Integrating competency analysis into national rehabilitation workforce evaluation: a case study.

BACKGROUND: Establishing a workforce capable of meeting population needs is contingent on evaluation that can inform sound policy and planning. Health workforce evaluation has traditionally relied on health labour market analysis and workload estimations. To date, competency analysis has not been included in national health workforce evaluation, despite that fact that the findings may go far in guiding decisions around workforce composition, optimisation and education and training. This case study sought to assess the feasibility and perceived added value of integrating competency analysis into national rehabilitation workforce evaluation, and to determine how competency analysis can shape rehabilitation workforce planning. The findings of the case study can be used to explore the integration of competency analysis in the evaluation of other health-related occupational groups. METHODS: Participant observation was complemented by key informant interviews with experts engaged in the national rehabilitation workforce evaluation in Poland. These experts represented stakeholders in policy, education, research, clinical practice and professional associations. RESULTS: The results indicated that competency analysis can be feasibly integrated into national rehabilitation workforce evaluation, particularly when implementation is supported through the use of online platforms. However, the collection of additional data using other tools, such as a survey of the behaviours and tasks of a wider sample of rehabilitation workers, could strengthen data reliability. Experts perceived findings of the competency analysis to be valuable for expanding the understanding of rehabilitation, shedding light on task allocation and deployment of the existing rehabilitation workforce, and advocating for the rehabilitation workforce to be strengthened, especially in relation to those occupations which may not be recognised or valued as rehabilitation workers. Although it was not possible to fully explore the impact of competency analysis data on rehabilitation workforce planning and development in this study, experts suggested that its availability would likely foster greater cooperation among occupations, which has been missing at the policy and planning level to date. It further demonstrates what competency data should be collected and reported, and provides richer information to guide decisions. CONCLUSIONS: Competency analysis complements traditional labour market analysis and workload estimates, adding depth to the understanding of how members of the workforce perform and perceive themselves, and how deficiencies in the workforce impact on the provision of care to specific population groups.

Point of Sale Advertising and Promotion of Cigarettes, Electronic Cigarettes, and Heated Tobacco Products in Warsaw, Poland-A Pilot Study.

Prevalence of smoking and e-cigarette use among teenagers in Poland is high. Polish law bans most advertising and promotion for cigarettes, e-cigarettes, and heated tobacco products (HTPs). This study investigates marketing for these products at points of sale (POS) near secondary schools in Warsaw, Poland, noting if the advertising and promotion were allowed under current Polish laws. All POS within 250 m radii of five selected secondary schools in each of three Warsaw districts were assessed for tobacco and e-cigarette direct advertising, inside and outside; offers of gifts or promotional discounts; tobacco merchandising, and tobacco displays. Of the 112 POS surveyed, 83% exposed customers to some form of advertising or promotion of cigarettes, e-cigarettes, or HTPs; in 76%, advertising or promotion that violated Polish law was present. More than 80% of POS surveyed displayed tobacco products; in 19%, these products were displayed near products of interest to minors. POS density observed here was 30.3 per km2, higher than in other European cities. In Poland, a high proportion of POS near schools violates the law banning the advertisement and promotion of tobacco and nicotine consumer products through a dense tobacco retailer network.

Dichotomy of lay people and health professionals perception of physical activity is a challenge for activity education and promotion within primary health care - a qualitative study.

