Improving cardiovascular health in primary care in Saint Lucia through the HEARTS Initiative.

Objective: To improve blood pressure control and hypertension registry coverage at six demonstration sites in St Lucia. Methods: From January 2020 to December 2021, St Lucia's Ministry of Health, with support of the Pan American Health Organization, implemented the HEARTS Technical Package in six primary health care facilities with six-monthly monitoring of blood pressure control and hypertension registry coverage. The modules included healthy-lifestyle counselling, evidence-based treatment protocols, access to essential medicines and technology, risk-based cardiovascular management, team-based care and systems for monitoring. Results: Levels of blood pressure control at 6, 12, 18 and 24-months after the intervention were 37.1%, 28.9%, 33.9% and 36.5% respectively. Hypertension registry coverage increased by 17.8% (1 434 to 1 689) for patients accessing service. Implementing the monitoring for action initiative 12 to 15 months after the start of the intervention resulted in policy and operational changes, improved documentation, and provided accurate and reliable data. Conclusions: The HEARTS initiative unearthed basic infrastructural challenges in blood pressure control. The essential elements for success were (1) buy in at all levels of the health sector; (2) addressing policy and operational changes; (3) accurate documentation and required analysis; (4) standardization of equipment and procedures and (5) regular monitoring and evaluation. Capacity building underpinned all changes.

Improving cardiovascular health in primary care in Saint Lucia through the HEARTS Initiative

[ABSTRACT]. Objective. To improve blood pressure control and hypertension registry coverage at six demonstration sites in St Lucia. Methods. From January 2020 to December 2021, St Lucia’s Ministry of Health, with support of the Pan Ameri- can Health Organization, implemented the HEARTS Technical Package in six primary health care facilities with six-monthly monitoring of blood pressure control and hypertension registry coverage. The modules included healthy-lifestyle counselling, evidence-based treatment protocols, access to essential medicines and technol- ogy, risk-based cardiovascular management, team-based care and systems for monitoring. Results. Levels of blood pressure control at 6, 12, 18 and 24-months after the intervention were 37.1%, 28.9%, 33.9% and 36.5% respectively. Hypertension registry coverage increased by 17.8% (1 434 to 1 689) for patients accessing service. Implementing the monitoring for action initiative 12 to 15 months after the start of the intervention resulted in policy and operational changes, improved documentation, and provided accurate and reliable data. Conclusions. The HEARTS initiative unearthed basic infrastructural challenges in blood pressure control. The essential elements for success were (1) buy in at all levels of the health sector; (2) addressing policy and operational changes; (3) accurate documentation and required analysis; (4) standardization of equipment and procedures and (5) regular monitoring and evaluation. Capacity building underpinned all changes.

[RESUMEN]. Objetivo. Mejorar el control de la presión arterial y aumentar la cobertura del registro de la hipertensión en seis centros de referencia en Santa Lucía. Métodos. Entre enero del 2020 y diciembre del 2021, el Ministerio de Salud de Santa Lucía, con el apoyo de la Organización Panamericana de la Salud, implementó el paquete técnico HEARTS en seis centros de atención primaria de salud acompañado de un seguimiento semestral del control de la presión arterial y la cobertura del registro de la hipertensión. Se incluyeron los siguientes módulos: asesoramiento sobre hábitos y estilos de vida saludables, protocolos clínicos basados en la evidencia, acceso a medicamentos y tecnologías esencia- les, manejo de las enfermedades cardiovasculares basado en la estratificación del riesgo, trabajo basado en equipos multidisciplinarios y sistemas de monitoreo. Resultados. Los niveles de control de la presión arterial a los 6, 12, 18 y 24 meses después de la inter- vención fueron de 37,1%, 28,9%, 33,9% y 36,5% respectivamente. La cobertura del registro de la hipertensión aumentó en 17,8% (de 1 434 a 1 689) para los pacientes que acceden al servicio. Con la implementación de la iniciativa de seguimiento entre los 12 y 15 meses después del inicio de la intervención se lograron cambios operativos y en las políticas, se mejoró la documentación y se obtuvieron datos rigurosos y fiables. Conclusiones. La iniciativa HEARTS reveló los desafíos básicos relativos a la infraestructura que afronta el control de la presión arterial. Los factores principales que contribuyeron al éxito fueron: 1) la aceptación en todos los niveles del sector de la salud; 2) el abordaje de cambios políticos y operativos; 3) una documentación rigurosa y la ejecución de los análisis necesarios; 4) la estandarización de los equipos y procedimientos; y 5) la ejecución de labores de seguimiento y evaluación con regularidad. El fortalecimiento de la capacidad fue la base de todos los cambios.

