Anorectal gonorrhoea and chlamydia among transgender women in Brazil: prevalence and assessment of performance and cost of anorectal infection detection and management approaches.

OBJECTIVES: We aimed to determine the prevalence of anorectal Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) among transgender women in Brazil, and to assess the performance and costs of various approaches for the diagnosis and management of anorectal NG/CT. METHODS: TransOdara was a multicentric, cross-sectional STI prevalence study among 1317 transgender women conducted in five capital cities representing all Brazilian regions. Participants aged >18 years were recruited using respondent-driven sampling (RDS), completed an interviewer-led questionnaire, offered an optional physical examination and given choice between self-collected or provider-collected samples for NG/CT testing. Performance and cost indicators of predetermined management algorithms based on the WHO recommendations for anorectal symptoms were calculated. RESULTS: Screening uptake was high (94.3%) and the estimated prevalence of anorectal NG, CT and NG and/or CT was 9.1%, 8.9% and 15.2%, respectively. Most detected anorectal NG/CT infections were asymptomatic (NG: 87.6%, CT: 88.9%), with a limited number of participants reporting any anorectal symptoms (9.1%). Of those who permitted anal examination, few had clinical signs of infection (13.6%). Sensitivity of the tested algorithms ranged from 1.4% to 5.1% (highest for treatment based on the reported anorectal discharge or ulcer and receptive anal intercourse (RAI) in the past 6 months) and specificity from 98.0% to 99.3% (highest for treatment based on the reported anorectal discharge with clinical confirmation or report of RAI). The estimated cost-per-true case of anorectal NG/CT infection treated varied from lowest providing treatment for anorectal discharge syndrome based on the reported RAI ($2.70-4.28), with algorithms including clinical examinations decreasing cost-effectiveness. CONCLUSIONS: High prevalence of mostly asymptomatic anorectal NG and CT was observed among Brazilian transgender women. Multi-site NG/CT screening should be offered to transgender women. Where diagnostic testing capacity is limited, syndromic management for those presenting with anorectal symptoms is recommended.

Underreporting of unfavorable outcomes of congenital syphilis on the Notifiable Health Conditions Information System in the state of São Paulo, Brazil, 2007-2018.

OBJECTIVE: to describe the frequency of underreporting of unfavorable outcomes of congenital syphilis in the state of São Paulo, Brazil, 2007-2018. METHODS: this was a descriptive study of cases of abortion, fetal and non-fetal deaths due to congenital syphilis reported on the Notifiable Health Conditions Information System (Sistema de Informação de Agravos de Notificação - SINAN), and those of congenital syphilis registered in any line in the Death Certificate, on the Mortality Information System (Sistema de Informações sobre Mortalidade - SIM), by means of probabilistic and deterministic linkage. RESULTS: of the 27,713 cases of congenital syphilis reported, 1,320 progressed to death (871 fetal deaths, 449 infant deaths) and were matched to the SIM; 355 deaths (259 fetal deaths, 96 infant deaths) were not included on SINAN; there was an increase in unfavorable outcomes,11.4% for infant deaths due to congenital syphilis, 3.0% for fetal deaths and 1.9% for abortions. CONCLUSION: the use of different relationship techniques proved to be adequate to identify the frequency of underreporting of unfavorable outcomes of congenital syphilis in the state of São Paulo.

Subnotificação de desfechos desfavoráveis da sífilis congênita no Sistema de Informação de Agravos de Notificação no estado de São Paulo, 2007-2018 / Subnotificación de resultados desfavorables de sífilis congénita en el Sistema de Información de Enfermedades de Declaración Obligatoria en el estado de São Paulo, Brasil, 2007-2018 / Underreporting of unfavorable outcomes of congenital syphilis on the Notifiable Health Conditions Information System in the state of São Paulo, Brazil, 2007-2018

Objective: to describe the frequency of underreporting of unfavorable outcomes of congenital syphilis in the state of São Paulo, Brazil, 2007-2018. Methods: this was a descriptive study of cases of abortion, fetal and non-fetal deaths due to congenital syphilis reported on the Notifiable Health Conditions Information System (Sistema de Informação de Agravos de Notificação - SINAN), and those of congenital syphilis registered in any line in the Death Certificate, on the Mortality Information System (Sistema de Informações sobre Mortalidade - SIM), by means of probabilistic and deterministic linkage. Results: of the 27,713 cases of congenital syphilis reported, 1,320 progressed to death (871 fetal deaths, 449 infant deaths) and were matched to the SIM; 355 deaths (259 fetal deaths, 96 infant deaths) were not included on SINAN; there was an increase in unfavorable outcomes,11.4% for infant deaths due to congenital syphilis, 3.0% for fetal deaths and 1.9% for abortions. Conclusion: the use of different relationship techniques proved to be adequate to identify the frequency of underreporting of unfavorable outcomes of congenital syphilis in the state of São Paulo.