INTRODUCTION: According to the WHO, healthy adults aged 18-64 should perform at least 150 min of moderate-intensity aerobic physical activity (PA), or at least 75 min of vigorous-intensity PA, throughout the week, or an equivalent combination of moderate and vigorous activity. These recommendations should be promoted and involved in primary health care (PHC) staff daily practice. Tailoring the education message depends on peoples' perspective on PA, but in Poland there is no research on the subject. OBJECTIVE: The aim of the study was to explore and compare the perception of lay people (LP) and health professionals (HP) of PA to find similarities and differences in their perspective - as this may have an impact on PHC-based education on PA (favourable or unfavourable). MATERIAL AND METHODS: Six mini FGIs were carried out. Research sample consisted of 16 LP from urban settings and 10 HP (doctors, nurses). RESULTS: LP and HP appreciated PA as important and considerably controllable health determinant. LP attributed the main gains of PA to psycho-social benefits, and HP strictly to diseases risk reduction. Both groups had difficulties in defining PA and doubts abounded about PA and exercise. Optimal dose (volume) of PA was generally unclear and the WHO recommendation were unknown. HP seemed to be more eager than LP to appreciate simple forms of PA, e.g. walking. Barriers to PA perceived by LP were described in terms of 'real life' factors (sportswear, access, job), and HP mostly by cognition (knowing, judging) and social status. LP preferred positive, rewarding motivation for PA, but HP one that was negative and fear-based. CONCLUSIONS: Referring to activity, LP and HP were like travellers in parallel universes. This created challenges in PHC-based education. Some suggestion for PA education were given. More qualitative and quantitative research are needed.

Understanding the modes of transmission model of new HIV infection and its use in prevention planning.

The modes of transmission model has been widely used to help decision-makers target measures for preventing human immunodeficiency virus (HIV) infection. The model estimates the number of new HIV infections that will be acquired over the ensuing year by individuals in identified risk groups in a given population using data on the size of the groups, the aggregate risk behaviour in each group, the current prevalence of HIV infection among the sexual or injecting drug partners of individuals in each group, and the probability of HIV transmission associated with different risk behaviours. The strength of the model is its simplicity, which enables data from a variety of sources to be synthesized, resulting in better characterization of HIV epidemics in some settings. However, concerns have been raised about the assumptions underlying the model structure, about limitations in the data available for deriving input parameters and about interpretation and communication of the model results. The aim of this review was to improve the use of the model by reassessing its paradigm, structure and data requirements. We identified key questions to be asked when conducting an analysis and when interpreting the model results and make recommendations for strengthening the model's application in the future.

Estimación y análisis de la incidencia de VIH en población adulta del Perú: resultados de la aplicación del modelo matemático MoT / Estimation and analysis of HIV incidence in the adult population in Peru: results of application of the MoT mathematical model

Objetivos. Estimar la incidencia de VIH en la población adulta del Perú, 2010, y analizar su distribución según comportamientos de riesgo. Materiales y métodos. Se aplicó el modelo de ONUSIDA según modos de transmisión (MoT). Los datos fueron obtenidos de la revisión detallada de 59 documentos (1984 - 2008). También se analizó bases de datos nacionales para obtener datos específicos. La selección final de los datos fue validada por el grupo técnico y un grupo de expertos. Después de la consulta con expertos, se corrigieron los valores y se realizó un análisis de incertidumbre. El modelo fue ajustado a la prevalencia nacional del 2009 (0,45%). Resultados. La incidencia estimada para el 2010 fue de 0,03%, (4346 nuevas infecciones). El 84% de nuevas infecciones se concentra en grupos de mayor riesgo: hombres que tienen sexo con hombres (55%) y personas que tienen sexo casual heterosexual (6,2%). El 16% restante corresponde a la población heterosexual de bajo riesgo. La transmisión heterosexual es el 43% de nuevos casos, y dentro de estos el 18% corresponde a parejas femeninas de sujetos de alto riesgo. Solo 2,2% de casos está relacionado al trabajo sexual femenino y 1,0% a usuarios de drogas inyectables. Conclusiones. El modelo proporciona una estimación de la incidencia y su distribución entre los grupos de riesgo según el modo de transmisión, consistente con los reportes de casos de VIH. El modelo permite crear escenarios para ayudar a la toma de decisiones y formulación de políticas, así como para vigilancia y planificación de la prevención y control.

