methods for sampling most-at-risk populations: respondent-driven sampling (RDS) and time-space sampling (TSS). The article describes steps in the process, the methods used in the 10 pilot studies, and lessons learned. The process was conducted in six steps, from a state-of-the-art seminar to a workshop on writing articles with the results of the pilot studies. The principal investigators reported difficulties in the fieldwork and data analysis, independently of the pilot sampling method. One of the most important results of the transfer process is that Brazil now has more than 100 researchers able to sample MARPs using RDS or TSS. The process also enabled the construction of baselines for MARPS, thus providing a broader understanding of the dynamics of HIV infection in the country and the use of evidence to plan the national response to the epidemic in these groups.

Implementation of respondent-driven sampling among female sex workers in Brazil, 2009.

Female sex workers are known in Brazil and elsewhere in the world as one of the most-at-risk populations for risk of HIV infection, due to their social vulnerability and factors related to their work. However, the use of conventional sampling strategies in studies on most-at-risk subgroups for HIV is generally problematic, since such subgroups are small in size and are associated with stigmatized behaviors and/or illegal activities. In 1997, a probabilistic sampling technique was proposed for hard-to-reach populations, called Respondent-Driven Sampling (RDS). The method is considered a variant of chain sampling and allows the statistical estimation of target variables. This article describes some assumptions of RDS and all the implementation stages in a study of 2,523 female sex workers in 10 Brazilian cities. RDS proved appropriate for recruiting sex workers, allowing the selection of a probabilistic sample and the collection of previously missing information on this group in Brazil.

Transfer of sampling methods for studies on most-at-risk populations (MARPs) in Brazil / Transferência de métodos de amostragem para estudos em populações sob maior risco à infecção pelo HIV no Brasil

The objective of this paper was to describe the process of transferring two methods for sampling most-at-risk populations: respondent-driven sampling (RDS) and time-space sampling (TSS). The article describes steps in the process, the methods used in the 10 pilot studies, and lessons learned. The process was conducted in six steps, from a state-of-the-art seminar to a workshop on writing articles with the results of the pilot studies. The principal investigators reported difficulties in the fieldwork and data analysis, independently of the pilot sampling method. One of the most important results of the transfer process is that Brazil now has more than 100 researchers able to sample MARPs using RDS or TSS. The process also enabled the construction of baselines for MARPS, thus providing a broader understanding of the dynamics of HIV infection in the country and the use of evidence to plan the national response to the epidemic in these groups.

O objetivo deste trabalho é descrever o processo de transferência de dois métodos de amostragem de populações sob maior risco ao HIV: RDS (respondent driven sampling) e o TSS (time space sampling). São descritas as etapas da transferência, os procedimentos metodológicos utilizados nos dez estudos-piloto conduzidos no Brasil e as lições aprendidas desse processo. O processo de transferência foi realizado em seis etapas, que envolveram desde a apresentação do estado da arte dos métodos de amostragem até a elaboração de artigo com os resultados dos estudos-piloto. Os pesquisadores apontaram dificuldades tanto na execução do campo como na análise dos dados dos estudos, independentemente do método de amostragem utilizado. Dentre os resultados mais importantes desse processo destaca-se a capacitação de mais de 100 pesquisadores. O processo de transferência possibilitou a realização de estudos específicos para construção das linhas de base para monitoramento da epidemia nos subgrupos sob maior risco para a infecção pelo HIV, e implicou o maior conhecimento da dinâmica da disseminação da infecção pelo HIV.

Implementation of respondent-driven sampling among female sex workers in Brazil, 2009 / Implementação do método de amostragem respondent-driven sampling entre mulheres profissionais do sexo no Brasil, 2009

Female sex workers are known in Brazil and elsewhere in the world as one of the most-at-risk populations for risk of HIV infection, due to their social vulnerability and factors related to their work. However, the use of conventional sampling strategies in studies on most-at-risk subgroups for HIV is generally problematic, since such subgroups are small in size and are associated with stigmatized behaviors and/or illegal activities. In 1997, a probabilistic sampling technique was proposed for hard-to-reach populations, called Respondent-Driven Sampling (RDS). The method is considered a variant of chain sampling and allows the statistical estimation of target variables. This article describes some assumptions of RDS and all the implementation stages in a study of 2,523 female sex workers in 10 Brazilian cities. RDS proved appropriate for recruiting sex workers, allowing the selection of a probabilistic sample and the collection of previously missing information on this group in Brazil.