[RESUMO]. Objetivo. Melhorar o controle da pressão arterial e a cobertura do registro de hipertensão em seis locais-pi- loto em Santa Lúcia. Métodos. De janeiro de 2020 a dezembro de 2021, o Ministério da Saúde de Santa Lúcia, com apoio da Organização Pan-Americana da Saúde, implementou o pacote técnico HEARTS em seis unidades básicas de saúde com monitoramento semestral do controle da pressão arterial e cobertura do registro de hipertensão. Os módulos incluíram aconselhamento sobre estilo de vida saudável, protocolos de tratamento baseados em evidências, acesso a medicamentos e tecnologias essenciais, manejo cardiovascular baseado em risco, cuidados em equipe e sistemas de monitoramento. Resultados. Os níveis de controle da pressão arterial aos 6, 12, 18 e 24 meses após a intervenção foram de 37,1%, 28,9%, 33,9% e 36,5%, respectivamente. A cobertura do registro de hipertensão aumentou 17,8% (de 1 434 para 1 689) para pacientes que acessam o serviço. A implementação da iniciativa de monitoramento para ação, 12 a 15 meses após o início da intervenção, resultou em mudanças de política e operacionais, melhoria da documentação e fornecimento de dados exatos e confiáveis. Conclusões. A iniciativa HEARTS revelou desafios básicos de infraestrutura para o controle da pressão arterial. Os elementos essenciais para o sucesso foram: (1) adesão em todos os níveis do setor de saúde; (2) abordagem das mudanças de política e operacionais; (3) documentação exata e análise necessária; (4) padronização de equipamentos e procedimentos; e (5) monitoramento e avaliação regulares. A capaci- tação foi a base de todas as mudanças.

Improving cardiovascular health in primary care in Saint Lucia through the HEARTS Initiative / Mejorar la salud cardiovascular en la atención primaria en Santa Lucía por medio de la iniciativa HEARTS / Melhorando a saúde cardiovascular na atenção primária em Santa Lúcia por meio da Iniciativa HEARTS

ABSTRACT Objective. To improve blood pressure control and hypertension registry coverage at six demonstration sites in St Lucia. Methods. From January 2020 to December 2021, St Lucia's Ministry of Health, with support of the Pan American Health Organization, implemented the HEARTS Technical Package in six primary health care facilities with six-monthly monitoring of blood pressure control and hypertension registry coverage. The modules included healthy-lifestyle counselling, evidence-based treatment protocols, access to essential medicines and technology, risk-based cardiovascular management, team-based care and systems for monitoring. Results. Levels of blood pressure control at 6, 12, 18 and 24-months after the intervention were 37.1%, 28.9%, 33.9% and 36.5% respectively. Hypertension registry coverage increased by 17.8% (1 434 to 1 689) for patients accessing service. Implementing the monitoring for action initiative 12 to 15 months after the start of the intervention resulted in policy and operational changes, improved documentation, and provided accurate and reliable data. Conclusions. The HEARTS initiative unearthed basic infrastructural challenges in blood pressure control. The essential elements for success were (1) buy in at all levels of the health sector; (2) addressing policy and operational changes; (3) accurate documentation and required analysis; (4) standardization of equipment and procedures and (5) regular monitoring and evaluation. Capacity building underpinned all changes.

RESUMEN Objetivo. Mejorar el control de la presión arterial y aumentar la cobertura del registro de la hipertensión en seis centros de referencia en Santa Lucía. Métodos. Entre enero del 2020 y diciembre del 2021, el Ministerio de Salud de Santa Lucía, con el apoyo de la Organización Panamericana de la Salud, implementó el paquete técnico HEARTS en seis centros de atención primaria de salud acompañado de un seguimiento semestral del control de la presión arterial y la cobertura del registro de la hipertensión. Se incluyeron los siguientes módulos: asesoramiento sobre hábitos y estilos de vida saludables, protocolos clínicos basados en la evidencia, acceso a medicamentos y tecnologías esenciales, manejo de las enfermedades cardiovasculares basado en la estratificación del riesgo, trabajo basado en equipos multidisciplinarios y sistemas de monitoreo. Resultados. Los niveles de control de la presión arterial a los 6, 12, 18 y 24 meses después de la intervención fueron de 37,1%, 28,9%, 33,9% y 36,5% respectivamente. La cobertura del registro de la hipertensión aumentó en 17,8% (de 1 434 a 1 689) para los pacientes que acceden al servicio. Con la implementación de la iniciativa de seguimiento entre los 12 y 15 meses después del inicio de la intervención se lograron cambios operativos y en las políticas, se mejoró la documentación y se obtuvieron datos rigurosos y fiables. Conclusiones. La iniciativa HEARTS reveló los desafíos básicos relativos a la infraestructura que afronta el control de la presión arterial. Los factores principales que contribuyeron al éxito fueron: 1) la aceptación en todos los niveles del sector de la salud; 2) el abordaje de cambios políticos y operativos; 3) una documentación rigurosa y la ejecución de los análisis necesarios; 4) la estandarización de los equipos y procedimientos; y 5) la ejecución de labores de seguimiento y evaluación con regularidad. El fortalecimiento de la capacidad fue la base de todos los cambios.

