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1.
Medicine (Baltimore) ; 98(39): e17071, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574806

RESUMO

Access to antiretroviral-based HIV prevention has been marked by sex asymmetries, and its effectiveness has been compromised by low clinical follow-up rates. We investigated risk profiles of women who received nonoccupational post-exposure prophylaxis (nPEP), as well as the rates and predictive factors of loss to follow-up after nPEP initiation.Retrospective study evaluating 501 women who received nPEP between 2014 and 2015 at 5 HIV centers (testing centers-VCT, outpatient clinics, and infectious diseases hospital). Risk profiles were drawn based on the characteristics of the women and their sexual partners, and then stratified by sociodemographic indicators and previous use of HIV prevention services. Loss to follow-up (LTFU) was defined as not presenting for follow-up visits or for HIV testing after nPEP initiation. Predictors of LTFU were analyzed by calculating adjusted prevalence ratios (aPRs).Approximately 90% of women had sexual encounters that met the criteria established in the Brazilian guidelines for nPEP. Those who declared to be sex workers (26.5%) or drug users (19.2%) had the highest social vulnerability indicators. In contrast, women who had intercourse with casual partners of unknown HIV risk (42.7%) had higher education and less experience with previous HIV testing (89.3%) or nPEP use (98.6%). Of the women who received nPEP after sexual intercourse with stable partners, 75.8% had HIV-infected partners. LTFU rate was 72.8% and predictors included being Black (aPR = 1.15, 95% confidence interval [CI]: 1.03-1.30), using drugs/alcohol (aPR = 1.15, 95% CI: 1.01-1.32) and having received nPEP at an HIV outpatient clinic (aPR = 1.35, 95% CI: 1.20-1.51) or at an infectious diseases hospital (aPR = 1.37, 95% CI: 1.11-1.69) compared with a VCT. The risk of LTFU declined as age increased (aPR 41-59 years = 0.80, 95% CI: 0.68-0.96).Most women who used nPEP had higher socioeconomic status and were not part of populations most affected by HIV. In contrast, factors that contribute to loss to follow-up were: having increased social vulnerability; increased vulnerability to HIV infection; and seeking nPEP at HIV treatment services as opposed to at a VCT.


Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/prevenção & controle , Profilaxia Pós-Exposição , Sexo sem Proteção , Adolescente , Adulto , Brasil , Coito , Feminino , Seguimentos , Humanos , Adesão à Medicação , Pessoa de Meia-Idade , Estudos Retrospectivos , Assunção de Riscos , Trabalho Sexual , Classe Social , Transtornos Relacionados ao Uso de Substâncias/complicações , Adulto Jovem
2.
Sex Reprod Health Matters ; 27(3): 1650587, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31533555

RESUMO

AIDS-related stigma is a major hurdle to care and it hinders people from accessing HIV prevention methods, such as post-exposure prophylaxis. This study was designed to explore how AIDS-related stigma impacts the experience of using non-occupational post-exposure prophylaxis (nPEP) for HIV after sexual contact. Data were gathered in in-depth interviews with 59 people who voluntarily sought out nPEP in five public healthcare facilities in Brazil between 2015 and 2016. Data were analysed into three thematic categories: fear of being mistaken for a person living with HIV and AIDS (PLWHA); desire to hide particular features of one's sexual life; and experiences of stigmatising behaviour due to nPEP use. Based on the Health Stigma and Discrimination Framework, predominant manifestations of AIDS-related stigma in each category were analysed, as well as their intersections with gender- and sexuality-related stigmas. Results show that experiences of using nPEP are permeated by AIDS-related stigma, intersecting with sexuality- and gender-related stigmas. Stigma experiences are mainly perceived, anticipated and internalised; stigma practices include prejudice and stigmatising behaviours. Taking antiretrovirals (ARVs) led participants to the fear of being discriminated against as a PLWHA and having particular features of their sexual identities disclosed. Thus, hiding nPEP was strategic to protect from stigmatising behaviour. As ARV-based prevention technologies are scaled-up, interventions designed to tackle AIDS- and sexuality-related stigmas must be expanded in Brazil. Required interventions include public campaigns about nPEP, educational programmes in healthcare settings to offer adequate support to nPEP users and investments in stigma research and monitoring.