Objectives. To estimate HIV incidence in the adult population of Peru, 2010, and analyze its distribution based on risk behavior. Materials and methods. The UNAIDS model was applied based on the modes of transmission (MoT). The information was obtained from the review detailed in 59 documents (1984 - 2008). National databases were also analyzed to obtain specific data. Final selection of data was validated by the technical group and a group of experts. After consultation with experts, values were corrected and an uncertainty analysis was conducted. The model was adjusted to 2009 national prevalence (0.45%). Results. Incidence estimated for 2010 was 0.03%, (4346 new infections). 84% of new infections concentrate on higher risk groups: men who have sex with men (55%) and people who have casual sex with heterosexuals (6.2%). The remaining 16% corresponds to low-risk heterosexual population. Heterosexual transmission accounts for 43% of new cases, 18% of which corresponds to female partners of high risk individuals. Only 2.2% of cases is related to female sexual work and 1.0% to injection drug users. Conclusions. The model provides an estimation of the incidence and its distribution among risk groups according to the mode of transmission, consistent with the HIV case reporting. The model creates scenarios to help decision making and policy formulation, as well as surveillance and planning of prevention and control.

Analysis of duration of risk behaviour for key populations: a literature review.

BACKGROUND: The objective of this paper is to review literature in order to calculate regional estimates of the average duration of time individuals maintain a specific high-risk behaviour. METHODS: The review targeted the key populations of female sex workers (FSW), male clients of female sex workers (MCFSW), people who inject drugs (injecting drug users (IDU)) and high-risk men who have sex with men (MSM). To be included in the review the study had to provide information on (1) the time a person spent at risk until death or cessation of the risk behaviour, (2) the percentage of the sample who initiated the risk behaviour in less than a year or (3) the mean or median duration of the behaviour from a representative sample. RESULTS: 49 papers were found for the FSW population describing the period of time FSW stay in sex work to be between 2.9 years (Asia) and 12 years (Latin America). Eight papers were found for MCFSW showing the duration of the risk behaviour in this category varying from 4.6 years in Africa to 32 years in Asia. 86 papers were reviewed for the population of IDU showing that the average time a person injects illegal drugs varies from 5.6 years (Africa) to 21 years (South America). No information was found for duration of high-risk behaviour among MSM; instead, the definitions found in the literature for high- and low-risk behaviour among MSM were described. CONCLUSIONS: There is high variability of estimates of duration of high-risk behaviours at regional level. More research is needed to inform models and prevention programmes on the average duration of time individuals maintain a specific high-risk behaviour.

Identifying and quantifying misclassified and under-reported AIDS deaths in Brazil: a retrospective analysis from 1985 to 2009.

BACKGROUND: A retrospective analysis of deaths registered in the Brazilian Mortality System was conducted to quantify the under-reporting of HIV/AIDS deaths and those misclassified to AIDS-related conditions in the 15-49 years old population in Brazil. METHODS: Death rates for AIDS-related diseases were calculated by age and sex for 1985-2009. Changes in the age-sex-specific death rates over time were used to identify conditions likely to be misclassified AIDS deaths and to quantify the corresponding number of misclassified deaths. Deaths due to ill-defined causes were redistributed across all other natural causes of death. The resulting total number of AIDS deaths was further adjusted for incompleteness of the mortality reporting system. RESULTS: Out of the 28 potential causes of death investigated, five increased in the same distinct age pattern as AIDS: pneumonia, Kaposi's sarcoma, other immunodeficiencies, other septicaemia and toxoplasmosis. 18 490 deaths due to these five causes were recoded to HIV/AIDS from 1985 to 2009. 38 145 deaths due to ill-defined causes were redistributed to AIDS and 15 485 were added to the number of AIDS deaths to correct for completeness of the mortality system in Brazil. Altogether, 72 120 deaths were recoded to AIDS between 1985 and 2009 and added to the reported 194 445 AIDS related deaths in the country, representing 27% misclassification of AIDS deaths in Brazil. CONCLUSIONS: This study demonstrated that AIDS mortality is underestimated by the official mortality information system in Brazil. Efforts need to be made to reduce misclassification of causes of death in the future and identify ways in which the confidentiality of information regarding cause of death can be maintained.