RESUMO Objetivo. Melhorar o controle da pressão arterial e a cobertura do registro de hipertensão em seis locais-piloto em Santa Lúcia. Métodos. De janeiro de 2020 a dezembro de 2021, o Ministério da Saúde de Santa Lúcia, com apoio da Organização Pan-Americana da Saúde, implementou o pacote técnico HEARTS em seis unidades básicas de saúde com monitoramento semestral do controle da pressão arterial e cobertura do registro de hipertensão. Os módulos incluíram aconselhamento sobre estilo de vida saudável, protocolos de tratamento baseados em evidências, acesso a medicamentos e tecnologias essenciais, manejo cardiovascular baseado em risco, cuidados em equipe e sistemas de monitoramento. Resultados. Os níveis de controle da pressão arterial aos 6, 12, 18 e 24 meses após a intervenção foram de 37,1%, 28,9%, 33,9% e 36,5%, respectivamente. A cobertura do registro de hipertensão aumentou 17,8% (de 1 434 para 1 689) para pacientes que acessam o serviço. A implementação da iniciativa de monitoramento para ação, 12 a 15 meses após o início da intervenção, resultou em mudanças de política e operacionais, melhoria da documentação e fornecimento de dados exatos e confiáveis. Conclusões. A iniciativa HEARTS revelou desafios básicos de infraestrutura para o controle da pressão arterial. Os elementos essenciais para o sucesso foram: (1) adesão em todos os níveis do setor de saúde; (2) abordagem das mudanças de política e operacionais; (3) documentação exata e análise necessária; (4) padronização de equipamentos e procedimentos; e (5) monitoramento e avaliação regulares. A capacitação foi a base de todas as mudanças.

Leptospirosis in the Caribbean: a literature review

[ABSTRACT]. Objective. To describe leptospirosis epidemiology, seroprevalence, and serovars among humans and animals in the Caribbean from 1979 – 2013. Methods. A retrospective study of the literature was performed on the general epidemiology, historical records, and geographical locations of leptospirosis outbreaks and cases in the Caribbean from 1979 – 2013. The primary sources of information were identified with PubMed Central, Google Scholar, CAREC, CaribVET, and The School of Veterinary Medicine at the University of the West Indies. Search terms used were: “human leptospirosis,” “animal leptospirosis,” “serovars,” “livestock,” “seroprevalence,” “Caribbean countries,” “risk factors,” “confirmed cases,” “suspected cases,” “MAT,” and “ELISA.” Confirmed and suspected cases of human and animal leptospirosis were identified through laboratory analysis. Results. Most cases of leptospirosis occurred during the rainy season (June – December) and had a positive correlation with flood conditions. The disease was more prevalent in males than females due to behavioral and occupational exposure. The highest incidence rates of human leptospirosis were recorded in Barbados, Trinidad and Tobago, and Jamaica. In animals, leptospirosis has been found in rodents, livestock, and dogs in many Caribbean countries. Inadequate active surveillance and misdiagnosis of human leptospirosis has contributed to under-reporting of the disease. Conclusion. This review highlights the epidemiology and distribution of leptospirosis in the Caribbean. Prevalence rates and serovars vary greatly among the countries. Leptospirosis poses a significant health risk for humans and animals in the Caribbean and requires a “One Health” multisectoral approach to reduce incidence rates and protect at-risk individuals. Increased laboratory capacity to identify leptospirosis cases is required, along with awareness campaigns for both the public and animal and human health professionals.

[RESUMEN]. Objetivo. Describir las características epidemiológicas de la leptospirosis, su seroprevalencia y serovariedades en seres humanos y animales en el Caribe desde 1979 hasta el 2013. Métodos. Se realizó un estudio retrospectivo de la bibliografía en relación con las características epidemiológicas generales, los registros históricos y las ubicaciones geográficas de los brotes y casos de leptospirosis en el Caribe desde 1979 hasta el 2013. Se determinaron las fuentes primarias de información con PubMed central, Google Scholar, CAREC, CaribVET y la Escuela de Medicina Veterinaria de la Universidad de las Indias Occidentales. Los términos de búsqueda que se usaron en inglés fueron los equivalentes de “leptospirosis humana”, “leptospirosis animal”, “serovariedades”, “ganado”, “seroprevalencia”, “países del Caribe”, “factores de riesgo”, “casos confirmados”, “presuntos casos”, “MAT” y “ELISA”. Se determinaron los casos confirmados y presuntos de leptospirosis humana y animal mediante el análisis de laboratorio. Resultados. La mayor parte de los casos de leptospirosis se dieron durante la temporada de lluvias (junio a diciembre) y tuvieron una correlación positiva con las inundaciones. La enfermedad fue más prevalente en los hombres que en las mujeres debido a la exposición laboral y por los comportamientos. Las tasas de incidencia más altas de leptospirosis humana se registraron en Barbados, Trinidad y Tabago y Jamaica. En el caso de los animales, la leptospirosis se ha detectado en los roedores, el ganado y los perros de muchos países del Caribe. La vigilancia activa insuficiente y el diagnóstico erróneo de la leptospirosis humana han contribuido a que haya una subnotificación de los casos de esta enfermedad. Conclusiones. En esta revisión se ponen de relieve las características epidemiológicas y la distribución de la leptospirosis en el Caribe. Las tasas de prevalencia y las serovariedades varían enormemente de un país a otro. La leptospirosis supone un riesgo considerable para la salud de los seres humanos y los animales en el Caribe y requiere un enfoque multisectorial de “Una Salud” para reducir la incidencia y proteger a las personas en riesgo. Se necesita una mayor capacidad en materia de laboratorios para detectar los casos de leptospirosis, junto con campañas de sensibilización tanto del público como de los profesionales de la sanidad animal y la salud humana.