3.
J Int AIDS Soc ; 22(1): e25233, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30697950

RESUMO

INTRODUCTION: People living with HIV (PLHIV) on antiretroviral therapy (ART) experience high rates of non-communicable diseases (NCDs). These co-morbidities often accumulate and older adults may suffer from multimorbidity. Multimorbidity has been associated with loss of quality of life, polypharmacy, and increased risk of frailty and mortality. Little is known of the trends or predictors NCD multimorbidity in PLHIV in low- and middle-income countries. METHODS: We examined NCD multimorbidity in adult PLHIV initiating ART between 2003 and 2014 using a multi-site, observational cohort in Brazil. NCDs included cardiovascular artery disease, hyperlipidemia (HLD), diabetes, chronic kidney disease, cirrhosis, osteoporosis, osteonecrosis, venous thromboembolism and non-AIDS-defining cancers. Multimorbidity was defined as the incident accumulation of two or more unique NCDs. We used Poisson regression to examine trends and Cox proportional hazard models to examine predictors of multimorbidity. RESULTS: Of the 6206 adults, 332 (5%) developed multimorbidity during the study period. Parallel to the ageing of the cohort, the prevalence of multimorbidity rose from 3% to 11% during the study period. Older age, female sex (adjusted hazard ratio (aHR) = 1.30 (95% confidence interval (CI) 1.03 to 1.65)) and low CD4 nadir (<100 vs. ≥200 cells/mm3 aHR = 1.52 (95% CI: 1.15 to 2.01)) at cohort entry were significantly associated with increased risk of multimorbidity. Among patients with incident multimorbidity, the most common NCDs were HLD and diabetes; however, osteoporosis was also frequent in women (16 vs. 35% of men and women with multimorbidity respectively). CONCLUSIONS: Among adult PLHIV in Brazil, NCD multimorbidity increased from 2003 to 2014. Females and adults with low CD4 nadir were at increased risk in adjusted analyses. Further studies examining prevention, screening and management of NCDs in PLHIV in low- and middle-income countries are needed.

4.
BMC Infect Dis ; 18(1): 617, 2018 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-30514215

RESUMO

BACKGROUND: The HIV-Brazil Cohort Study (HIV-BCS) is a research primarily based on data collection from medical records of people living with HIV/AIDS in Brazil. The aim of this study was to present the validating design and results for the laboratory biomarkers viral load and CD4+ T-cell count from the HIV-Brazil Cohort Study. METHODS: A total of 8007 patients who were started cART from 2003 to 2013 were considered eligible for this study. Total follow-up time was 32,397 years. The median duration of follow-up was 3.51 years (interquartile range - IQR 1.63-6.13 years; maximum 11.51 years). We used secondary data from the Brazilian Laboratory Tests Control System (SISCEL). Incidence of lab testing rates per 100 person years (100 py) were used to compare the number of laboratory tests carried out among cohort sites considering different databases for CD4+ T-cell counts and HIV viral load assessments. Descriptive statistics including 95% confidence interval, Pearson correlation coefficient, Bland-Altman agreement analysis and kappa coefficient agreement were applied for analysis. RESULTS: A total of 80,302 CD4+ T-cell counts and 79,997 HIV viral load assessments were observed in HIV-BCS versus 94,083 CD4+ T-cell counts and 84,810 viral loads from the Brazilian Laboratory Tests Control System. The general CD4+ T-cell HIV-BCS testing rate was 247 per 100 py versus 290 per 100 py and the viral load HIV-BCS testing rate was 246 per 100 py versus 261 per 100 py. The general correlation observed for the lowest quantitative CD4+ T-cell count before cART was 0.970 (p < 0.001) and for the log of the highest viral load before cART was 0.971 (p < 0.001). The general agreement coefficient for categorized CD4+ T-cell count was 0.932 (p < 0.001) and for viral load was 0.996 (p < 0.001). CONCLUSIONS: The current study confirms that biomarkers CD4+ T-cell count and viral load from the HIV-BCS have a high correlation and agreement with data from SISCEL, rendering both databases reliable and useful for epidemiological studies on HIV care in Brazil.