Focusing the HIV response through estimating the major modes of HIV transmission: a multi-country analysis.

OBJECTIVE: An increasing number of countries have been estimating the distribution of new adult HIV infections by modes of transmission (MOT) to help prioritise prevention efforts. We compare results from studies conducted between 2008 and 2012 and discuss their use for planning and responding to the HIV epidemic. METHODS: The UNAIDS recommended MOT model helps countries to estimate the proportion of new HIV infections that occur through key transmission modes including sex work, injecting drug use (IDU), men having sex with men (MSM), multiple sexual partnerships, stable relationships and medical interventions. The model typically forms part of a country-led process that includes a comprehensive review of epidemiological data. Recent revisions to the model are described. RESULTS: Modelling results from 25 countries show large variation between and within regions. In sub-Saharan Africa, new infections occur largely in the general heterosexual population because of multiple partnerships or in stable discordant relationships, while sex work contributes significantly to new infections in West Africa. IDU and sex work are the main contributors to new infections in the Middle East and North Africa, with MSM the main contributor in Latin America. Patterns vary substantially between countries in Eastern Europe and Asia in terms of the relative contribution of sex work, MSM, IDU and spousal transmission. CONCLUSIONS: The MOT modelling results, comprehensive review and critical assessment of data in a country can contribute to a more strategically focused HIV response. To strengthen this type of research, improved epidemiological and behavioural data by risk population are needed.

[Estimation and analysis of HIV incidence in the adult population in Peru: results of application of the MoT mathematical model]. / Estimación y análisis de la incidencia de VIH en población adulta del Perú: resultados de la aplicación del modelo matemático MoT.

OBJECTIVES: To estimate HIV incidence in the adult population of Peru, 2010, and analyze its distribution based on risk behavior. MATERIALS AND METHODS: The UNAIDS model was applied based on the modes of transmission (MoT). The information was obtained from the review detailed in 59 documents (1984 - 2008). National databases were also analyzed to obtain specific data. Final selection of data was validated by the technical group and a group of experts. After consultation with experts, values were corrected and an uncertainty analysis was conducted. The model was adjusted to 2009 national prevalence (0.45%). RESULTS: Incidence estimated for 2010 was 0.03%, (4346 new infections). 84% of new infections concentrate on higher risk groups: men who have sex with men (55%) and people who have casual sex with heterosexuals (6.2%). The remaining 16% corresponds to low-risk heterosexual population. Heterosexual transmission accounts for 43% of new cases, 18% of which corresponds to female partners of high risk individuals. Only 2.2% of cases is related to female sexual work and 1.0% to injection drug users. CONCLUSIONS: The model provides an estimation of the incidence and its distribution among risk groups according to the mode of transmission, consistent with the HIV case reporting. The model creates scenarios to help decision making and policy formulation, as well as surveillance and planning of prevention and control.

Hepatitis C virus among non-injecting cocaine users (NICUs) in South America: can injectors be a bridge?

AIM: To investigate the factors associated with hepatitis C virus (HCV) infection among non-injecting cocaine users (NICUs) and to compare practices associated with HCV and HIV infection. DESIGN: An intercountry cross-sectional study. Setting Buenos Aires and Montevideo metropolitan areas. PARTICIPANTS: A total of 871 NICUs. MEASUREMENTS: NICUs were interviewed and their blood was drawn and used for HCV, HIV, HBV surface antigen (HbsAg), HB-anticore and Venereal Disease Research Laboratory (VRDL) antibody assays. Bivariate and multivariate logistic regression analyses included comparisons of HCV and HIV mono-infected participants with HCV-HIV seronegatives. FINDINGS: Prevalence rates were 8.8 [95% confidence interval (CI): 6.9-10.8) for HCV and 7.9 (95% CI: 6.1-9.7) for HIV. HCV-infected NICUs were twice as likely as HCV-HIV seronegatives to have shared straws for cocaine snorting or sniffing, even when adjusted for other variables. HCV prevalence rates ranged from 3.6% among NICUs who denied sharing straws and having had an injection drug user (IDU) or an HIV-positive sexual partner to 12.6% among participants who reported ever having shared straws or having had either an IDU- or HIV-positive sexual partner (χ(2) (trend) = 6.56, P = 0.01). CONCLUSIONS: Non-injecting cocaine users from South America are vulnerable to multiple infections and HCV infection appears to occur through the sharing of straws. HCV infection is associated with intimate relationships with IDUs or HIV-seropositive partners, supporting the hypothesis that HCV risk may be due primarily to risk-taking behaviour associated with drugs in this population.