O grupo das mulheres profissionais do sexo é reconhecido, nacional e internacionalmente, como uma população de maior risco à infecção pelo HIV pela sua vulnerabilidade social e por fatores relacionados à atividade profissional. Porém, a utilização de estratégias convencionais de amostragem em estudos nos subgrupos de maior risco de contraírem HIV é, em geral, problemática, já que estes têm pequena magnitude em termos populacionais e estão vinculados a comportamentos estigmatizados ou atividades ilegais. Em 1997, foi proposta uma técnica de amostragem probabilística para populações de difícil acesso, o Respondent-Driven Sampling (RDS). O método é considerado como uma variante da amostragem em cadeia e possibilita a estimação estatística dos parâmetros de interesse. Este artigo descreve alguns pressupostos do RDS e todas as etapas de implementação em um estudo com 2.523 profissionais do sexo em dez municípios brasileiros. A utilização do RDS mostrou-se apropriada para recrutamento de profissionais do sexo, possibilitando a seleção de uma amostra probabilística e a coleta de informações inexistentes sobre este grupo no Brasil.

Sampling studies to estimate the HIV prevalence rate in female commercial sex workers.

INTRODUCTION: We investigated sampling methods being used to estimate the HIV prevalence rate among female commercial sex workers. METHODS: The studies were classified according to the adequacy or not of the sample size to estimate HIV prevalence rate and according to the sampling method (probabilistic or convenience). RESULTS: We identified 75 studies that estimated the HIV prevalence rate among female sex workers. Most of the studies employed convenience samples. The sample size was not adequate to estimate HIV prevalence rate in 35 studies. DISCUSSION: The use of convenience sample limits statistical inference for the whole group. It was observed that there was an increase in the number of published studies since 2005, as well as in the number of studies that used probabilistic samples. This represents a large advance in the monitoring of risk behavior practices and HIV prevalence rate in this group.

Sampling studies to estimate the HIV prevalence rate in female commercial sex workers

INTRODUCTION: We investigated sampling methods being used to estimate the HIV prevalence rate among female commercial sex workers. METHODS: The studies were classified according to the adequacy or not of the sample size to estimate HIV prevalence rate and according to the sampling method (probabilistic or convenience). RESULTS: We identified 75 studies that estimated the HIV prevalence rate among female sex workers. Most of the studies employed convenience samples. The sample size was not adequate to estimate HIV prevalence rate in 35 studies. DISCUSSION: The use of convenience sample limits statistical inference for the whole group. It was observed that there was an increase in the number of published studies since 2005, as well as in the number of studies that used probabilistic samples. This represents a large advance in the monitoring of risk behavior practices and HIV prevalence rate in this group.

[Trends in the AIDS epidemic in groups at highest risk in Brazil, 1980-2004]. / Tendências da epidemia de AIDS entre subgrupos sob maior risco no Brasil, 1980-2004.

The objective of this paper was to present the trends in the AIDS epidemic in the population groups at highest risk in Brazil. Discriminant analysis was used to reclassify cases with unknown risk into one of the three groups: IDU (injecting drug users), MSM (men who have sex with men), and heterosexuals. AIDS incidence rates by gender and exposure category were estimated for the period 1980-2004. In 1980-1988, 63.6% of AIDS cases were homosexual or bisexual males and 10% were females. Since 1988, there has been a decrease in the proportion of MSM and an increase in the other categories. Despite the incidence trends observed by exposure category, when the incidence rates were compared, the risk was much higher among MSM as compared to heterosexuals. Analysis of the AIDS epidemic dynamics in Brazil emphasizes the importance of MSM and male IDU as higher-risk groups.

