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1.
Front Public Health ; 9: 673959, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34368050

RESUMO

Background: Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) have been increasingly available in Europe. Due to the high burden of HIV in key populations, these could benefit from their use. In 2016, in Portugal, an open, non-interval, prospective cohort study was established in a network of 26 community-based voluntary HIV/STI counseling and testing centers. Data collected included questions on PEP and PrEP knowledge and use. We aimed to estimate the proportion of PEP and PrEP knowledge and its use among key populations, visiting the centers between 2016 and 2019. Method and results: Individuals who self-identify as being among at least one key population for HIV, men who have sex with men (MSM), people who inject drugs (PWID), sex workers (SW), migrants, and male-to-female transgender individuals (MTF), responded to questions on PEP and PrEP knowledge and use while waiting for their test results between 2016 and 2019 (n = 12,893 for PEP; n = 10,973 for PrEP). Reported knowledge was low in all key populations for both tools: 15.7% of respondents reported knowing about PEP and 10.9% about PrEP over the course of 4 years. PEP was used by 1.8% and PrEP by 0.4% of the respondents, MSM being 88.9% of PrEP users, and 52.8% of PEP users. Multivariate logistic regression showed multiple factors associated with knowing the tools, including age, education, country of birth, gender, year of test, having a reactive HIV test in the same visit, reporting an STI or condomless sex in the last 12 months, and identifying with being MSM or SW. Conclusions: Knowledge and use of PEP and PrEP remain low among key populations in Portugal. The need remains to increase knowledge and use among those at risk for HIV infection.


Assuntos
Infecções por HIV , Minorias Sexuais e de Gênero , Doenças Sexualmente Transmissíveis , Feminino , Infecções por HIV/epidemiologia , Homossexualidade Masculina , Humanos , Masculino , Portugal/epidemiologia , Estudos Prospectivos
2.
Occup Environ Med ; 78(9): 648-653, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34193594

RESUMO

OBJECTIVES: To assess the prevalence of SARS-CoV-2-specific IgM and IgG antibodies among workers of the three public higher education institutions of Porto, Portugal, up to July 2020. METHODS: A rapid point-of-care test for specific IgM and IgG antibodies of SARS-CoV-2 was offered to all workers (SD Biosensor STANDARD Q COVID-19 IgM/IgG Duo and STANDARD Q COVID-19 IgM/IgG Combo). Testing was performed and a questionnaire was completed by 4592 workers on a voluntary basis from 21 May to 31 July 2020. We computed the apparent IgM, IgG, and combined IgM or IgG prevalence, along with the true prevalence and 95% credible intervals (95% CrI) using Bayesian inference. RESULTS: We found an apparent prevalence of 3.1% for IgM, 1.0% for IgG and 3.9% for either. The estimated true prevalence was 2.0% (95% CrI 0.1% to 4.3%) for IgM, 0.6% (95% CrI 0.0% to 1.3%) for IgG, and 2.5% (95% CrI 0.1% to 5.3%) for IgM or IgG. A SARS-CoV-2 molecular diagnosis was reported by 21 (0.5%) workers; and of these, 90.5% had a reactive IgG result. Seroprevalence was higher among those reporting contacts with confirmed cases, having been quarantined, having a previous molecular negative test or having had symptoms. CONCLUSIONS: The seroprevalence among workers from the three public higher education institutions of Porto after the first wave of the SARS-CoV-2 infection was similar to national estimates for the same age working population. However, the estimated true seroprevalence was approximately five times higher than the reported SARS-CoV-2 infection based on a molecular test.


Assuntos
COVID-19/epidemiologia , SARS-CoV-2/imunologia , Instituições Acadêmicas/estatística & dados numéricos , Local de Trabalho/estatística & dados numéricos , Adulto , Idoso , Anticorpos Antivirais/sangue , COVID-19/sangue , Estudos Transversais , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Masculino , Pessoa de Meia-Idade , Portugal/epidemiologia , Prevalência , Estudos Soroepidemiológicos
3.
Harm Reduct J ; 18(1): 14, 2021 01 28.
Artigo em Inglês | MEDLINE | ID: mdl-33509200