Infecciones y otros problemas de salud en usuarios de pasta base de cocaina en un centro asistencial de Buenos Aires, Argentina / Infections and other health problems among coca paste users at a drug treatment center in Buenos Aires, Argentina

INTRODUCCIÓN: la pasta base de cocaína (PBC) es una forma fumable de cocaína de creciente utilización entre los jóvenes. OBJETIVO: describir el patrón de consumo de drogas, las seroprevalencias de VIH, hepatitis B (VHB), hepatitis C (VHC), sífilis y otrosproblemas de salud en usuarios de PBC en un centro asistencial de Argentina. MÉTODO: se incluyeron voluntarios mayores de 18 años, asistidos en el Centro Nacional de Reeducación Social (CENARESO)en el período 2006-2007, que consumieron PBC en los 6 meses anteriores a la entrevista y que nunca utilizaron drogas inyectables. Se aplicó un cuestionario estructurado, se tomó una muestra de sangre para serología de VIH, VHB, VHC y sífilis, y se analizó una sub-muestra de radiografías de tórax. RESULTADOS: más de la mitad de los 146 voluntarios manifestó haber fumado PBC varias veces por semana. Los participantes eran también consumidores frecuentes de cocaína en polvo (64%), cannabis (80,8%) y tranquilizantes (44,5%). Los principales problemas de salud auto-percibidos como consecuencia del consumo de PBC fueron las lesiones orales y la pérdida de peso. El 4,3% de los voluntarios resultó VIH-positivo. Las prevalencias de infección por sífilis, VHB y VHC fueron 2,7%, 5,5%, y 5,5%, respectivamente. El 16% estaba coinfectado con uno o más de los agentes estudiados. DISCUSIÓN: la prevalencia de infecciones, unida a otros problemas de salud de los usuarios de PBC, indica la necesidad de nuevas investigaciones a fin de diseñar intervenciones preventivas y terapéuticas apropiadas

INTRODUCTION: cocaine paste is a smokable form of cocaine increasingly used among young people. OBJECTIVE:to describe patterns of drugs, seroprevalences of HIV, hepatitis B (HBV), hepatitis C (HCV), syphilis and other health problems among coca paste users assisted at a drug treatment center in Argentina. METHOD: volunteers, eighteen-year-old and olderassisted at the National Center for Social Re-education (CENARESO)during 2006-2007, who had consumed coca paste over the past 6 months previous to the interview and had never injected drugs, were selected. A structured questionnaire wasused and blood was drawn to test HIV, HBV, HCV and syphilis. A sub-sample of thorax X-rays was analyzed. RESULTS: morethan half of the 146 volunteers had smoked coca paste severaltimes a week. The use of other drugs was frequently associated: sniffed cocaine 64%, cannabis 80,8%, and tranquilizers 44,5. Oral lesions and lost of weight were referred as health problems stemming from coca paste use. Out of the 146 volunteers, 4.3%resulted HIV-positive. Prevalences of infection for syphilis, HBV, and HCV were 2,7%, 5,5% and 5,5%, respectively. 16% wasco-infected with one or more infectious agents. DISCUSSION: the prevalence of infections detected, along with other clinical problems found among this coca paste users, show the need for further research, in order to design proper preventive and therapeutic interventions

Sexual behavior and HBV infection among noninjecting cocaine users (NICUs).