Tendências da epidemia de AIDS entre subgrupos sob maior risco no Brasil, 1980-2004 / Trends in the AIDS epidemic in groups at highest risk in Brazil, 1980-2004

O presente trabalho tem por objetivo apresentar as tendências da epidemia de AIDS em grupos populacionais sob maior risco no Brasil. A técnica de análise discriminante foi utilizada para reclassificação dos casos masculinos com categoria de exposição ignorada em um dos três grupos homens que fazem sexo com homens (HSH), usuários de drogas injetáveis (UDI) ou heterossexuais. Foram estimadas as taxas de incidência de AIDS por sexo e categoria de exposição no período 1980-2004. No período 1980-1988, os casos homossexuais ou bissexuais masculinos correspondiam a 63,6 por cento dos casos, e a proporção de mulheres era de 10 por cento. Posteriormente, há um decréscimo importante no papel desempenhado pelos HSH e ocorre um acréscimo nas outras categorias de exposição. Apesar das tendências de decréscimo para as incidências de casos HSH e UDI e acréscimo entre os heterossexuais masculinos e as mulheres, quando as taxas de incidência são comparadas o risco é maior entre os HSH e UDI. A análise da dinâmica da epidemia de AIDS no Brasil mostra a importância dos grupos HSH e UDI masculinos enquanto grupos de risco diferenciado.

The objective of this paper was to present the trends in the AIDS epidemic in the population groups at highest risk in Brazil. Discriminant analysis was used to reclassify cases with unknown risk into one of the three groups: IDU (injecting drug users), MSM (men who have sex with men), and heterosexuals. AIDS incidence rates by gender and exposure category were estimated for the period 1980-2004. In 1980-1988, 63.6 percent of AIDS cases were homosexual or bisexual males and 10 percent were females. Since 1988, there has been a decrease in the proportion of MSM and an increase in the other categories. Despite the incidence trends observed by exposure category, when the incidence rates were compared, the risk was much higher among MSM as compared to heterosexuals. Analysis of the AIDS epidemic dynamics in Brazil emphasizes the importance of MSM and male IDU as higher-risk groups.

HIV testing during pregnancy: use of secondary data to estimate 2006 test coverage and prevalence in Brazil.

This paper describes a methodological proposal based on secondary data and the main results of the HIV-Sentinel Study among childbearing women, carried out in Brazil during 2006. A probabilistic sample of childbearing women was selected in two stages. In the first stage, 150 health establishments were selected, stratified by municipality size (<50,000; 50,000-399,999; 400,000+). In the second stage, 100-120 women were selected systematically. Data collection was based on HIV-test results registered in pre-natal cards and in hospital records. The analysis focused on coverage of HIV-testing during pregnancy and HIV prevalence rate. Logistic regression models were used to test inequalities in HIV-testing coverage during pregnancy by macro-region of residence, municipality size, race, educational level and age group. The study included 16,158 women. Results were consistent with previous studies based on primary data collection. Among the women receiving pre-natal care with HIV-test results registered in their pre-natal cards, HIV prevalence was 0.41%. Coverage of HIV-testing during pregnancy was 62.3% in the country as a whole, but ranged from 40.6% in the Northeast to 85.8% in the South. Significant differences according to race, educational level and municipality size were also found. The proposed methodology is low-cost, easy to apply, and permits identification of problems in routine service provision, in addition to monitoring compliance with Ministry of Health recommendations for pre-natal care.

HIV testing during pregnancy: use of secondary data to estimate 2006 test coverage and orevalence in Brazil

This paper describes a methodological proposal based on secondary data and the main results of the HIV-Sentinel Study among childbearing women, carried out in Brazil during 2006. A probabilistic sample of childbearing women was selected in two stages. In the first stage, 150 health establishments were selected, stratified by municipality size (<50,000; 50,000-399,999; 400,000+). In the second stage, 100-120 women were selected systematically. Data collection was based on HIV-test results registered in pre-natal cards and in hospital records. The analysis focused on coverage of HIV-testing during pregnancy and HIV prevalence rate. Logistic regression models were used to test inequalities in HIV-testing coverage during pregnancy by macro-region of residence, municipality size, race, educational level and age group. The study included 16,158 women. Results were consistent with previous studies based on primary data collection. Among the women receiving pre-natal care with HIV-test results registered in their pre-natal cards, HIV prevalence was 0.41 percent. Coverage of HIV-testing during pregnancy was 62.3 percent in the country as a whole, but ranged from 40.6 percent in the Northeast to 85.8 percent in the South. Significant differences according to race, educational level and municipality size were also found. The proposed methodology is low-cost, easy to apply, and permits identification of problems in routine service provision, in addition to monitoring compliance with Ministry of Health recommendations for pre-natal care.