[RESUMO]. Objetivo. Descrever o perfil epidemiológico, a soroprevalência e as sorovariedades da leptospirose em seres humanos e animais no Caribe de 1979 a 2013. Métodos. Estudo retrospectivo de revisão da literatura científica realizado sobre a epidemiologia geral, registros históricos e localizações geográficas de casos e surtos de leptospirose no Caribe no período de 1979 a 2013. As fontes primárias de informação foram identificadas através das bases de dados PubMed Central, Google Scholar, CAREC, CaribVET e Faculdade de Medicina Veterinária da Universidade das Índias Ocidentais. Os seguintes termos de busca foram usados: “human leptospirosis”, “animal leptospirosis”, “serovars”, “livestock”, “seroprevalence”, “Caribbean countries”, “risk factors”, “confirmed cases”, “suspected cases”, “MAT” e “ELISA” (leptospirose humana, leptospirose animal, sorovariedades, gado, soroprevalência, países do Caribe, fatores de risco, casos confirmados, casos suspeitos, MAT e ELISA). Os casos suspeitos e confirmados de leptospirose humana e animal foram identificados por exames laboratoriais. Resultados. A maioria dos casos de leptospirose ocorreu no período de chuvas (junho a dezembro), apresentando uma correlação positiva com a ocorrência de enchentes. A doença foi mais prevalente no sexo masculino que no feminino devido à exposição comportamental e ocupacional. As maiores taxas de incidência de leptospirose humana foram registradas em Barbados, Trinidad e Tobago e Jamaica. Entre os animais, foi verificada a ocorrência de leptospirose em roedores, gado e cães em vários países do Caribe. Vigilância ativa insatisfatória e diagnóstico incorreto dos casos de leptospirose humana são fatores que contribuem para a subnotificação da doença. Conclusões. Este estudo de revisão destacou a epidemiologia e a distribuição da leptospirose no Caribe. As taxas de prevalência e sorovariedades variam muito entre os países. A leptospirose representa um importante risco à saúde dos seres humanos e animais no Caribe, sendo necessário um enfoque multissetorial baseado no conceito de saúde única (one health) para reduzir a incidência da doença e proteger os indivíduos em risco. Faz-se necessário melhorar a capacidade laboratorial de identificar os casos de leptospirose, juntamente com campanhas de conscienti

Leptospirosis in the Caribbean: a literature review.

OBJECTIVE: To describe leptospirosis epidemiology, seroprevalence, and serovars among humans and animals in the Caribbean from 1979 - 2013. METHODS: A retrospective study of the literature was performed on the general epidemiology, historical records, and geographical locations of leptospirosis outbreaks and cases in the Caribbean from 1979 - 2013. The primary sources of information were identified with PubMed Central, Google Scholar, CAREC, CaribVET, and The School of Veterinary Medicine at the University of the West Indies. Search terms used were: "human leptospirosis," "animal leptospirosis," "serovars," "livestock," "seroprevalence," "Caribbean countries," "risk factors," "confirmed cases," "suspected cases," "MAT," and "ELISA." Confirmed and suspected cases of human and animal leptospirosis were identified through laboratory analysis. RESULTS: Most cases of leptospirosis occurred during the rainy season (June - December) and had a positive correlation with flood conditions. The disease was more prevalent in males than females due to behavioral and occupational exposure. The highest incidence rates of human leptospirosis were recorded in Barbados, Trinidad and Tobago, and Jamaica. In animals, leptospirosis has been found in rodents, livestock, and dogs in many Caribbean countries. Inadequate active surveillance and misdiagnosis of human leptospirosis has contributed to under-reporting of the disease. CONCLUSION: This review highlights the epidemiology and distribution of leptospirosis in the Caribbean. Prevalence rates and serovars vary greatly among the countries. Leptospirosis poses a significant health risk for humans and animals in the Caribbean and requires a "One Health" multisectoral approach to reduce incidence rates and protect at-risk individuals. Increased laboratory capacity to identify leptospirosis cases is required, along with awareness campaigns for both the public and animal and human health professionals.

Leptospirosis in the Caribbean: a literature review / Leptospirosis en el Caribe: una revisión bibliográfica / Leptospirose no Caribe: uma revisão da literatura científica

ABSTRACT Objective To describe leptospirosis epidemiology, seroprevalence, and serovars among humans and animals in the Caribbean from 1979 - 2013. Methods A retrospective study of the literature was performed on the general epidemiology, historical records, and geographical locations of leptospirosis outbreaks and cases in the Caribbean from 1979 - 2013. The primary sources of information were identified with PubMed Central, Google Scholar, CAREC, CaribVET, and The School of Veterinary Medicine at the University of the West Indies. Search terms used were: "human leptospirosis," "animal leptospirosis," "serovars," "livestock," "seroprevalence," "Caribbean countries," "risk factors," "confirmed cases," "suspected cases," "MAT," and "ELISA." Confirmed and suspected cases of human and animal leptospirosis were identified through laboratory analysis. Results Most cases of leptospirosis occurred during the rainy season (June - December) and had a positive correlation with flood conditions. The disease was more prevalent in males than females due to behavioral and occupational exposure. The highest incidence rates of human leptospirosis were recorded in Barbados, Trinidad and Tobago, and Jamaica. In animals, leptospirosis has been found in rodents, livestock, and dogs in many Caribbean countries. Inadequate active surveillance and misdiagnosis of human leptospirosis has contributed to under-reporting of the disease. Conclusion This review highlights the epidemiology and distribution of leptospirosis in the Caribbean. Prevalence rates and serovars vary greatly among the countries. Leptospirosis poses a significant health risk for humans and animals in the Caribbean and requires a "One Health" multisectoral approach to reduce incidence rates and protect at-risk individuals. Increased laboratory capacity to identify leptospirosis cases is required, along with awareness campaigns for both the public and animal and human health professionals.