The aim is to estimate HBV prevalence and the associated risks among noninjecting cocaine users (NICUs). In 2002-2003, a total of 824 NICUs from Buenos Aires (Argentina) and Montevideo (Uruguay) were interviewed using a structured questionnaire. Serologic tests were carried out for Human Immunodeficiency Virus (HIV), hepatitis B (HBV), syphilis, and others. The population was divided into two serologic groups: HBV-infected and seronegative group. Univariate and binary logistic model were developed. The results seem to indicate that, among NICUs, HBV is transmitted through sexual contact. Prevention measures, including vaccine, are needed in order to control and minimize risks. The study's limitations are noted.

Prevalences, genotypes, and risk factors for HIV transmission in South America.

HIV cross-sectional studies were conducted among high-risk populations in 9 countries of South America. Enzyme-linked immunosorbent assay screening and Western blot confirmatory testing were performed, and env heteroduplex mobility assay genotyping and DNA sequencing were performed on a subset of HIV-positive subjects. HIV prevalences were highest among men who have sex with men (MSM; 2.0%-27.8%) and were found to be associated with multiple partners, noninjection drug use (non-IDU), and sexually transmitted infections (STIs). By comparison, much lower prevalences were noted among female commercial sex workers (FCSWs; 0%-6.3%) and were associated mainly with a prior IDU and STI history. Env subtype B predominated among MSM throughout the region (more than 90% of strains), whereas env subtype F predominated among FCSWs in Argentina and male commercial sex workers in Uruguay (more than 50% of strains). A renewed effort in controlling STIs, especially among MSM groups, could significantly lessen the impact of the HIV epidemic in South America.

High seroprevalence of bloodborne viruses among street-recruited injection drug users from Buenos Aires, Argentina.

Injection drug use is the main mechanism of human immunodeficiency virus (HIV) transmission in Argentina (40% of reported AIDS cases in Argentina). This study was conducted among street-recruited injection drug users (IDUs) from Buenos Aires, with the aim of estimating seroprevalence and coinfection of HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), and human T-lymphotropic viruses (HTLVs). A total of 174 volunteers participated in this study; 137 were men (78.7% of volunteers). The average age of the participants was 30 years. Only 64 of participants (37%) had no viral infection, whereas 110 (63%) were infected with > or =1 viruses. Seroprevalences were 44.3% for HIV, 54.6% for HCV, 42.5% for HBV, 2.3% for HTLV-I, and 14.5% for HTLV-II. Among the 77 HIV-infected persons, only 6.5% (5 persons) were not coinfected with other viruses; 88.3% (68) were coinfected with HCV and 68.8% (53) were coinfected with HBV. We demonstrated the existence of multiple viral infections with a high rate of prevalence in IDUs in Buenos Aires, Argentina.

Status of the HIV/AIDS epidemic and methods to monitor it in the Latin America and Caribbean region.

The paper presented is a review of the available epidemiological data on the situation in the Latin America and Caribbean (LAC) region, and looks at HIV prevalence in specific population groups. At the end of 2001, HIV remains an important health issue in the LAC region. Twelve countries in the region have an estimated prevalence of 1% or higher among pregnant women. Most of the LAC countries with generalized epidemics are located in the Caribbean basin. In the past decade there has been a slow but continuous increase in HIV prevalence rates among the general population and vulnerable groups, although information in some countries is limited. In many countries, the highest HIV prevalence among vulnerable groups is found among men who have sex with men. HIV infections related to injecting drug use are concentrated in the countries of the Southern Cone and Brazil. HIV is well anchored in the region, concentrated in vulnerable groups in most countries, but with an increasing presence in some countries in the general population. There is a need to improve data collection and introduce new tools to monitor behavior trends and the impact of interventions.

Access to antiretroviral treatment in Latin American countries and the Caribbean.