Desafios para o monitoramento da epidemia de HIV/aids entre os grupos populacionais sob maior risco no Brasil / Monitoring of the HIV / AIDS among the population groups at greatest risk in Brazil

Os modelos matemáticos têm destacado a contribuição desproporcional dos grupos sob maior risco ao HIV na disseminação da epidemia de aids, tais como os usuários de drogas injetáveis (UDI), os homens que fazem sexo com outros homens (HSH) e as mulheres trabalhadoras do sexo (TS). Nesta tese, apresentada sob a forma de três artigos, mostra-se que o risco de desenvolver aids em certos grupos populacionais ainda é desproporcionalmente elevado, e analisam-se aspectos importantes da implementação das atividades de monitoramento da epidemia de HIV e aids para esses grupos. No primeiro artigo, discute-se a evolução temporal dos indicadores para o monitoramento da Declaração de Compromisso sobre HIV/aids, acordada durante Assembléia Geral das Nações Unidas (UNGASS) visando à desaceleração da epidemia de HIV/aids. Analisam-se a disponibilidade de informações e as limitações para o cálculo dos indicadores propostos no Brasil e discute-se a adequação dos indicadores propostos para o monitoramento da epidemia brasileira. No segundo artigo, apresentam-se as tendências da epidemia de aids em grupos populacionais sob maior risco no Brasil, por meio do cálculo das taxas de incidência de aids por sexo e categoria de exposição no período 1980-2004. A análise da dinâmica da epidemia de aids no Brasil mostra a importância dos grupos HSH e UDI masculinos enquanto grupos de risco diferenciado. No terceiro artigo, apresentam-se dois métodos probabilísticos para amostragem de populações sob maior risco o Respondent Driven Sampling (RDS) e o Time Space Sampling (TSS). Descreve-se, adicionalmente, o processo de transferência metodológica para capacitar pesquisadores brasileiros na aplicação dessas técnicas de amostragem, discutindo-se as implicações para o monitoramento do HIV/aids nesses grupos populacionais.

Resultados do estudo sentinela-parturiente, 2006: desafios para o controle da sífilis congênita no Brasil / Results of the sentinel surveillance project, 2006: challenges for the control of congenital syphilis in Brazil

Objetivo: estimar a prevalência de HIV e sífilis em parturientes e a cobertura dos testes de HIV e sífilis na gestação com base em informações registradas nos cartões de pré-natal e nos prontuários hospitalares. Métodos: o processo de amostragem foi probabilístico, em dois estágios de seleção. No primeiro, foram selecionadas 150 maternidades do SUS, estratificadas por porte populacional do município. Em cada maternidade, foram selecionadas 100 a 120 parturientes. A cobertura de sífilis foi estimada entre as parturientes que realizaram dois testes na gestação e um na hora do parto. A taxa de prevalência de sífilis foi estimada entre as parturientes que realizaram o teste na hora do parto. Resultados: somente 14,1% das parturientes obedeceram às recomendações de dois testes de sífilis durante a gestação e um no parto. O percentual de gestantes que apresentaram pelo menos um teste no cartão de pré-natal foi de 75,1%, porém apenas 16,9% apresentaram os resultados dos dois testes. Das parturientes que realizaram o teste no parto, 1,1% teve resultado positivo. Entre as mulheres que haviam feito o primeiro teste no pré-natal e obtiveram resultado negativo, 0,4% teve resultado positivo no segundo teste. Entre as gestantes que não fizeram atendimento pré-natal, 1,8% teve resultado positivo na hora do parto. Conclusão: a baixa cobertura do segundo teste de sífilis no pré-natal indica que as recomendações do Ministério da Saúde não estão sendo seguidas rotineiramente. Os achados aqui apresentados indicam a necessidade de realização do segundo teste de sífilis no pré-natal para o adequado controle da transmissão vertical.