5.
Cad Saude Publica ; 34(7): e00206617, 2018 07 23.
Artigo em Português | MEDLINE | ID: mdl-30043853

RESUMO

Pre-exposure prophylaxis (PrEP) has been considered a promising strategy for controlling the global HIV epidemic. However, it is necessary to translate the knowledge accumulated from clinical trials and demosntration studies to the reality of health services and the groups most vulnerable to infection in order to achieve broad coverage with PrEP. The article proposes a reflection on this challenge, focusing on three dimensions: users of prophylaxis, with an emphasis on the contexts of sexual practices and the potential exposures to HIV; the advantages of prophylaxis as compared to other methods and the challenges for protective and safe use; and health services, considering the organizational principles to ensure greater success in the supply and incorporation of PrEP as part of combination prevention strategies. The following principles were analyzed: uniqueness of care, freedom of choice and non-hierarchization of prevention methods, sexual risk management, scheduling flexibility, and complementary and multidisciplinary care. These principles can foster organization of the health service and care, facilitating linkage and retention in care. Some comments were offered on the relative incompatibility between the existing structure of services and the Brazilian Ministry of Health guidelines for offering PrEP. The conclusion was that the success of PrEP as a public health policy depends on two essential factors: ensuring that health services are culturally diverse settings, free of discrimination, and the intensification of community-based interventions, including social networks, in order to reduce inequalities in access to PrEP and health services as a whole.


Assuntos
Infecções por HIV/prevenção & controle , Programas Nacionais de Saúde , Profilaxia Pré-Exposição/métodos , Populações Vulneráveis , Fármacos Anti-HIV/uso terapêutico , Brasil , Feminino , Humanos , Masculino , Serviços Preventivos de Saúde , Fatores de Risco , Assunção de Riscos , Comportamento Sexual
6.
Cad. Saúde Pública (Online) ; 34(7): e00206617, 2018. tab
Artigo em Português | LILACS-Express | ID: biblio-952414

RESUMO

Resumo: A profilaxia pré-exposição sexual (PrEP) tem sido considerada estratégica e promissora no controle da epidemia de HIV globalmente. Contudo, faz-se necessário transpor o conhecimento acumulado pelos estudos de eficácia e demonstrativos à realidade dos serviços e das populações mais vulneráveis à infecção, de forma a alcançar uma ampla cobertura da PrEP. Propõe-se uma reflexão sobre tal desafio enfocando duas dimensões: os usuários da profilaxia, com ênfase nos contextos de práticas e de potencial exposição ao HIV; as vantagens comparativas da profilaxia em relação aos demais métodos e os desafios para um uso protetivo e seguro; e os serviços, considerando os princípios organizativos que poderão conferir maior êxito na oferta e na incorporação da PrEP, no bojo das estratégias de prevenção combinada. Foram analisados como alguns princípios - singularidade no cuidado, autonomia para escolha e não hierarquização dos métodos, gestão de risco sexual e flexibilidade de agendamento e complementaridade de uma equipe multiprofissional - podem favorecer a organização do serviço e do cuidado, facilitando a vinculação e retenção dos usuários. Teceram-se algumas considerações acerca de uma relativa incompatibilidade entre a estrutura existente nos serviços e as diretrizes do Ministério da Saúde para oferta de PrEP. Concluiu-se que o maior êxito da PrEP como política pública de saúde depende de dois aspectos centrais: assegurar que os serviços sejam ambientes culturalmente diversos e livres de discriminação e a intensificação das intervenções comunitárias, incluindo as redes sociais, de forma a reduzir iniquidades no acesso aos serviços e à PrEP.