Objetivo: describir la frecuencia de la subnotificación de resultados desfavorables por sífilis congénita en el estado de São Paulo, de 2007 a 2018. Métodos: estudio descriptivo de los casos de aborto espontáneo, muertes fetales y no fetales por sífilis congénita notificados en la Información Sistema de Enfermedades de Declaración Obligatoria (Sinan), y las registradas con sífilis congénita en el Sistema de Información de Mortalidad (SIM) mediante relaciones probabilísticas y determinísticas. Resultados: de los 27.713 casos de sífilis congénita, fallecieron 1.320 (871 fetales, 449 infantiles) y se emparejaron con SIM; 355 muertes (259 fetales, 96 infantiles) no se incluyeron en Sinan. Hubo un aumento en los resultados desfavorables: 11,4% muertes infantiles por sífilis congénita; 3,0% muertes fetales y 1,9% abortos. Conclusión: el uso de diferentes técnicas de vinculación demostró ser adecuado para identificar la frecuencia de subregistro de resultados desfavorables de sífilis congénita en el estado de São Paulo.

Objetivo: descrever a frequência de subnotificação de desfechos desfavoráveis da sífilis congênita no estado de São Paulo, Brasil, 2007-2018. Métodos: estudo descritivo dos casos de aborto, óbitos fetais e não fetais por sífilis congênita notificados no Sistema de Informação de Agravos de Notificação (Sinan), e daqueles registrados com sífilis congênita, em qualquer linha da Declaração de Óbito, no Sistema de Informações sobre Mortalidade (SIM), mediante relacionamentos probabilístico e determinístico. Resultados: dos 27.713 casos de sífilis congênita notificados, 1.320 evoluíram para óbito (871 fetais, 449 infantis) e foram pareados com o SIM; 355 óbitos (259 fetais, 96 infantis) não constavam no Sinan; ocorreu incremento de desfechos desfavoráveis, de 11,4% para óbitos infantis por sífilis congênita, 3,0% para óbitos fetais e 1,9% para abortos. Conclusão: o emprego de diferentes técnicas de relacionamento mostrou-se adequado para identificar a frequência da subnotificação dos desfechos desfavoráveis da sífilis congênita no estado de São Paulo.

Primary health care performance according to clusters of convergent municipalities in the state of São Paulo.

OBJECTIVE: To describe the performance of Primary Health Care, according to conglomerates of São Paulo cities that present homogeneous indicators. METHODS: This is a descriptive study, based on secondary data extracted from official sources of the Unified Health System, for the year 2018. An analysis matrix was created, with the proposition of performance (access, effectiveness and adequacy) and context indicators (population, health determinants and financing) selected and organized in dimensions and sub-dimensions. Cluster Analysis was used to identify the groups of homogeneous municipalities. RESULTS: 645 municipalities were divided in 6 conglomerates. Clusters 2 and 3 were formed predominantly by small municipalities with greater access to health; cluster 3 has less social vulnerability and greater investment in health. Clusters 1, 4 and 5 were formed by the largest municipalities with less access to health; cluster 4 presents greater social vulnerability, less coverage of private health plans and a greater percentage of health resources; cluster 5 was characterized by greater Gross Domestic Product per capita and greater coverage of private health plans. Cluster 6, formed by the city of São Paulo, was a particular case. Cluster 2 drew attention, as it was shown to have increased coverage, but signaled lower efficacy and adequacy levels. Cluster 3 had the best performance among all clusters. CONCLUSION: These findings can support regional and municipal management, given the complexity of the territory of São Paulo, pointing to scenarios that demand broader public management initiatives.

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

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

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

Primary health care performance according to clusters of convergent municipalities in the state of São Paulo / Desempenho da atenção primária à saúde, segundo clusters de municípios convergentes no estado de São Paulo

ABSTRACT: Objective: To describe the performance of Primary Health Care, according to conglomerates of São Paulo cities that present homogeneous indicators. Methods: This is a descriptive study, based on secondary data extracted from official sources of the Unified Health System, for the year 2018. An analysis matrix was created, with the proposition of performance (access, effectiveness and adequacy) and context indicators (population, health determinants and financing) selected and organized in dimensions and sub-dimensions. Cluster Analysis was used to identify the groups of homogeneous municipalities. Results: 645 municipalities were divided in 6 conglomerates. Clusters 2 and 3 were formed predominantly by small municipalities with greater access to health; cluster 3 has less social vulnerability and greater investment in health. Clusters 1, 4 and 5 were formed by the largest municipalities with less access to health; cluster 4 presents greater social vulnerability, less coverage of private health plans and a greater percentage of health resources; cluster 5 was characterized by greater Gross Domestic Product per capita and greater coverage of private health plans. Cluster 6, formed by the city of São Paulo, was a particular case. Cluster 2 drew attention, as it was shown to have increased coverage, but signaled lower efficacy and adequacy levels. Cluster 3 had the best performance among all clusters. Conclusion: These findings can support regional and municipal management, given the complexity of the territory of São Paulo, pointing to scenarios that demand broader public management initiatives.

RESUMO: Objetivo: Descrever o desempenho da atenção primária à saúde, segundo clusters de municípios paulistas que apresentaram indicadores homogêneos. Métodos: Trata-se de um estudo descritivo, com base em dados secundários extraídos de fontes oficiais do Sistema Único de Saúde, referentes ao ano de 2018. Foi elaborada uma matriz de análise, com a proposição de indicadores de desempenho (acesso, efetividade e adequação) e contexto (população, determinantes de saúde e financiamento), selecionados e organizados em dimensões e subdimensões. Para identificar os grupos de municípios homogêneos, foi utilizada a análise de cluster Resultados: Dos 645 municípios, constituíram-se seis clusters. Os clusters 2 e 3 foram formados, predominantemente, por municípios pequenos e com maior acesso; entre eles, o cluster 3 apresentou menor vulnerabilidade social e maior investimento em saúde. Os clusters 1, 4 e 5, em contrapartida, foram formados por municípios maiores e com menor acesso; entre eles, o cluster 4 apresentou maior vulnerabilidade social, menor cobertura de planos privados de saúde e maior percentual de recursos utilizados em saúde; e o cluster 5, maior produto interno bruto per capita e maior cobertura de planos privados de saúde. O cluster 6, formado pelo município de São Paulo, demonstrou ser um caso particular. Ainda, o cluster 2 chamou atenção. Apresentando maior cobertura, sinalizou menor efetividade e adequação. Entre todos os clusters, o cluster 3 alcançou o melhor desempenho. Conclusão: Os resultados podem subsidiar a gestão regional e municipal, diante da complexidade do território paulista, apontando para cenários que demandam maiores inciativas de gestão pública.