Objective: estimating HIV and syphilis prevalence rates among parturient women and coverage of HIV and syphilis testing during pregnancy bymeans of registered information in prenatal and hospital records. Methods: the sampling was probabilistic in two selection stages. In the first one,150 hospitals were selected, stratified by population size of the municipality. In each health establishment, 100-120 parturient were randomly selected.Coverage of syphilis testing was estimated among parturient women who took two syphilis tests during prenatal care and one test at delivery. Syphilis prevalence rate was estimated among parturient women tested at the delivery. Results: only 14.1% of the women followed the recommendations of two syphilis tests during pregnancy and one at the delivery. The percentage of pregnant women with at least one syphilis test registered in the prenatal record was 75.1% but only 16.9% showed two test results. Among pregnant women that were tested at delivery, 1.1% had positive results.Among women that were tested during prenatal care and were negative, 0.4% got positive in the second test. Among women who did not have prenatalcare and were tested at delivery, 1.8% had positive results. Conclusion: the low coverage of the second syphilis test indicates that the Ministry of Health recommendations are not being obeyed in the routine of health services. The findings depicted indicate the need of the second syphilis test during pregnancy for the adequate vertical transmission control.

[Proposed UNGASS indicators and the monitoring of the AIDS epidemic in Brazil]. / Indicadores propostos pela UNGASS e o monitoramento da epidemia de Aids no Brasil.

The objective of this study was to analyze, on the national level, the process of monitoring the proposed UNGASS indicators through the use of the Brazilian National Program for STD/AIDS indicators. Two groups of proposed indicators were analyzed in 2002 and 2005 respectively, as part of the monitoring of the progress of the UNGASS Declaration of Commitment. The availability of information and limitations in calculating the proposed indicators in Brazil were analyzed and the appropriateness of the indicators for monitoring the epidemic in Brazil was discussed. Of the 13 quantitative indicators originally proposed by UNGASS, five were not included in the National Program. One was not included due to its qualitative nature. Two of the indicators were considered to be of little use and two were not included due to the lack of available data needed for their calculation. As the epidemic in Brazil is characterized as being concentrated, within the second group of proposed UNGASS indicators those that refer to the accompaniment of epidemic among high-risk population groups were prioritized. The study highlights that the National Program concentrates its efforts in the development, adaptation, and sharing of sampling methodologies for hard to reach populations. Such activities are geared towards estimating the size of vulnerable population groups, as well as obtaining more information regarding their knowledge, attitudes, and practices. The study concludes that by creating the possibility of international comparisons between advances achieved, the proposal of supranational indicators stimulates countries to discuss and make their construction viable. In a complementary way, the national monitoring systems should focus on program improvement by covering areas that permit the evaluation of specific control and intervention actions.

Indicadores propostos pela UNGASS e o monitoramento da epidemia de Aids no Brasil / Proposed UNGASS indicators and the monitoring of the AIDS epidemic in Brazil