RESUMEN Objetivo Describir las características epidemiológicas de la leptospirosis, su seroprevalencia y serovariedades en seres humanos y animales en el Caribe desde 1979 hasta el 2013. Métodos Se realizó un estudio retrospectivo de la bibliografía en relación con las características epidemiológicas generales, los registros históricos y las ubicaciones geográficas de los brotes y casos de leptospirosis en el Caribe desde 1979 hasta el 2013. Se determinaron las fuentes primarias de información con PubMed central, Google Scholar, CAREC, CaribVET y la Escuela de Medicina Veterinaria de la Universidad de las Indias Occidentales. Los términos de búsqueda que se usaron en inglés fueron los equivalentes de "leptospirosis humana", "leptospirosis animal", "serovariedades", "ganado", "seroprevalencia", "países del Caribe", "factores de riesgo", "casos confirmados", "presuntos casos", "MAT" y "ELISA". Se determinaron los casos confirmados y presuntos de leptospirosis humana y animal mediante el análisis de laboratorio. Resultados La mayor parte de los casos de leptospirosis se dieron durante la temporada de lluvias (junio a diciembre) y tuvieron una correlación positiva con las inundaciones. La enfermedad fue más prevalente en los hombres que en las mujeres debido a la exposición laboral y por los comportamientos. Las tasas de incidencia más altas de leptospirosis humana se registraron en Barbados, Trinidad y Tabago y Jamaica. En el caso de los animales, la leptospirosis se ha detectado en los roedores, el ganado y los perros de muchos países del Caribe. La vigilancia activa insuficiente y el diagnóstico erróneo de la leptospirosis humana han contribuido a que haya una subnotificación de los casos de esta enfermedad. Conclusiones En esta revisión se ponen de relieve las características epidemiológicas y la distribución de la leptospirosis en el Caribe. Las tasas de prevalencia y las serovariedades varían enormemente de un país a otro. La leptospirosis supone un riesgo considerable para la salud de los seres humanos y los animales en el Caribe y requiere un enfoque multisectorial de "Una Salud" para reducir la incidencia y proteger a las personas en riesgo. Se necesita una mayor capacidad en materia de laboratorios para detectar los casos de leptospirosis, junto con campañas de sensibilización tanto del público como de los profesionales de la sanidad animal y la salud humana.

RESUMO Objetivo Descrever o perfil epidemiológico, a soroprevalência e as sorovariedades da leptospirose em seres humanos e animais no Caribe de 1979 a 2013. Métodos Estudo retrospectivo de revisão da literatura científica realizado sobre a epidemiologia geral, registros históricos e localizações geográficas de casos e surtos de leptospirose no Caribe no período de 1979 a 2013. As fontes primárias de informação foram identificadas através das bases de dados PubMed Central, Google Scholar, CAREC, CaribVET e Faculdade de Medicina Veterinária da Universidade das Índias Ocidentais. Os seguintes termos de busca foram usados: "human leptospirosis", "animal leptospirosis", "serovars", "livestock", "seroprevalence", "Caribbean countries", "risk factors", "confirmed cases", "suspected cases", "MAT" e "ELISA" (leptospirose humana, leptospirose animal, sorovariedades, gado, soroprevalência, países do Caribe, fatores de risco, casos confirmados, casos suspeitos, MAT e ELISA). Os casos suspeitos e confirmados de leptospirose humana e animal foram identificados por exames laboratoriais. Resultados A maioria dos casos de leptospirose ocorreu no período de chuvas (junho a dezembro), apresentando uma correlação positiva com a ocorrência de enchentes. A doença foi mais prevalente no sexo masculino que no feminino devido à exposição comportamental e ocupacional. As maiores taxas de incidência de leptospirose humana foram registradas em Barbados, Trinidad e Tobago e Jamaica. Entre os animais, foi verificada a ocorrência de leptospirose em roedores, gado e cães em vários países do Caribe. Vigilância ativa insatisfatória e diagnóstico incorreto dos casos de leptospirose humana são fatores que contribuem para a subnotificação da doença. Conclusões Este estudo de revisão destacou a epidemiologia e a distribuição da leptospirose no Caribe. As taxas de prevalência e sorovariedades variam muito entre os países. A leptospirose representa um importante risco à saúde dos seres humanos e animais no Caribe, sendo necessário um enfoque multissetorial baseado no conceito de saúde única (one health) para reduzir a incidência da doença e proteger os indivíduos em risco. Faz-se necessário melhorar a capacidade laboratorial de identificar os casos de leptospirose, juntamente com campanhas de conscientização dirigidas ao público em geral e aos profissionais de saúde humana e animal.