Baseline factors associated with death in a COVID-19 hospital cohort, Sao Paulo, 2020.

This study aimed to verify socio-demographic and baseline clinical factors associated with death in a hospital cohort of patients with COVID-19. A retrospective cohort study was conducted between February and December 2020 in a university hospital in the city of São Paulo, using Hospital Epidemiology Center data. RT-PCR-positive patients were selected to compose the sample (n = 1,034). At the end of the study, 362 (32%) patients died. In this cohort, age equal to or greater than sixty years (HR = 1.49) and liver disease (HR = 1.81) were independent risk factors for death from COVID-19 associated with higher in-hospital mortality.

Usual source of healthcare and use of sexual and reproductive health services by female sex workers in Brazil. / Fonte habitual de cuidado em saúde e o uso de serviços de saúde sexual e reprodutiva entre mulheres trabalhadoras do sexo no Brasil.

The fact of having a usual source of care can improve access to health services and preventive activities. The article aimed to estimate the proportion of factors associated with usual source of care among female sex workers. This was a socio-behavioral survey with 4,328 female sex workers, ≥ 18 years, in 12 Brazilian cities. Female sex workers were recruited by the respondent-driven sampling method (RDS). A descriptive profile was performed of the female sex workers who had usual source of care and the association was analyzed between usual source of care and indicators of access to HIV prevention and reproductive health. As effect measure, the study used adjusted odds ratio (OR) in a logistic regression model. The data were weighted by the RDS-II estimator. 71.5% of the female sex workers reported having a usual source of care, and of these, 54.3% cited primary healthcare (PHC) as their main usual source of care. Among female sex workers 18-24 years of age, there was an association between usual source of care and having a Pap smear test (OR = 2.27; 95%CI: 1.66-3.12), seven or more prenatal visits (OR = 2.56; 95%CI: 1.30-5.03), and the use of a contraceptive method (OR = 1.64; 95%CI: 1.09-2.46). Among female sex workers ≥ 25 years, there was an association between usual source of care and attending talks on sexually transmitted infections (STIs) (OR = 1.45; 95%CI: 1.12-1.89), prior knowledge of post-exposure prophylaxis (OR = 1.32; 95%CI: 1.02-1.71), and history of Pap smear test (OR = 1.92; 95%CI: 1.54-2.40). The study's results showed that female sex workers have PHC as their main usual source of care. usual source of care can also positively impact care and activities in reproductive health and prevention of HIV and STIs in this population group.

Ter uma fonte habitual de cuidado pode melhorar o acesso a serviços de saúde e ações de prevenção. Assim, o objetivo foi estimar a proporção e fatores associados à fonte habitual de cuidado entre mulheres trabalhadoras do sexo. É um inquérito sociocomportamental com 4.328 mulheres trabalhadoras do sexo, ≥ 18 anos, realizado em 12 cidades brasileiras. Essas mulheres foram recrutadas pelo método respondent-driven sampling (RDS). Foi realizada uma análise descritiva do perfil das mulheres trabalhadoras do sexo que possuíam fonte habitual de cuidado e investigada sua associação aos indicadores de acesso à prevenção do HIV e à saúde reprodutiva. Utilizou-se como medidas de efeito o odds ratio (OR) ajustado em um modelo de regressão logística. Os dados foram ponderados pelo estimador RDS-II. Referiram ter fonte habitual de cuidado, 71,5% das mulheres trabalhadoras do sexo e, destas, 54,3% indicaram a atenção primária à saúde (APS) como a principal fonte habitual de cuidado. Entre as mulheres trabalhadoras do sexo com idades de 18-24 anos, observou-se associação entre a fonte habitual de cuidado e a realização de exame de preventivo ginecológico (OR = 2,27; IC95%: 1,66-3,12), realização de sete ou mais consultas de pré-natal (OR = 2,56; IC95%: 1,30-5,03) e utilização de método contraceptivo (OR = 1.64; IC95%: 1.09-2.46). Entre as mulheres trabalhadoras do sexo com idade ≥ 25 anos, verificou-se associação entre a fonte habitual de cuidado e a participação em palestras sobre infecções sexualmente transmissíveis (IST) (OR = 1,45; 1,12-1,89), conhecimento prévio de profilaxia pós-exposição (OR = 1,32; IC95%: 1,02-1,71) e realização de exame de preventivo ginecológico (OR = 1,92; IC95%: 1,54-2,40). Os resultados deste estudo mostraram que as mulheres trabalhadoras do sexo têm a APS como principal fonte habitual de cuidado. Além disso, a fonte habitual de cuidado pode impactar nos cuidados e ações em relação à saúde reprodutiva e à prevenção de HIV e IST nessa população.