O objetivo do estudo foi analisar o processo de monitoramento de indicadores centrais propostos pela UNGASS, em nível nacional, vis-à-vis aos indicadores do Programa Nacional de DST e Aids. Foram avaliados os dois conjuntos de indicadores propostos, respectivamente, em 2002 e 2005, para o monitoramento de progresso da Declaração de Compromisso da UNGASS. Foram analisadas a disponibilidade de informações e as limitações para o cálculo dos indicadores propostos no Brasil, incluindo discussão sobre a adequação dos indicadores propostos para o monitoramento da epidemia brasileira. Dos 13 indicadores quantitativos inicialmente propostos pela UNGASS, cinco não estão incluídos no sistema de monitoramento do Programa Pacional. Um deles não foi incluído por ser um indicador qualitativo. Dois dos indicadores foram considerados de pouca utilidade e dois não foram contemplados pela falta de dados disponíveis para o seu cálculo. Como o Brasil é caracterizado por ter uma epidemia concentrada, no segundo conjunto de indicadores propostos pela UNGASS, prioriza-se o acompanhamento da epidemia entre as populações sob maior risco. Destacou-se que o Programa Nacional centra seus esforços no desenvolvimento, adaptação e transferência de metodologias de amostragem em populações de difícil acesso. Tais ações são voltadas para a estimação do tamanho dos grupos vulneráveis, bem como para obter mais informações sobre seu comportamento, atitudes e práticas. Concluiu-se que, pela possibilidade de comparações internacionais dos avanços conseguidos, a proposição de indicadores supranacionais estimula os países a discutir e viabilizar sua construção. De maneira complementar, os sistemas nacionais de monitoramento devem ser focados na melhoria do programa, cobrindo áreas que permitam avaliar as ações de controle e intervenções específicas.

Knowledge, practices and behaviours related to HIV transmission among the Brazilian population in the 15-54 years age group, 2004.

OBJECTIVE: To describe transmission vulnerability for acquiring HIV infection among the Brazilian population aged 15-54 years. DESIGN: A population-based survey. METHODS: Sampling was stratified by geographical region. A total of 6006 interviews were conducted. Indicators of knowledge and sexual practices and the relative sizes of the vulnerable subgroups were estimated. Logistic regression analysis was used to determine the main factors associated with safe sex practices. RESULTS: Regarding knowledge indicators in the age group 15-24 years, a high percentage (91%) spontaneously cited sexual intercourse as a form of HIV transmission, and 62% had correct knowledge of the modes of HIV transmission (five correct items). The proportion of consistent condom use with casual partners was 52%, increasing to 59% in the youngest age group. Higher proportions of inconsistent condom use with any kind of partner were found among women and among the poorest. A multiplicity of sexual partners, low socio-economic status and cocaine use were important predictors of unprotected sex among men living without a companion. Among individuals aged 15-49 years, 0.2% currently inject cocaine, 4.6% of the men paid for sex at least once over the past year and 1.0% of the women were paid in exchange for sex. Among sexually active men of the same age group, 3.5% reported sexual relations with other men. CONCLUSION: Besides the need to establish the role exercised by the vulnerable subgroups in the HIV transmission dynamics, results indicate that it is necessary to investigate unsafe sexual practices further among the poorer sectors of society.

Evaluation of rapid tests for anti-HIV detection in Brazil.

OBJECTIVES: This assessment in Brazil was to evaluate the performance of commercially available HIV rapid test (RT) against the gold standard testing and to establish a highly sensitive and specific RT algorithm for HIV diagnosis. DESIGN: A prospective, anonymous and unlinked study. METHODS: An evaluation of seven commercially available RT to compare their performance against the gold standard tests for Brazil. This includes two competing enzyme immunoassays plus a Western blot for confirmation. After informed consent, whole blood samples were collected from volunteers in voluntary counselling and testing sites (n = 400), antenatal clinics (n = 500) and from HIV-positive controls in AIDS treatment centres (n = 200). Two seroconversion panels, one HIV-1 subtype (B, B', C and F) panel and an operational assay performance evaluation were also part of the study parameters. RESULTS: For the seven RT the clinical sensitivity ranged from 97.74 to 100% and clinical specificity from 99.43 to 100%. However, only four RT were considered acceptable after full evaluation. The two EIA had a clinical sensitivity of 100% and clinical specificity of 99.32 and 99.66%. Two RT had the same performance on the seroconversions panels as the EIA. The operational assay performance evaluation for the RT indicated that Hexagon and Capillus could not be classified as simple assays. CONCLUSION: We have provided evidence that RT assays can perform equally or better than EIA for the detection of HIV antibodies. The simplicity and rapidity of the RT warrants its utilization in an algorithm for a rapid diagnosis of HIV infection.

Temporal trends of HIV-related risk behavior among Brazilian military conscripts, 1997-2002.