Review of HIV treatment progress, gaps, and challenges in the Caribbean, 2005-2015 / Examen del progreso, los retos y las brechas en torno al tratamiento de la infección por el VIH en el Caribe, 2005-2015

ABSTRACT Objective To highlight the current context of the HIV response in the Caribbean and what remains to be addressed to close gaps in HIV treatment and care and end AIDS by 2030. Methods We reviewed and analyzed reports from peer-reviewed and gray literature for the period of 2005–2015 on HIV treatment progress and gaps in the Caribbean, based on searches done in four bibliographic databases and three organizations’ websites and/or libraries. Data were extracted using forms detailing study objectives, thematic areas for HIV care and treatment in the Caribbean, results, and other key information. Before being included in the descriptive review, each publication was assessed for its relevance to the HIV response in the Caribbean. Results We carefully analyzed a total of 62 sources addressing HIV treatment coverage in the Caribbean, including peer-reviewed articles, gray literature reports, and abstracts. The Caribbean has made remarkable progress in reducing new infections and in increasing health care access. Coverage with antiretroviral (ARV) treatment rose between 2005 and 2015, and HIV-related mortality fell by half. Despite the decline in HIV incidence rates, some Caribbean countries have reported challenges with linkages to care, access and adherence to ARV treatment, and viral suppression. Conclusion The risk of HIV infection in the Caribbean among at-risk populations, including men who have sex with men, transgender persons, and sex workers, is disproportionately high. Caribbean countries need to work together to face the HIV threat. National programs need to fast-track HIV treatment services and accelerate other responses to HIV by 2020, and then maintain sustained actions up through 2030.

RESUMEN Objetivo Destacar el contexto actual de la respuesta a la infección por el VIH en el Caribe y las acciones pendientes para subsanar las brechas en el tratamiento y la atención de la infección por el VIH y poner fin al sida para el 2030. Métodos Se examinaron y analizaron informes tanto de la bibliografía revisada por pares como la bibliografía gris en el período comprendido entre el 2005 y el 2015 sobre el progreso y las brechas en el tratamiento de la infección por el VIH en el Caribe, encontrados por medio de búsquedas en cuatro bases de datos bibliográficas y sitios web o bibliotecas de tres organizaciones. Los datos se extrajeron empleando formularios que detallaban los objetivos del estudio, las áreas temáticas de la atención y el tratamiento de la infección por el VIH en el Caribe, los resultados y otra información de importancia. Antes de incluirlos en el examen descriptivo, se evaluó la relevancia de cada publicación en lo concerniente a la respuesta a la infección por el VIH en el Caribe. Resultados Se hizo un análisis pormenorizado de un total de 62 fuentes que abordaban la cobertura del tratamiento de la infección por el VIH en el Caribe, entre las que se incluyeron artículos sometidos a revisión de pares, informes de bibliografía gris y resúmenes. El Caribe ha logrado avances notables en la reducción del número de nuevas infecciones y el aumento del acceso a la atención de salud. La cobertura del tratamiento antirretroviral (ARV) se incrementó entre el 2005 y el 2015 y la mortalidad atribuible a la infección por el VIH se redujo a la mitad. Si bien las tasas de incidencia de la infección por el VIH han disminuido, algunos países del Caribe han informado que los vínculos entre la atención, el acceso y el cumplimiento del tratamiento antirretroviral, así como la supresión de la carga viral, plantean retos. Conclusiones El riesgo de contraer la infección por el VIH en las poblaciones en riesgo, especialmente en el caso de los hombres que tienen relaciones sexuales con otros hombres, las personas transgénero y los profesionales del sexo, es desproporcionadamente alto en el Caribe. Los países del Caribe deben unir esfuerzos para enfrentarse a la amenaza del VIH. Los programas nacionales deben agilizar los servicios de tratamiento de la infección por el VIH y acelerar otras respuestas a la infección por el VIH para el 2020 y, posteriormente, aplicar medidas sostenidas para mantener los logros hasta el 2030.

Review of HIV treatment progress, gaps, and challenges in the Caribbean, 2005–2015 / Examen del progreso, los retos y las brechas en torno al tratamiento de la infección por el VIH en el Caribe, 2005-2015

Objective: To highlight the current context of the HIV response in the Caribbean and what remains to be addressed to close gaps in HIV treatment and care and end AIDS by 2030. Methods: We reviewed and analyzed reports from peer-reviewed and gray literature for the period of 2005–2015 on HIV treatment progress and gaps in the Caribbean, based on searches done in four bibliographic databases and three organizations’ websites and/or libraries. Data were extracted using forms detailing study objectives, thematic areas for HIV care and treatment in the Caribbean, results, and other key information. Before being included in the descriptive review, each publication was assessed for its relevance to the HIV response in the Caribbean. Results: We carefully analyzed a total of 62 sources addressing HIV treatment coverage in the Caribbean, including peer-reviewed articles, gray literature reports, and abstracts. The Caribbean has made remarkable progress in reducing new infections and in increasing health care access. Coverage with antiretroviral (ARV) treatment rose between 2005 and 2015, and HIV-related mortality fell by half. Despite the decline in HIV incidence rates, some Caribbean countries have reported challenges with linkages to care, access and adherence to ARV treatment, and viral suppression. Conclusion: The risk of HIV infection in the Caribbean among at-risk populations, including men who have sex with men, transgender persons, and sex workers, is disproportionately high. Caribbean countries need to work together to face the HIV threat. National programs need to fast-track HIV treatment services and accelerate other responses to HIV by 2020, and then maintain sustained actions up through 2030.