Abstract: Pre-exposure prophylaxis (PrEP) has been considered a promising strategy for controlling the global HIV epidemic. However, it is necessary to translate the knowledge accumulated from clinical trials and demosntration studies to the reality of health services and the groups most vulnerable to infection in order to achieve broad coverage with PrEP. The article proposes a reflection on this challenge, focusing on three dimensions: users of prophylaxis, with an emphasis on the contexts of sexual practices and the potential exposures to HIV; the advantages of prophylaxis as compared to other methods and the challenges for protective and safe use; and health services, considering the organizational principles to ensure greater success in the supply and incorporation of PrEP as part of combination prevention strategies. The following principles were analyzed: uniqueness of care, freedom of choice and non-hierarchization of prevention methods, sexual risk management, scheduling flexibility, and complementary and multidisciplinary care. These principles can foster organization of the health service and care, facilitating linkage and retention in care. Some comments were offered on the relative incompatibility between the existing structure of services and the Brazilian Ministry of Health guidelines for offering PrEP. The conclusion was that the success of PrEP as a public health policy depends on two essential factors: ensuring that health services are culturally diverse settings, free of discrimination, and the intensification of community-based interventions, including social networks, in order to reduce inequalities in access to PrEP and health services as a whole.


Resumen: La profilaxis pre-exposición sexual (PrEP) ha sido considerada una estratégica y prometedora acción en el control de la epidemia de VIH globalmente. No obstante, se hace necesario trasladar el conocimiento acumulado por los estudios de eficacia, que muestren la realidad de los servicios y la población más vulnerable a la infección, de manera que se alcance una amplia cobertura de la PrEP. Se propone una reflexión sobre este desafío centrándose en dos dimensiones: usuarios de profilaxis, con énfasis en contextos de prácticas y potencial exposición al VIH; ventajas comparativas de la profilaxis, respecto a los demás métodos, y los desafíos para un uso con protección y seguro; y los servicios, considerando principios organizativos que podrían otorgar un mayor éxito a la oferta e incorporación de la PrEP, en el seno de estrategias de prevención combinada. Se analizaron como algunos principios: singularidad en el cuidado, autonomía para la elección y no jerarquización de los métodos, gestión del riesgo sexual y flexibilidad de citas y complementariedad de un equipo multiprofesional. Todos ellos pueden favorecer la organización del servicio y del cuidado, facilitando la vinculación y preservación de los usuarios. Se elaboraron algunas consideraciones, acerca de una relativa incompatibilidad entre la estructura existente en los servicios y las directrices del Ministerio de Salud de Brasil para la oferta de PrEP. Se concluyó que el mayor éxito de la PrEP, como política pública de salud, depende de dos aspectos centrales: asegurar que los servicios sean ambientes culturalmente diversos y libres de discriminación y la intensificación de las intervenciones comunitarias, incluyendo redes sociales, de forma que se reduzcan las inequidades en el acceso a los servicios y al PrEP.

9.
Rev Bras Epidemiol ; 18 Suppl 1: 43-62, 2015 Sep.
Artigo em Inglês, Português | MEDLINE | ID: mdl-26630298

RESUMO

A spectrum of diverse prevention methods that offer high protection against HIV has posed the following challenge: how can national AIDS policies with high coverage for prevention and treatment make the best use of new methods so as to reverse the current high, and even rising, incidence rates among specific social groups? We conducted a narrative review of the literature to examine the prevention methods and the structural interventions that can have a higher impact on incidence rates in the context of socially and geographically concentrated epidemics. Evidence on the protective effect of the methods against sexual exposure to HIV, as well as their limits and potential, is discussed. The availability and effectiveness of prevention methods have been hindered by structural and psychosocial barriers such as obstacles to adherence, inconsistent use over time, or only when individuals perceive themselves at higher risk. The most affected individuals and social groups have presented limited or absence of use of methods as this is moderated by values, prevention needs, and life circumstances. As a result, a substantial impact on the epidemic cannot be achieved by one method alone. Programs based on the complementarity of methods, the psychosocial aspects affecting their use and the mitigation of structural barriers may have the highest impact on incidence rates, especially if participation and community mobilization are part of their planning and implementation.