OBJECTIVES: To assess the access to antiretroviral therapy in the Latin America and Caribbean region and the main issues involved. METHODS: A review of National AIDS Programmes reports, published studies on HIV access to antiretroviral drugs, and personal communications from National AIDS Programmes in the region. RESULTS: Most countries have, or are in the process of developing, laws and regulations to ensure better access to antiretroviral drugs for people in need. However, there are still many countries that either have not implemented policies or do not have policies. There has been an important decrease in the cost of drugs, but prices are still too high for all countries to afford them. The benefits in decreased mortality and hospitalizations in the countries with high coverage are significant. The number of people receiving antiretroviral therapy has been estimated to be close to 170,000 individuals; however, this figure only represents a fraction of the people in need in the region. Some different strategies will have to be implemented in order to increase coverage. CONCLUSION: Renewed efforts are needed from both governments and international community organizations to strengthen the health services and increase access to antiretroviral drugs.

Analisis de la participacion en encuestas de cinco paises : relevancia para la investigacion en salud publica / Analysis of participation in surveys in five countries : the importance for public health research

Se presenta una comparación de las tasas de participación y de las razones de la falta de respuesta en encuestas realizadas en cinco países de América Latina y el Caribe con el objetivo de medir la prevalencia de comportamientos de riesgo que determinan la transmisión del virus de la inmunodeficiencia humana. Dichas encuestas se basaron en muestras probabilísticas de la población de ambos sexos comprendida entre 15 y 49 años de edad, excepto en México, donde se estudió solo a los hombres. Se estimaron tres componentes de la participación: las proporciones de viviendas entrevistadas, de viviendas entrevistadas con personas elegibles y de personas elegibles que cumplimentaron la entrevista. Además, se calculó un índice global que combinaba los tres componentes. La tasa global de respuesta osciló entre 35,6 por ciento en México y 81,4 por ciento en Chile, y el componente de esta tasa con mayor variabilidad fue la participación de personas elegibles, que varió entre 50 por ciento en México y 95 por ciento en Cuba. Estos valores fueron más bajos de lo esperado, sobre todo en los hombres, y servirán de orientación para futuras encuestas, ya que se deberán considerar tasas de rechazo mayores de las previstas en el protocolo. Los resultados permiten inferir la validez de las estimaciones de la prevalencia de los diversos comportamientos de riesgo observados y establecen una referencia para calcular el tamaño muestral de futuras encuestas y mejorar la metodología de la investigación

Analisis de la participacion en encuestas de cinco paises: relevancia para la investigacion en salud publica / Analysis of participation in surveys in five countries: the importance for public health research

Se presenta una comparación de las tasas de participación y de las razones de la falta de respuesta en encuestas realizadas en cinco países de América Latina y el Caribe con el objetivo de medir la prevalencia de comportamientos de riesgo que determinan la transmisión del virus de la inmunodeficiencia humana. Dichas encuestas se basaron en muestras probabilísticas de la población de ambos sexos comprendida entre 15 y 49 años de edad, excepto en México, donde se estudió solo a los hombres. Se estimaron tres componentes de la participación: las proporciones de viviendas entrevistadas, de viviendas entrevistadas con personas elegibles y de personas elegibles que cumplimentaron la entrevista. Además, se calculó un índice global que combinaba los tres componentes. La tasa global de respuesta osciló entre 35,6 por ciento en México y 81,4 por ciento en Chile, y el componente de esta tasa con mayor variabilidad fue la participación de personas elegibles, que varió entre 50 por ciento en México y 95 por ciento en Cuba. Estos valores fueron más bajos de lo esperado, sobre todo en los hombres, y servirán de orientación para futuras encuestas, ya que se deberán considerar tasas de rechazo mayores de las previstas en el protocolo. Los resultados permiten inferir la validez de las estimaciones de la prevalencia de los diversos comportamientos de riesgo observados y establecen una referencia para calcular el tamaño muestral de futuras encuestas y mejorar la metodología de la investigación