Objetivo. Destacar el contexto actual de la respuesta a la infección por el VIH en el Caribe y las acciones pendientes para subsanar las brechas en el tratamiento y la atención de la infección por el VIH y poner fin al sida para el 2030. Métodos. Se examinaron y analizaron informes tanto de la bibliografía revisada por pares como la bibliografía gris en el período comprendido entre el 2005 y el 2015 sobre el progreso y las brechas en el tratamiento de la infección por el VIH en el Caribe, encontrados por medio de búsquedas en cuatro bases de datos bibliográficas y sitios web o bibliotecas de tres organizaciones. Los datos se extrajeron empleando formularios que detallaban los objetivos del estudio, las áreas temáticas de la atención y el tratamiento de la infección por el VIH en el Caribe, los resultados y otra información de importancia. Antes de incluirlos en el examen descriptivo, se evaluó la relevancia de cada publicación en lo concerniente a la respuesta a la infección por el VIH en el Caribe. Resultados. Se hizo un análisis pormenorizado de un total de 62 fuentes que abordaban la cobertura del tratamiento de la infección por el VIH en el Caribe, entre las que se incluyeron artículos sometidos a revisión de pares, informes de bibliografía gris y resúmenes. El Caribe ha logrado avances notables en la reducción del número de nuevas infecciones y el aumento del acceso a la atención de salud. La cobertura del tratamiento antirretroviral (ARV) se incrementó entre el 2005 y el 2015 y la mortalidad atribuible a la infección por el VIH se redujo a la mitad. Si bien las tasas de incidencia de la infección por el VIH han disminuido, algunos países del Caribe han informado que los vínculos entre la atención, el acceso y el cumplimiento del tratamiento antirretroviral, así como la supresión de la carga viral, plantean retos. Conclusiones. El riesgo de contraer la infección por el VIH en las poblaciones en riesgo, especialmente en el caso de los hombres que tienen relaciones sexuales con otros hombres, las personas transgénero y los profesionales del sexo, es desproporcionadamente alto en el Caribe. Los países del Caribe deben unir esfuerzos para enfrentarse a la amenaza del VIH. Los programas nacionales deben agilizar los servicios de tratamiento de la infección por el VIH y acelerar otras respuestas a la infección por el VIH para el 2020 y, posteriormente, aplicar medidas sostenidas para mantener los logros hasta el 2030.

Review of HIV treatment progress, gaps, and challenges in the Caribbean, 2005-2015.

OBJECTIVE: To highlight the current context of the HIV response in the Caribbean and what remains to be addressed to close gaps in HIV treatment and care and end AIDS by 2030. METHODS: We reviewed and analyzed reports from peer-reviewed and gray literature for the period of 2005-2015 on HIV treatment progress and gaps in the Caribbean, based on searches done in four bibliographic databases and three organizations' websites and/or libraries. Data were extracted using forms detailing study objectives, thematic areas for HIV care and treatment in the Caribbean, results, and other key information. Before being included in the descriptive review, each publication was assessed for its relevance to the HIV response in the Caribbean. RESULTS: We carefully analyzed a total of 62 sources addressing HIV treatment coverage in the Caribbean, including peer-reviewed articles, gray literature reports, and abstracts. The Caribbean has made remarkable progress in reducing new infections and in increasing health care access. Coverage with antiretroviral (ARV) treatment rose between 2005 and 2015, and HIV-related mortality fell by half. Despite the decline in HIV incidence rates, some Caribbean countries have reported challenges with linkages to care, access and adherence to ARV treatment, and viral suppression. CONCLUSION: The risk of HIV infection in the Caribbean among at-risk populations, including men who have sex with men, transgender persons, and sex workers, is disproportionately high. Caribbean countries need to work together to face the HIV threat. National programs need to fast-track HIV treatment services and accelerate other responses to HIV by 2020, and then maintain sustained actions up through 2030.

Zika virus infection, transmission, associated neurological disorders and birth abnormalities:A review of progress in research, priorities and knowledge gaps

On February 1, 2016, the World Health Organization declared that the cluster of microcephaly cases and other neurological disorders constitute public health emergency of international concern. Furthermore, few studies demonstrated that there was an increased evidence of causal relationship of Zika virus (ZIKAV) infection and micro-cephaly, birth abnormalities and neurological disorders such as Guillain–Barr ′e syndrome. ZIKAV transmission occurs mainly by the bite of infected mosquitos (Aedes species), but there are also reports that infections could occur via the placenta, breast milk, saliva, blood transfusion and sex. This article reviews the global efforts, progress in scientific research to understand the pathogenesis of ZIKAV infection & disease, clinical pre-sentations, congenital transmission and autoimmune neurological disorders. The paper further explores the knowledge gaps, future priority research agenda for strategic response including vector control and prevention. We conducted a systematic literature review to synthesise available evidence on ZIKAV infection and its vector and host interaction from electronic databases.

HIV prevalence and related behaviors among sex workers in Jamaica.

BACKGROUND: The aims of the study were to estimate HIV prevalence among sex workers (SWs) in Jamaica and to identify risk factors associated with HIV infection. METHOD: Face to face interviews and HIV testing of 450 SWs across Jamaica were conducted in 2005. Participants were identified by key informants. RESULTS: About 9% of SWs were HIV-positive. HIV-positive SWs tended to be older, less educated, have a history of crack/cocaine use, and were less likely to be aware of the Ministry of Health's prevention programme. More than 90% of SWs reported having easy access to condoms and using condoms at last sex with local and tourist clients. However, 30% of SWs used condoms with nonpaying partners. Knowledge of HIV prevention methods was high but only 38.6% of SWs appropriately rejected myths about HIV transmission by mosquito bites and meal sharing. CONCLUSION: Prevention programmes targeting SWs must emphasize the risk associated with both paying and nonpaying sexual partners while providing knowledge about HIV prevention. Increased access to prevention programmes is likely to reduce HIV prevalence among this population.