Contar con una fuente habitual de cuidado puede mejorar el acceso a servicios de salud, así como las acciones de prevención. El objetivo fue estimar la proporción de fuente habitual de cuidado, y analizar factores asociados entre mujeres trabajadoras del sexo de 12 ciudades brasileñas. Se trata de una encuesta sociocomportamental con 4.328 mujeres trabajadoras del sexo, edad ≥ 18 años en 12 ciudades brasileñas. Las mujeres trabajadoras del sexo se reclutaron mediante el método respondent-driven sampling (RDS). Se realizó un análisis descriptivo del perfil de las mujeres trabajadoras del sexo que poseían fuente habitual de cuidado. Y se analiza la asociación entre fuente habitual de cuidado e indicadores de acceso a la prevención del VIH, así como a la salud reproductiva, a través del odds ratio (OR) ajustado en modelos de regresión logística. Los dados fueron ponderados mediante el estimador RDS-II. Un 71,5% de las mujeres trabajadoras del sexo informaron tener fuente habitual de cuidado, de estas un 54,31% indicaron la atención primaria en salud. Entre las mujeres trabajadoras del sexo con ≥ 25 años se observó una asociación entre fuente habitual de cuidado y participación en ponencias sobre infecciones sexualmente trasmisibles (IST) (OR = 1,45; IC95%: 1,12-1,89), uso de método anticonceptivo (OR = 1.64; IC95%: 1.09-2.46), conocimiento previo de la profilaxia pos-exposición (OR = 1,32; IC95%: 1,02-1,71), haber realizado un examen preventivo ginecológico (OR = 1,92; IC95%: 1,54-2,40) y haber tenido 7 o más consultas prenatales (OR = 2,56; IC95%: 1,30-5,03). Los resultados de este estudio muestran que las trabajadoras sexuales tienen la APS como su principal fuente habitual de atención. Además, la fuente habitual de atención puede impactar la atención y las acciones en relación con la salud reproductiva y la prevención del VIH y las ITS en esta población.

Baseline factors associated with death in a COVID-19 hospital cohort, Sao Paulo, 2020

ABSTRACT This study aimed to verify socio-demographic and baseline clinical factors associated with death in a hospital cohort of patients with COVID-19. A retrospective cohort study was conducted between February and December 2020 in a university hospital in the city of São Paulo, using Hospital Epidemiology Center data. RT-PCR-positive patients were selected to compose the sample (n = 1,034). At the end of the study, 362 (32%) patients died. In this cohort, age equal to or greater than sixty years (HR = 1.49) and liver disease (HR = 1.81) were independent risk factors for death from COVID-19 associated with higher in-hospital mortality.

Fonte habitual de cuidado em saúde e o uso de serviços de saúde sexual e reprodutiva entre mulheres trabalhadoras do sexo no Brasil / Fuente habitual de cuidados de salud y el uso de los servicios de salud sexual y reproductiva entre mujeres trabajadoras sexuales en Brasil / Usual source of healthcare and use of sexual and reproductive health services by female sex workers in Brazil

Ter uma fonte habitual de cuidado pode melhorar o acesso a serviços de saúde e ações de prevenção. Assim, o objetivo foi estimar a proporção e fatores associados à fonte habitual de cuidado entre mulheres trabalhadoras do sexo. É um inquérito sociocomportamental com 4.328 mulheres trabalhadoras do sexo, ≥ 18 anos, realizado em 12 cidades brasileiras. Essas mulheres foram recrutadas pelo método respondent-driven sampling (RDS). Foi realizada uma análise descritiva do perfil das mulheres trabalhadoras do sexo que possuíam fonte habitual de cuidado e investigada sua associação aos indicadores de acesso à prevenção do HIV e à saúde reprodutiva. Utilizou-se como medidas de efeito o odds ratio (OR) ajustado em um modelo de regressão logística. Os dados foram ponderados pelo estimador RDS-II. Referiram ter fonte habitual de cuidado, 71,5% das mulheres trabalhadoras do sexo e, destas, 54,3% indicaram a atenção primária à saúde (APS) como a principal fonte habitual de cuidado. Entre as mulheres trabalhadoras do sexo com idades de 18-24 anos, observou-se associação entre a fonte habitual de cuidado e a realização de exame de preventivo ginecológico (OR = 2,27; IC95%: 1,66-3,12), realização de sete ou mais consultas de pré-natal (OR = 2,56; IC95%: 1,30-5,03) e utilização de método contraceptivo (OR = 1.64; IC95%: 1.09-2.46). Entre as mulheres trabalhadoras do sexo com idade ≥ 25 anos, verificou-se associação entre a fonte habitual de cuidado e a participação em palestras sobre infecções sexualmente transmissíveis (IST) (OR = 1,45; 1,12-1,89), conhecimento prévio de profilaxia pós-exposição (OR = 1,32; IC95%: 1,02-1,71) e realização de exame de preventivo ginecológico (OR = 1,92; IC95%: 1,54-2,40). Os resultados deste estudo mostraram que as mulheres trabalhadoras do sexo têm a APS como principal fonte habitual de cuidado. Além disso, a fonte habitual de cuidado pode impactar nos cuidados e ações em relação à saúde reprodutiva e à prevenção de HIV e IST nessa população.