RESUMO

BACKGROUND: Condom provision is one of the most effective harm reduction interventions to control sexually transmitted infections (STIs) including HIV/AIDS and viral hepatitis in prisons. Yet, very few countries around the world provide prisoners with condoms. The present study aimed to elucidate principles of effective prison-based condom programs from the perspective of European public health and prison health experts. METHODS: As a part of the "Joint Action on HIV and Co-infection Prevention and Harm Reduction (HA-REACT)" twenty-one experts from the field of prison health from eight European countries were invited to discuss the principles of condom provision programs in prisons within two focus groups. The audio records were transcribed verbatim, coded, categorized, and analyzed using thematic analysis method. RESULTS: Six components emerged from the analysis as essential for successful condom programs in prisons: (1) highlighting the necessity of condom provision in prisons, (2) engagement of internal and external beneficiaries in all stages of designing and implementing the program, (3) conducting a pilot phase, (4) condom program in a comprehensive package of harm reduction interventions, (5) vending machine as the best method of condom distribution in prisons and (6) assuring the sustainability and quality of the intervention. CONCLUSION: Results of the present study can help prison health policy makers to design and conduct acceptable, accessible and high-quality prison-based condom provision programs, and consequently to mitigate the burden of STIs in prisons. Having access to high-quality healthcare services including condom provision programs is not only the right of prisoners to health, but also is a move towards achieving the sustainable development goal 3 of "leaving no one behind."

4.
AIDS Behav ; 25(6): 1975-1983, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33387137

RESUMO

We aimed to study the uptake of preexposure prophylaxis (PrEP) before and after its implementation in the Portuguese National Health Service (PNHS) among men who have sex with men (MSM). We studied 6164 participants in the Lisbon Cohort of MSM who participated between March 2014 and July 2019. 198 participants (3.2%) reported having recently used PrEP. Approximately one-third started PrEP after its implementation. PrEP uptake increased from 0.15% in 2014 to 5.36% in 2019. In their first use, 86 participants (70.5%) used it daily. How PrEP was obtained varied according to the timing of the first use: prescribed by a physician in Portugal (11.1% before vs 68.8% after implementation) and online (40.7% before vs 14.1% after). We observed an increase in the uptake and in the prescription by a physician, particularly after its implementation in the PNHS representing a change to a more equitable and safer way of using PrEP.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Profilaxia Pré-Exposição , Minorias Sexuais e de Gênero , Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Homossexualidade Masculina , Humanos , Masculino , Portugal , Medicina Estatal
5.
Euro Surveill ; 25(28)2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32700673

RESUMO

IntroductionGuidelines for pre-exposure prophylaxis (PrEP) provide criteria to identify individuals at higher risk of HIV infection. We compared the ability to predict HIV seroconversion of four guidelines: the World Health Organization (WHO), the United States Public Health Service and Centers for Disease Control and Prevention (US CDC), the European AIDS Clinical Society (EACS) and the Portuguese National Health Service (PNHS).AimWe aimed to measure the association between guideline-specific eligibility and HIV seroconversion.MethodsWe studied 1,254 participants from the Lisbon Cohort of men who have sex with men with at least two evaluations between March 2014 and March 2018, corresponding to 1,724.54 person-years (PY) of follow-up. We calculated incidence rates (IR) according to each guideline eligibility definition and incident rate ratios (IRR) to test the association between eligibility at baseline and HIV seroconversion.ResultsWe found 28 incident cases (IR: 1.62/100 PY; 95% confidence interval (CI) 1.12-2.35). Guidelines' sensitivity varied from 60.7% (EACS) to 85.7% (PNHS) and specificity varied from 31.8% (US CDC) to 51.5% (EACS). IR was highest among those defined as eligible by the PNHS guideline (2.46/100 PY; IRR = 4.61; 95% CI: 1.60-13.27) and lowest for the WHO guideline (1.89/100 PY; IRR = 1.52; 95% CI: 0.69-3.35).ConclusionsBeing identified as eligible for PrEP was associated with a higher risk of infection. The magnitude of risk varied according to the guideline used. However, the number of HIV infections identified among ineligible participants highlights the potential for missing people who need PrEP.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Guias como Assunto , Infecções por HIV/prevenção & controle , Soronegatividade para HIV , Homossexualidade Masculina/estatística & dados numéricos , Profilaxia Pré-Exposição/métodos , Adulto , Estudos de Coortes , Definição da Elegibilidade , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Portugal/epidemiologia , Espanha/epidemiologia
6.
J Public Health Afr ; 9(1): 744, 2018 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-30079164

RESUMO

The aim was to estimate the prevalence of sexual and physical intimate partner violence (IPV) and its associated factors, in a sample of pregnant women using antenatal care (ANC) in Nampula province - Mozambique. This cross-sectional study was carried out in six health units in Nampula, from February 2013 to January 2014. Overall, 869 participants answered the Conflict Tactics Scale 2. The lifetime and past year prevalence of sexual abuse was 49% and 46%, and of physical abuse was 46% and 44%, respectively. Lifetime and past year sexual abuse was significantly associated with living as a couple, alcohol drinking and having a past diagnosis of gonorrhea. Lifetime and past year physical abuse increased significantly with age and was associated with living as a couple, alcohol drinking and history with syphilis. The prevalence of lifetime and previous year violence among women using ANC was high and similar showing that most women were constantly exposed to IPV. ANC provides a window of opportunity for identifying and acting on violence against women.