Assuntos
Infecções por HIV/prevenção & controle , Comportamento Sexual , Preservativos Femininos , Humanos , Fatores de Risco
11.
Rev. bras. epidemiol ; 18(supl.1): 43-62, Jul.-Sep. 2015.
Artigo em Português | LILACS | ID: lil-770676

RESUMO

ABSTRACT A spectrum of diverse prevention methods that offer high protection against HIV has posed the following challenge: how can national AIDS policies with high coverage for prevention and treatment make the best use of new methods so as to reverse the current high, and even rising, incidence rates among specific social groups? We conducted a narrative review of the literature to examine the prevention methods and the structural interventions that can have a higher impact on incidence rates in the context of socially and geographically concentrated epidemics. Evidence on the protective effect of the methods against sexual exposure to HIV, as well as their limits and potential, is discussed. The availability and effectiveness of prevention methods have been hindered by structural and psychosocial barriers such as obstacles to adherence, inconsistent use over time, or only when individuals perceive themselves at higher risk. The most affected individuals and social groups have presented limited or absence of use of methods as this is moderated by values, prevention needs, and life circumstances. As a result, a substantial impact on the epidemic cannot be achieved by one method alone. Programs based on the complementarity of methods, the psychosocial aspects affecting their use and the mitigation of structural barriers may have the highest impact on incidence rates, especially if participation and community mobilization are part of their planning and implementation.


RESUMO A existência de diferentes métodos preventivos que oferecem elevado grau de proteção contra o HIV tem trazido à luz um desafio: como países que proporcionaram ampla cobertura de prevenção e tratamento poderão utilizar novos métodos preventivos para reverter taxas de incidência que permanecem elevadas, até mesmo crescentes, em grupos sociais específicos? Realizamos uma revisão narrativa da literatura com a finalidade de examinar os métodos preventivos e as intervenções estruturais que, no contexto de epidemias concentradas populacional e geograficamente, podem ter maior impacto nas taxas de incidência. Com isso, analisamos o conhecimento acerca do grau de proteção dos diferentes métodos, seus limites e suas potencialidades. O alcance e a efetividade dos métodos têm sido minimizados, notadamente, por barreiras estruturais e psicossociais, como falhas de adesão, uso inconsistente ao longo do tempo ou apenas em situações em que as pessoas se percebem em maior risco. Indivíduos e grupos sociais mais atingidos pela epidemia têm limitado o uso e o não uso de métodos de acordo com seus valores, necessidades identificadas de prevenção e condições de vida. Isso impede que um método isoladamente venha a promover um forte impacto de redução na epidemia. Políticas baseadas na oferta conjunta e na complementaridade entre os métodos, na atenção aos aspectos psicossociais que interferem no seu uso e na redução das barreiras estruturais de acesso poderão ter maior impacto na incidência, especialmente se forem planejadas e implantadas com participação e mobilização social.