Contar con una fuente habitual de cuidado puede mejorar el acceso a servicios de salud, así como las acciones de prevención. El objetivo fue estimar la proporción de fuente habitual de cuidado, y analizar factores asociados entre mujeres trabajadoras del sexo de 12 ciudades brasileñas. Se trata de una encuesta sociocomportamental con 4.328 mujeres trabajadoras del sexo, edad ≥ 18 años en 12 ciudades brasileñas. Las mujeres trabajadoras del sexo se reclutaron mediante el método respondent-driven sampling (RDS). Se realizó un análisis descriptivo del perfil de las mujeres trabajadoras del sexo que poseían fuente habitual de cuidado. Y se analiza la asociación entre fuente habitual de cuidado e indicadores de acceso a la prevención del VIH, así como a la salud reproductiva, a través del odds ratio (OR) ajustado en modelos de regresión logística. Los dados fueron ponderados mediante el estimador RDS-II. Un 71,5% de las mujeres trabajadoras del sexo informaron tener fuente habitual de cuidado, de estas un 54,31% indicaron la atención primaria en salud. Entre las mujeres trabajadoras del sexo con ≥ 25 años se observó una asociación entre fuente habitual de cuidado y participación en ponencias sobre infecciones sexualmente trasmisibles (IST) (OR = 1,45; IC95%: 1,12-1,89), uso de método anticonceptivo (OR = 1.64; IC95%: 1.09-2.46), conocimiento previo de la profilaxia pos-exposición (OR = 1,32; IC95%: 1,02-1,71), haber realizado un examen preventivo ginecológico (OR = 1,92; IC95%: 1,54-2,40) y haber tenido 7 o más consultas prenatales (OR = 2,56; IC95%: 1,30-5,03). Los resultados de este estudio muestran que las trabajadoras sexuales tienen la APS como su principal fuente habitual de atención. Además, la fuente habitual de atención puede impactar la atención y las acciones en relación con la salud reproductiva y la prevención del VIH y las ITS en esta población.

The fact of having a usual source of care can improve access to health services and preventive activities. The article aimed to estimate the proportion of factors associated with usual source of care among female sex workers. This was a socio-behavioral survey with 4,328 female sex workers, ≥ 18 years, in 12 Brazilian cities. Female sex workers were recruited by the respondent-driven sampling method (RDS). A descriptive profile was performed of the female sex workers who had usual source of care and the association was analyzed between usual source of care and indicators of access to HIV prevention and reproductive health. As effect measure, the study used adjusted odds ratio (OR) in a logistic regression model. The data were weighted by the RDS-II estimator. 71.5% of the female sex workers reported having a usual source of care, and of these, 54.3% cited primary healthcare (PHC) as their main usual source of care. Among female sex workers 18-24 years of age, there was an association between usual source of care and having a Pap smear test (OR = 2.27; 95%CI: 1.66-3.12), seven or more prenatal visits (OR = 2.56; 95%CI: 1.30-5.03), and the use of a contraceptive method (OR = 1.64; 95%CI: 1.09-2.46). Among female sex workers ≥ 25 years, there was an association between usual source of care and attending talks on sexually transmitted infections (STIs) (OR = 1.45; 95%CI: 1.12-1.89), prior knowledge of post-exposure prophylaxis (OR = 1.32; 95%CI: 1.02-1.71), and history of Pap smear test (OR = 1.92; 95%CI: 1.54-2.40). The study's results showed that female sex workers have PHC as their main usual source of care. usual source of care can also positively impact care and activities in reproductive health and prevention of HIV and STIs in this population group.

Trend of preventable deaths up to the 6th day of life in the state of São Paulo - 2008 to 2017.

OBJECTIVE: To analyze the trend of early neonatal infant mortality in the state of São Paulo according to preventability and region of residence. METHODS: Ecological study with secondary data from 2008 to 2017, obtained from the Sistema de Informação sobre Nascidos Vivos (Sinasc - Live Birth Information System) and the Sistema de Informação sobre Mortalidade (SIM - Mortality Information System). The causes of death were classified according to preventability groups, and the annual percentage changes in the death rates of each preventability group were estimated using the Joinpoint software. RESULTS: The early neonatal component showed a reduction trend with an annual percentage change of -1.18 (95%CI -1.63 to -0.72), less pronounced than the other age components of infant mortality. In the analysis according to preventability, the causes reducible by attention to the woman during pregnancy and those reducible by attention to the fetus and the newborn presented annual percentage change of -1.03 (95%CI: -1.92 to -0.13) and -2.6 (95%CI: -4.07 to -1.11), respectively. In the causes reducible by attention to women during delivery, no reduction trend was observed. Regional discrepancies occurred in the variation of early neonatal infant mortality rates according to type of preventability. CONCLUSIONS: Mortality up to the 6th day of life presented greater difficulty of reduction when compared with the other age components. The absence of a reduction trend in preventable deaths due to the attention to women during delivery points to possible fragility in the attention to delivery.

Syphilis in the state of São Paulo, Brazil, 2011‒2017. / Sífilis no estado de São Paulo, Brasil, 2011‒2017.