PURPOSE: To present selected results of military conscript surveys related to HIV/AIDS, conducted in Brazil, 1997-2002. METHODS: Questionnaires including information on socio-demographic data, sexual behavior practices, sexually transmitted infections-related problems, and use of injecting drugs were completed by 30970 individuals, obtained through a 2-stage sampling. An index of sexual risk behavior was developed to take into account multiplicity of partners and irregularity of condom use. The HIV infection prevalence rate was estimated for 2002. Logistic regression was used to identify the most important determinants of HIV infection. RESULTS: The percentage of regular condom use increased from 38% (1997) to 49% (2002), and the index of sexual risk behavior decreased from 0.98 in 1997 to 0.87, in 2002. The HIV infection prevalence rate was 0.09%, in 2002, which remained unchanged since 1998 Riskier sexual practices among young men with incomplete education and among "men who have sex with men" were found as well as among the participants who reported at least one sexually transmitted infections - related problem. The most important predictor of HIV infection was to be positive for syphilis. CONCLUSIONS: The estimated value of the HIV infection prevalence supports the diagnosis of a concentrated HIV epidemic, in Brazil. Results indicate that particular attention needs to be paid for regional differentials, and for special subgroups, in Brazil.

Temporal trends of HIV-related risk behavior among brazilian military conscripts, 1997-2002

OBJETIVO: Apresentar determinados resultados de levantamentos sobre HIV/AIDS em conscritos do Exército Brasileiro, conduzidos em 1997-2002. MÉTODOS: Aplicaram-se questionários em 30970 conscritos, selecionados segundo um esquema de amostragem em 2 estágios, para obter informações sobre comportamento sexual, problemas relacionados a infecções sexualmente transmitidas e uso de drogas injetáveis. Desenvolveu-se um índice de comportamento sexual de risco para contemplar multiplicidade de parceria sexual e uso de preservativo. Estimou-se, para o ano de 2002, a taxa de prevalência de infecção pelo HIV. RESULTADOS: A porcentagem de uso regular de preservativo aumentou de 38%, em 1997, para 49%, em 2002. O índice de comportamento sexual de risco decresceu de 0,98 em 1997 para 0,87, em 2002. O índice de prevalência de infecção HIV foi de 0.09%, in 2002, permanecendo inalterado desde 1998 Práticas sexuais de maior risco foram observadas entre aqueles com baixa escolaridade e em "homens que fazem sexo com homens", como também entre aqueles com problemas de infecções sexualmente transmissíveis. O mais importante preditor de infecção pelo HIV foi a soropositividade para lues. CONCLUSÕES: A prevalência estimada de infeção pelo HIV suporta o diagnóstico que a epidemia de AIDS, no Brasil, é do tipo "concentrada". Os resultados indicam que são necessárias medidas de intervenção que contemplem diferenças regionais e também voltadas para subgrupos populacionais especiais.

[HIV infection during pregnancy: the Sentinel Surveillance Project, Brazil, 2002]. / Infecção pelo HIV durante a gestação: estudo-Sentinela Parturiente, Brasil, 2002.

OBJECTIVE: To evaluate the actual coverage of HIV infection detection during pregnancy at national level. METHODS: The actual coverage of HIV testing during pregnancy was defined as the proportion of women who attended prenatal care visits (at least one visit), ordering HIV testing and knowledge of test result before delivery. The coverage was estimated by sampling procedures based on the 2002 Sentinel Surveillance Study data. Actual coverage Inequalities were assessed by: country regions; population size of the municipality where delivery took place; and mother's schooling. RESULTS: The actual coverage of HIV testing during pregnancy was 52%. Huge sociogeographic inequalities are seen between the Northeastern (24%) and Southern regions (72%); illiterate mothers (19%) and those with complete basic education (64%); mothers who delivered in small municipalities (36%) and those who delivered in municipalities with more than 500,000 inhabitants (66%). Ministry of Health recommendations were fully followed by only 27% pregnant women. CONCLUSIONS: The study results show a need for actions aiming at increasing HIV detection coverage during pregnancy, and indicate that HIV/STD programs should be intensified with joint strategies between the National AIDS Program and infant-maternal programs.