Assuntos
Humanos , Infecções por HIV/prevenção & controle , Comportamento Sexual , Preservativos Femininos , Fatores de Risco
13.
BMJ Open ; 5(8): e009021, 2015 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-26307622

RESUMO

INTRODUCTION: Few results from programmes based on combination prevention methods are available. We propose to analyse the degree of protection provided by postexposure prophylaxis (PEP) for consensual sexual activity at healthcare clinics, its compensatory effects on sexual behaviour; and the effectiveness of combination prevention methods and pre-exposure prophylaxis (PrEP), compared with exclusively using traditional methods. METHODS AND ANALYSIS: A total of 3200 individuals aged 16 years or older presenting for PEP at 5 sexually transmitted disease (STD)/HIV clinics in 3 regions of Brazil will be allocated to one of two groups: the PEP group-individuals who come to the clinic within 72 h after a sexual exposure and start PEP; and the non-PEP group-individuals who come after 72 h but within 30 days of exposure and do not start PEP. Clinical follow-up will be conducted initially for 6 months and comprise educational interventions based on information and counselling for using prevention methods, including PrEP. In the second study phase, individuals who remain HIV negative will be regrouped according to the reported use of prevention methods and observed for 18 months: only traditional methods; combined methods; and PrEP. Effectiveness will be analysed according to the incidence of HIV, syphilis and hepatitis B and C and protected sexual behaviour. A structured questionnaire will be administered to participants at baseline and every 6 months thereafter. Qualitative methods will be employed to provide a comprehensive understanding of PEP-seeking behaviour, preventive choices and exposure to HIV. ETHICS AND DISSEMINATION: This study will be conducted in accordance with the resolution of the School of Medicine Research Ethics Commission of Universidade de São Paulo (protocol no. 251/14). The databases will be available for specific studies, after management committee approval. Findings will be presented to researchers, health managers and civil society members by means of newspapers, electronic media and scientific journals and meetings.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/prevenção & controle , Profilaxia Pós-Exposição , Profilaxia Pré-Exposição , Síndrome de Imunodeficiência Adquirida/prevenção & controle , Adolescente , Brasil , Seguimentos , Humanos , Aceitação pelo Paciente de Cuidados de Saúde , Educação de Pacientes como Assunto , Comportamento Sexual
15.
Cad. saúde pública ; 26(12): 2355-2367, 2010.
Artigo em Português | Sec. Est. Saúde SP, SESSP-ISPROD, Sec. Est. Saúde SP, SESSP-ISACERVO | ID: ses-30504

RESUMO

Identificar diferentes perfis da epidemia de AIDS no Brasil relacionando-os à organização do setor saúde, às situações relacionadas ao risco de infecção e ao grau de implantação da resposta...(AU)


Assuntos
Humanos , Masculino , Feminino , Síndrome de Imunodeficiência Adquirida , Disparidades nos Níveis de Saúde , Desenvolvimento de Programas , Epidemias , Risco
16.
Cad. saúde pública ; 27(supl.1): S114-S128, 2011.
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-ISPROD, Sec. Est. Saúde SP, SESSP-ISACERVO | ID: ses-30511

RESUMO

The aim of this study was to evaluate strategies by the Brazilian Ministry of Health to expand the municipal response to AIDS...(AU)


Assuntos
Humanos , Masculino , Feminino , Síndrome de Imunodeficiência Adquirida , Estatística como Assunto
17.
Rev Bras Epidemiol ; 17(2): 341-54, 2014 Apr-Jun.
Artigo em Inglês, Português | MEDLINE | ID: mdl-24918408

RESUMO

INTRODUCTION: Homeless people are a vulnerable group to sexually transmitted diseases (STD) with high prevalence of syphilis and hepatitis. OBJECTIVES: To estimate the prevalence of syphilis infection and its association with risky behaviors for STDs in a sample of homeless people, and to assess the feasibility of the use of rapid syphilis test (RST) in this population. METHODS: Cross-sectional study, in a convenience sample of homeless people assisted in social support services of São Paulo, between 2006 and 2007. A structured questionnaire was applied and RST was performed. In addition, a blood sample for syphilis detection was also collected. The sensitivity and specificity of the RST was estimated using conventional laboratory diagnosis (VDRL + TPHA) as reference. RESULTS: 1,405 volunteers were included in the study. The prevalence rate of syphilis was 7.0%, and was associated with homosexual practices (OR(adj) 4.9; 95%CI 2.6 - 9.4), prior history of STD (OR(adj) 2.6; 95%CI 1.7 - 4.0) and with self-referred non-white race (OR(adj) 1.9; 95%CI 1.1 - 3.4). The sensitivity and specificity of the RST for syphilis were, respectively, 81.4 and 92.1%. CONCLUSION: The high prevalence of syphilis infection among homeless people shows the need for actions for its control and the utilization of RST that can be considered an efficient strategy due to its sensitivity and specificity. Public Health policymakers must strengthen actions for syphilis control, with screening tests for syphilis and early treatment, decreasing morbidity with the improvement of sexual and reproductive health of the population in general and especially the most vulnerable.