HIV morbidity and mortality in Jamaica: analysis of national surveillance data, 1993--2005.

OBJECTIVES: Pre-antiretroviral therapy (ART) HIV-related survival and timing of HIV identification have not been reported from the Caribbean. Using Jamaican national surveillance data, we estimated overall, AIDS-free, and AIDS survival, identified factors influencing HIV-related mortality, and examined factors associated with late HIV/AIDS identification. METHODS: The Jamaican HIV/AIDS tracking system (HATS) national surveillance data included timing of first positive HIV test, stage at identification, date of AIDS diagnosis, and death. We estimated overall and AIDS-free survival by initial stage, using a proportional hazard model to identify factors associated with worse survival, and logistic regression to examine factors related to later case identification. RESULTS: Of 10674 reported HIV cases, 48% were asymptomatic, 14% symptomatic, and 38% first reported with AIDS. Five-year AIDS-free survival was 77% for asymptomatic persons and 63% for symptomatic. Median survival after AIDS diagnosis was 1.02 years. Age, number of opportunistic diseases, and initial stage were strongly associated with mortality. Older age, drug use, and sex with a commercial sex worker were associated with later identification. CONCLUSIONS: In the pre-ART era, over one-third of HIV-infected persons in Jamaica were first identified with advanced disease. This highlights the need for earlier diagnosis as ART programs roll out in the Caribbean.

Trends in HIV risk perception, condom use and sexual history among Jamaican youth, 1996-2004.

As the number of HIV/AIDS cases continues to increase among youth, aged 15-24 years, it becomes critically important to identify the factors that are contributing to this increase. Trends in perceived risk and risk behaviours were examined among youth by sex and age in an attempt to address this concern. National-level cross-sectional data across three time periods (1996, 2000, 2004) gathered from youths, aged 15-24 years in Jamaica for six outcomes were examined (perceived risk, ever had sex, initiation of sex before age 14, multiple sexual partnerships, condom use at last sex with regular and non-regular partners). Trend analyses were employed for each outcome for the total sample and separately by sex and age. A significant positive increase in condom use emerged; males reported higher levels of condom use at last sex with most recent regular partner (55.7% in 1996, 67.9% in 2004, p < 0.01). Condom use by females with regular and non-regular partners did not increase. There was no significant change in the percent of youths reporting multiple partnerships, the percent initiating sex or age at first sex. Youths did perceive themselves to be at greater risk for HIV in 2004 than in 1996 (40.0% vs. 17.6%, p < 0.001). These analyses revealed inadequate protective behaviour adoption by Jamaican youths. Prevention programs targeting youths need to be expanded significantly, be culturally relevant, and also address social vulnerability.

Prevalence and correlates of HIV testing: an analysis of university students in Jamaica.

BACKGROUND: Prevention programs often promote HIV testing as one possible strategy of combating the spread of the disease. OBJECTIVE: To examine levels of HIV testing practices among a large sample of university students and the relationship among HIV testing, sociodemographic variables, and HIV-related behaviors. METHODS: A total of 1252 students were surveyed between June 2001 and February 2002 using a 193-item questionnaire measuring a variety of HIV-related knowledge and attitudinal and behavioral items. RESULTS: Hierarchical logistic regression analyses revealed that youths, married persons, persons who had attended an HIV education forum, and those who knew someone with HIV/AIDS were more likely to report a previous HIV test. However, HIV testing was not associated with condom use or number of sex partners. CONCLUSION: The lack of significant findings between testing and risky sexual behaviors should not negate the importance of HIV testing. Being informed regarding personal HIV serostatus is one of the first steps in self-protection. Effective messages and programs need to be developed and implemented in Jamaica to promote HIV testing and help persons to adequately assess their level of risk with respect to contracting HIV.

Prevalence and Correlates of HIV Testing: An Analysis of University Students in Jamaica.

BACKGROUND: Prevention programs often promote HIV testing as one possible strategy of combating the spread of the disease. OBJECTIVE: To examine levels of HIV testing practices among a large sample of university students and the relationship among HIV testing, sociodemographic variables, and HIV-related behaviors. METHODS: A total of 1252 students were surveyed between June 2001 and February 2002 using a 193-item questionnaire measuring a variety of HIV-related knowledge and attitudinal and behavioral items. RESULTS: Hierarchical logistic regression analyses revealed that youths, married persons, persons who had attended an HIV education forum, and those who knew someone with HIV/AIDS were more likely to report a previous HIV test. However, HIV testing was not associated with condom use or number of sex partners. CONCLUSION: The lack of significant findings between testing and risky sexual behaviors should not negate the importance of HIV testing. Being informed regarding personal HIV serostatus is one of the first steps in self-protection. Effective messages and programs need to be developed and implemented in Jamaica to promote HIV testing and help persons to adequately assess their level of risk with respect to contracting HIV.