OBJECTIVE: To analyze how syphilis detection rates evolved from 2011 to 2017 according to sex, age and place of residence in the state of São Paulo. METHODS: A historical series was organized with data from the Notification Disease Information System. The acquired syphilis detection rates (ASDR) per 100,000 inhabitants and the acquired syphilis detection rates including pregnant women with syphilis (PASDR) per 100,000 inhabitants were described. For a trend analysis of the rates in the studied period, the Poisson Jointpoint (inflection point) model was performed, and the annual percentage change (APC) per segment and the average annual percentage change (AAPC) were estimated, with respective 95% confidence intervals (95%CI). RESULTS: A total of 205,424 cases of acquired syphilis and syphilis in pregnant women in the period were reported. The ASDR per 100,000 inhabitants ranged from 26.0 to 84.6 between 2011 and 2017 and the PASDR per 100,000 inhabitants ranged from 33.7 to 108.9; the trend was increasing in both, and an inflection point was identified dividing the ASDR and PASDR curve into two periods: 2011 to 2013 and 2013 to 2017: the AAPC found for ASDR was 21.0% (95%CI 15.5 ‒ 26.4) and the PASDR was 21.2% (95%CI 16.4 ‒ 26.1), in the age groups up to 24 years old, there was a significant growth in both sexes. A heterogeneity in the evolution of rates by region of the state was observed between 2011 and 2017. CONCLUSIONS: The increasing trend in acquired syphilis detection rates can be attributed to better adherence to notification and disproportionate involvement of young people.

OBJETIVO: Analisar a evolução, de 2011 a 2017, das taxas de detecção de sífilis notificada por sexo, faixa etária e região de residência no estado de São Paulo (ESP). MÉTODOS: Foi organizada série histórica com dados do Sistema de Informação de Agravos de Notificação (SINAN). Foram descritas as taxas de detecção de sífilis adquirida (TDSA) e de sífilis adquirida incluindo as gestantes com sífilis (TDSAG), por 100.000 hab. Para análise de tendência da evolução das taxas no período estudado, foi empregado o modelo Jointpoint (ponto de inflexão), bem como foram estimadas a variação percentual anual (VPA) por segmento e a média da variação percentual anual (MVPA), com os respectivos intervalos de confiança de 95% (IC95%). RESULTADOS: Foram notificados 205.424 casos de sífilis adquirida e sífilis em gestantes no período. Entre 2011 e 2017, a TDSA por 100 mil habitantes variou de 26,0 a 84,6 e a TDSAG por 100 mil habitantes, de 33,7 a 108,9; a tendência foi crescente em ambas as curvas e identificou-se um ponto de inflexão dividindo a curva de TDSA e de TDSAG em dois períodos: de 2011 a 2013 e de 2013 a 2017. A MVPA encontrada da TDSA foi de 21,0% (IC95% 15,7 ‒ 26,4) e da TDSAG, de 21,2% (IC95% 16,4 ‒ -26,1). Nas faixas etárias até 24 anos ocorreu crescimento expressivo em ambos os sexos. Observou-se heterogeneidade na evolução das taxas segundo região do Estado. CONCLUSÕES: A tendência crescente das taxas de detecção de sífilis adquirida pode ser atribuída a melhor adesão à notificação e ao acometimento desproporcional dos jovens.

Work and health issues of the transgender population: factors associated with entering the labor market in the state of São Paulo, Brazil. / Trabalho e saúde na população transexual: fatores associados à inserção no mercado de trabalho no estado de São Paulo, Brasil.

The transgender population encounters several barriers in entering the labor market, whichfurther impacts their health. In this cross-sectional study, the factors associated with their insertion in the formal job market were analyzed. Participants were recruited in seven municipalities of the state of São Paulo between 2014 and 2015. Logistic regression was used to estimate the odds ratios (OR) of the association between formal insertion and selected characteristics. We included 672 individuals, of which 82.3% were working, 13.1% were not employed, and 4.6% were not in the labor market. Among those working, only 16.7% were in the formal labor market. Factors independently associated with formal employment were: being atrans man, having 12 years or more of education, being under follow-up for gender transition procedures in the healthcare services, having private health insurance, and never having been arrested. Our results highlightpart of the obstacles the transgender population has toovercome to enter the labor market, and point to the need for public policies specifically designed for the transgender population aiming to reduce school dropout and expand access to comprehensive health care, thereby reducing theirvulnerability.

Trend of preventable deaths up to the 6th day of life in the state of São Paulo - 2008 to 2017 / Tendência das mortes evitáveis até o 6º dia de vida no estado de São Paulo - 2008 a 2017

ABSTRACT OBJECTIVE: To analyze the trend of early neonatal infant mortality in the state of São Paulo according to preventability and region of residence. METHODS: Ecological study with secondary data from 2008 to 2017, obtained from the Sistema de Informação sobre Nascidos Vivos (Sinasc - Live Birth Information System) and the Sistema de Informação sobre Mortalidade (SIM - Mortality Information System). The causes of death were classified according to preventability groups, and the annual percentage changes in the death rates of each preventability group were estimated using the Joinpoint software. RESULTS: The early neonatal component showed a reduction trend with an annual percentage change of −1.18 (95%CI −1.63 to −0.72), less pronounced than the other age components of infant mortality. In the analysis according to preventability, the causes reducible by attention to the woman during pregnancy and those reducible by attention to the fetus and the newborn presented annual percentage change of −1.03 (95%CI: −1.92 to −0.13) and −2.6 (95%CI: −4.07 to −1.11), respectively. In the causes reducible by attention to women during delivery, no reduction trend was observed. Regional discrepancies occurred in the variation of early neonatal infant mortality rates according to type of preventability. CONCLUSIONS: Mortality up to the 6th day of life presented greater difficulty of reduction when compared with the other age components. The absence of a reduction trend in preventable deaths due to the attention to women during delivery points to possible fragility in the attention to delivery.