Assuntos
Sífilis/epidemiologia , Adolescente , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Pessoas em Situação de Rua , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Assunção de Riscos , Sorodiagnóstico da Sífilis/métodos , Fatores de Tempo , Saúde da População Urbana , Adulto Jovem
18.
Rev. bras. epidemiol ; 17(2): 341-354, 06/2014. tab
Artigo em Inglês | LILACS | ID: lil-711278

RESUMO

Introduction: Homeless people are a vulnerable group to sexually transmitted diseases (STD) with high prevalence of syphilis and hepatitis. Objectives: To estimate the prevalence of syphilis infection and its association with risky behaviors for STDs in a sample of homeless people, and to assess the feasibility of the use of rapid syphilis test (RST) in this population. Methods: Cross-sectional study, in a convenience sample of homeless people assisted in social support services of São Paulo, between 2006 and 2007. A structured questionnaire was applied and RST was performed. In addition, a blood sample for syphilis detection was also collected. The sensitivity and specificity of the RST was estimated using conventional laboratory diagnosis (VDRL + TPHA) as reference. Results: 1,405 volunteers were included in the study. The prevalence rate of syphilis was 7.0%, and was associated with homosexual practices (ORadj 4.9; 95%CI 2.6 - 9.4), prior history of STD (ORadj 2.6; 95%CI 1.7 - 4.0) and with self-referred non-white race (ORadj 1.9; 95%CI 1.1 - 3.4). The sensitivity and specificity of the RST for syphilis were, respectively, 81.4 and 92.1%. Conclusion: The high prevalence of syphilis infection among homeless people shows the need for actions for its control and the utilization of RST that can be considered an efficient strategy due to its sensitivity and specificity. Public Health policymakers must strengthen actions for syphilis control, with screening tests for syphilis and early treatment, decreasing morbidity with the improvement of sexual and reproductive health of the population in general and especially the most vulnerable. .


Introdução: Pessoas em situação de rua constituem um grupo com alta vulnerabilidade às doenças sexualmente transmissíveis (DST), com altas prevalências de sífilis e hepatites. Objetivos: Descrever comportamentos, atitudes e práticas de risco para as DST, estimar a prevalência da sífilis, os fatores associados e avaliar a exequibilidade de uso do Teste Rápido (TR) para sífilis em pessoas em situação de rua. Metodologia: Estudo transversal em uma amostra não probabilística de pessoas em situação de rua assistidas em serviços de apoio social da cidade de São Paulo, entre 2006 e 2007. Foi aplicado questionário estruturado e realizado TR, além de coleta de sangue para detecção de sífilis. Estimou-se a sensibilidade e especificidade do TR utilizando como referência o diagnóstico laboratorial convencional (VDRL + TPHA). Resultados: Entre 1.405 voluntários, observou-se prevalência de sífilis de 7,0% que esteve associada à prática homossexual (ORaj 4,9; IC95% 2,6 - 9,4), ao relato de história de DST (ORaj 2,6; IC95% 1,7 - 4,0) e à raça/cor autorreferida não branca (ORaj 1,9; IC95% 1,1 - 3,4). A sensibilidade e especificidade do TR para sífilis foram, respectivamente, de 81,4 e 92,1%. Conclusão: A alta prevalência de sífilis, em pessoas em situação de rua evidencia a necessidade de ações para o seu controle e o uso do TR, devido sua sensibilidade e especificidade, pode ser levado em consideração como uma estratégia eficaz. Políticas públicas de saúde devem priorizar ações para o controle da sífilis, com estratégias de rastreamento, diagnóstico e tratamento precoces, diminuindo a morbidade e com melhoria da saúde sexual e reprodutiva da população ...


Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Sífilis/epidemiologia , Brasil/epidemiologia , Estudos Transversais , Pessoas em Situação de Rua , Prevalência , Fatores de Risco , Assunção de Riscos , Sorodiagnóstico da Sífilis/métodos , Fatores de Tempo , Saúde da População Urbana
19.
PLoS One ; 9(5): e95673, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24789106

RESUMO

BACKGROUND: The HIV-Brazil Cohort Study was established to analyze the effectiveness of combination antiretroviral therapy (cART) and the impact of this treatment on morbidity, quality of life (QOL) and mortality. The study design, patients' profiles and characteristics of cART initiation between 2003 and 2010 were described. METHODOLOGY/PRINCIPAL FINDINGS: Since 2003, the HIV-Brazil Cohort has been following HIV-infected adults receiving cART at 26 public health care facilities, using routine clinical care data and self-reported QOL questionnaires. When not otherwise available, data are obtained from national information systems. The main outcomes of interest are diseases related or unrelated to HIV; suppression of viral replication; adverse events; virological, clinical and immunological failures; changes in the cART; and mortality. For the 5,061 patients who started cART between 2003 and 2010, the median follow-up time was 4.1 years (IQR 2.2-5.9 years) with an 83.4% retention rate. Patient profiles were characterized by a predominance of men (male/female ratio 1.7∶1), with a mean age of 36.9 years (SD 9.9 years); 55.2% had been infected with HIV via heterosexual contact. The majority of patients (53.4%) initiated cART with a CD4+ T-cell count ≤200 cells/mm3. The medications most often used in the various treatment regimens were efavirenz (59.7%) and lopinavir/ritonavir (18.2%). The proportion of individuals achieving viral suppression within the first 12 months of cART use was 77.4% (95% CI 76.1-78.6). Nearly half (45.4%) of the patients presented HIV-related clinical manifestations after starting cART, and the AIDS mortality rate was 13.9 per 1,000 person-years. CONCLUSIONS/SIGNIFICANCE: Results from cART use in the daily practice of health services remain relatively unknown in low- and middle-income countries, and studies with the characteristics of the HIV-Brazil Cohort contribute to minimizing these shortcomings, given its scope and patient profile, which is similar to that of the AIDS epidemic in the country.


Assuntos
Infecções por HIV/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Antirretroviral de Alta Atividade , Brasil/epidemiologia , Contagem de Linfócito CD4 , Estudos de Coortes , Comorbidade , Feminino , Seguimentos , Geografia , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade , Mortalidade , Qualidade de Vida , Fatores de Risco , Resultado do Tratamento , Carga Viral , Adulto Jovem
20.
Saúde Soc ; 21(4): 954-975, out-dez 2012.
Artigo em Português | Sec. Est. Saúde SP, SESSP-ISPROD, Sec. Est. Saúde SP, SESSP-ISACERVO | ID: ses-29392

RESUMO

Objetivo: Analisar a cobertura da Política de Incentivo do Ministério da Saúde para Programas de Aids e as caracteristicas das ações de prevenção, assistência, gestão e apoio às organizações da sociedade civil induzidas nos Estados e municipios...(AU)


Assuntos
Humanos , Masculino , Feminino , Síndrome de Imunodeficiência Adquirida , Prevenção de Doenças , Avaliação de Programas e Projetos de Saúde , Epidemiologia Descritiva , Populações Vulneráveis
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