RESUMO OBJETIVO: Analisar a tendência da mortalidade infantil neonatal precoce no estado de São Paulo segundo evitabilidade e região de residência. MÉTODO: Estudo ecológico com dados secundários de 2008 a 2017, obtidos a partir do Sistema de Informação sobre Nascidos Vivos e do Sistema de Informação sobre Mortalidade. As causas de óbito foram classificadas segundo grupos de evitabilidade, sendo estimadas as variações percentuais anuais das taxas de óbito de cada grupo de evitabilidade, por meio do software Joinpoint . RESULTADOS: O componente neonatal precoce apresentou tendência de redução com variação percentual anual de −1,18 (IC95% −1,63 - −0,72), menos acentuado que os demais componentes etários da mortalidade infantil. Na análise segundo evitabilidade, as causas reduzíveis por atenção à mulher na gestação e as reduzíveis por cuidado ao feto e ao recém-nascido apresentaram variação percentual anual, respectivamente de −1,03 (IC95%: −1,92 - −0,13) e −2,6 (IC95%: −4,07 - −1,11). Nas causas reduzíveis por atenção à mulher no parto, não se observou tendência de redução. Ocorreram discrepâncias regionais na variação das taxas de mortalidade infantil neonatal precoce segundo evitabilidade. CONCLUSÕES: A mortalidade até o 6º dia de vida apresentou maior dificuldade de redução na comparação com os outros componentes etários. A ausência de tendência de redução nos óbitos evitáveis pelo cuidado à mulher no parto aponta para possível fragilidade na atenção ao parto.

Coinfecção tuberculose/HIV: perfil sociodemográfico e saúde de usuários de um centro especializado / Coinfección tuberculosis/VIH: perfil sociodemográfico y salud de usuarios de un centro especializado / Tuberculosis/HIV co-infection: sociodemographic and health profile of users of a specialized center

Resumo Objetivo Descrever algumas características sociodemográficas e de saúde de pessoas que apresentaram a coinfecção tuberculose e vírus da imunodeficiência humana notificada em um centro especializado do município de São Paulo. Métodos Estudo descritivo de casos de coinfecção tuberculose/HIV notificados em um Centro de Referência e Treinamento de Doenças Sexualmente Transmissíveis e Aids do município de São Paulo, entre 2007 e 2016. A fonte de informações foi o Sistema de Notificação e Acompanhamento dos Casos de Tuberculose - TBWEB. Resultados Foram notificados 745 casos de coinfecção, 76,6% eram do sexo masculino, 67,8% encontravam-se na faixa etária de 30 a 49 anos e 62,6% possuíam oito anos ou mais de escolaridade. Em relação ao desfecho do tratamento da tuberculose, 46,3% dos casos evoluíram para cura e 13,3% foram a óbito. Ao comparar os períodos de notificação de 2007-2011 e 2012-2016, pôde-se observar que ocorreu uma redução percentual de 43,0% no número de casos notificados e 76,6% na frequência de evolução para óbito. Conclusão O conhecimento da situação epidemiológica da coinfecção tuberculose/HIV possibilita fornecer subsídios para repensar as atividades do cuidado em saúde e para o aprimoramento de políticas públicas.

Resumen Objetivo Describir algunas características sociodemográficas y de salud de personas que presentaron la coinfección tuberculosis y virus de la inmunodeficiencia humana notificada en un centro especializado del municipio de São Paulo. Métodos Estudio descriptivo de casos de coinfección tuberculosis/VIH notificados en un Centro de Referencia y Capacitación de Enfermedades de Transmisión Sexual y SIDA del municipio de São Paulo, entre 2007 y 2016. La fuente de información fue el Sistema de Notificación y Seguimiento de Casos de Tuberculosis (TBWEB). Resultados Se notificaron 745 casos de coinfección, el 76,6 % del sexo masculino, el 67,8 % del grupo de edad de 30 a 49 años y el 62,6 % con ocho o más años de escolaridad. Con relación al resultado del tratamiento de la tuberculosis, el 46,3 % de los casos se recuperó y el 13,9 % falleció. Al comparar los períodos de notificación 2007-2011 y 2012-2016, puede observarse que se redujo un 43,0 % la cantidad de casos notificados y un 76,6 % la frecuencia de muerte. Conclusión El conocimiento sobre la situación epidemiológica de la coinfección tuberculosis/VIH permite proporcionar subsidios para repensar las actividades de cuidado de la salud y para la mejora de políticas públicas.

Abstract Objective To describe some sociodemographic features and health of individuals who present tuberculosis, and HIV co-infection of a specialized center located in the municipality of Sao Paulo. Methods This was a descriptive study of tuberculosis/HIV co-infection reported in a referral and training center of sexual transmissible diseases and AIDS in the municipality of Sao Paulo, conducted between 2007 and 2016. The source of information was a notification system and follow-up of tuberculosis cases. Results We notified 745 cases of co-infection, 76.6% were men, 67.8% were aged between 30 to 49 years, and 62.6% had 8 years or more of formal education. In relation to end of treatment of tuberculosis, 46.3% of cases evolved cure and 13.3% were death. The comparison of periods of notification from 2007-2011 and 2012-2016 can be observed by the occurrence of percentage reduction of 43.0% in the number of reported cases, and 76.6% in frequency of evolution of death. Conclusion The knowledge of the epidemiological situation of tuberculosis/HIV co-infection enables the provision of subsides to rethink the activities of health care and to enhance public policies.

Trabalho e saúde na população transexual: fatores associados à inserção no mercado de trabalho no estado de São Paulo, Brasil / Work and health issues of the transgender population: factors associated with entering the labor market in the state of São Paulo, Brazil

Resumo A população transexual enfrenta diversas barreiras para sua inserção no mercado de trabalho, com impacto sobre a sua saúde. Neste estudo foram analisados fatores associados à sua inserção no mercado de trabalho formal. Trata-se de estudo transversal conduzido em sete municípios do estado de São Paulo entre 2014 e 2015. Foi estimado "odds ratio" (OR) da associação entre inserção formal e características selecionadas. Foram incluídos 672 indivíduos, 82,3% com algum vínculo de trabalho, 13,1% não ocupados e 4,6% fora do mercado de trabalho. Entre os ocupados, apenas 16,7% encontravam-se no mercado de trabalho formal. Os fatores associados independentemente ao vínculo formal de trabalho foram: identidade de gênero homem trans, ter 12 anos ou mais de estudo, estar realizando a transição de gênero em serviço de saúde, ter seguro de saúde privado e nunca ter sido preso na vida. Os nossos resultados revelam parte dos obstáculos superados por uma pequena parcela da população de pessoas transexuais para se inserir no mercado de trabalho formal e apontam para a necessidade de políticas públicas desenhadas especificamente para a população transexual, visando a redução do abandono escolar e ampliação do acesso à saúde integral, reduzindo assim sua vulnerabilidade.

Abstract The transgender population encounters several barriers in entering the labor market, whichfurther impacts their health. In this cross-sectional study, the factors associated with their insertion in the formal job market were analyzed. Participants were recruited in seven municipalities of the state of São Paulo between 2014 and 2015. Logistic regression was used to estimate the odds ratios (OR) of the association between formal insertion and selected characteristics. We included 672 individuals, of which 82.3% were working, 13.1% were not employed, and 4.6% were not in the labor market. Among those working, only 16.7% were in the formal labor market. Factors independently associated with formal employment were: being atrans man, having 12 years or more of education, being under follow-up for gender transition procedures in the healthcare services, having private health insurance, and never having been arrested. Our results highlightpart of the obstacles the transgender population has toovercome to enter the labor market, and point to the need for public policies specifically designed for the transgender population aiming to reduce school dropout and expand access to comprehensive health care, thereby reducing theirvulnerability.

Factors associated with HIV co-infection in cases of acquired syphilis reported in a Reference Center for Sexually Transmitted Diseases and AIDS in the municipality of São Paulo, Brazil, 2014. / Fatores associados à coinfecção por HIV em casos de sífilis adquirida notificados em um Centro de Referência de Doenças Sexualmente Transmissíveis e Aids no município de São Paulo, 2014.

OBJECTIVE: to describe sociodemographic and behavioral characteristics and to identify factors associated with human immunodeficiency virus (HIV) co-infection in cases of acquired syphilis reported in a Reference Center for Sexually Transmitted Diseases (STD) and AIDS. METHODS: cross-sectional study with secondary data from a Reference Center for STD and AIDS in the municipality of São Paulo, Brazil, in 2014; the Poisson regression was used to estimate prevalence ratios (PR) and 95% confidence intervals (95%CI). RESULTS: 648 cases of acquired syphilis were reported, and 98% were male; 88% were men who have sex with men (MSM) and 57% had HIV co-infection; male sex (PR=1.95; 95%CI 1.05;3.61) and MSM (PR=1.87; 95%CI 1.38;2.53) were factors independently associated with HIV co-infection. CONCLUSION: there was a high prevalence of HIV co-infection in the service analyzed, disproportionately affecting MSM who were notified with acquired syphilis.

Hospitais filantrópicos beneficiados por programa de incentivo financeiro: uma análise de desempenho / Philanthropic hospitals benefited by financial incentive program: a performance analysis

RESUMO O estado de São Paulo adotou um programa de incentivo financeiro para hospitais filantrópicos. O objetivo deste estudo foi analisar o desempenho dos hospitais participantes desse programa em 2012. Foram analisados os indicadores de desempenho segundo o porte hospitalar e o porte municipal, empregando-se o modelo de desempenho do Proadess (Avaliação de Desempenho do Sistema de Saúde). Encontrou-se diferença no desempenho dos hospitais segundo porte: os hospitais de pequeno porte apresentaram resultados desfavoráveis com relação aos indicadores de acesso, eficiência e efetividade. Esse resultado corrobora a necessidade de reavaliar programas de incentivo financeiro para hospitais de pequeno porte configurados como hospitais gerais.

ABSTRACT The state of São Paulo has adopted a financial incentive program for philanthropic hospitals. The objective of this study was to analyze the performance of the hospitals participating in this program in 2012. Performance indicators were analyzed according to hospital size and municipal size, using the Proadess performance model (Evaluation of Health System Performance). There was a difference in the performance of the hospitals according to the size: small hospitals presented unfavorable results in relation to the indicators of access, efficiency and effectiveness. This result corroborates the need to reassess financial incentive programs for small hospitals configured as general hospitals.