7.
AIDS Care ; 30(9): 1161-1167, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29701075

RESUMO

The assessment of pregnant women's knowledge about modes of infections transmission is essential to tailor programs to their needs. This study aimed to assess knowledge about human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) among pregnant women in Nampula - Mozambique, a high-risk area for sexually transmitted infections. At their first antenatal visit, women were invited to participate and data were collected by trained nurses at six public health facilities. Knowledge about HIV transmission modes was high but relevant misconceptions remained. However, knowledge regarding HBV and HCV transmission modes was very limited. There was a significant association between knowledge level and socioeconomic position, making education and women's empowerment key factors in a comprehensive strategy to prevent infections.


Assuntos
Infecções por HIV/transmissão , Hepatite B/transmissão , Hepatite C/transmissão , Conhecimento , Complicações Infecciosas na Gravidez/virologia , Adulto , Feminino , Humanos , Moçambique , Gravidez , Cuidado Pré-Natal , Adulto Jovem
8.
J Allergy Clin Immunol Pract ; 6(2): 451-456.e1, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28566137

RESUMO

BACKGROUND: Food allergy and eosinophilic esophagitis are a substantial and evolving public health issue. Clinicians should know the relationship between these diseases and how one may predispose to the other. This can help minimize misdiagnosis. OBJECTIVE: The objective of this study was to assess esophageal eosinophilia and eosinophilic esophagitis frequency in patients with persistent cow's milk allergy and anaphylaxis manifestations. METHODS: Patients with persistent cow's milk allergy with anaphylaxis manifestations were enrolled from 2012 through 2016 at the São Paulo University Hospital, Brazil. All of them were submitted to endoscopy despite the presence or absence of gastrointestinal symptoms. Demographics data, atopic comorbidities, medication use, endoscopic findings, and esophageal eosinophilia frequency were evaluated. RESULTS: Eighty-nine patients were selected. The median age was 8 years. It was observed that 34 of 89 patients (38.2%; 95% confidence interval [CI]: 28.14%-49.16%) presented with esophageal eosinophilia. Five patients (7.1%) presented proton pump inhibitor-responsive esophageal eosinophilia, and 10 patients (14.2%) presented eosinophilic esophagitis. We found that 29.4% were asymptomatic patients, 23.5% had nonspecific symptoms, 23.5% had persistent typical symptoms, and 23.5% had intermittent typical symptoms. There was an association with inflammatory endoscopy findings in 21 patients (61.7%). CONCLUSIONS: This description demands scientific attention because it is the highest frequency of esophageal eosinophilia yet described in a group of patients with cow's milk allergy presenting with anaphylaxis. Eosinophilic esophagitis is a condition that can coexist "silently" with an IgE-mediated food allergy and is most often underestimated and underdiagnosed.


Assuntos
Anafilaxia , Esofagite Eosinofílica/diagnóstico , Hipersensibilidade a Leite , Adolescente , Adulto , Biópsia , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
9.
BMJ Glob Health ; 2(4): e000408, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29225949

RESUMO

Postpartum care (PPC) has remained relatively neglected in many interventions designed to improve maternal and neonatal health in sub-Saharan Africa. The Missed Opportunities in Maternal and Infant Health project developed and implemented a context-specific package of health system strengthening and demand generation in four African countries, aiming to improve access and quality of PPC. A realist evaluation was conducted to enable nuanced understanding of the influence of different contextual factors on both the implementation and impacts of the interventions. Mixed methods were used to collect data and test hypothesised context-mechanism-outcome configurations: 16 case studies (including interviews, observations, monitoring data on key healthcare processes and outcomes), monitoring data for all study health facilities and communities, document analysis and participatory evaluation workshops. After evaluation in individual countries, a cross-country analysis was conducted that led to the development of four middle-range theories. Community health workers (CHWs) were key assets in shifting demand for PPC by 'bridging' communities and facilities. Because they were chosen from the community they served, they gained trust from the community and an intrinsic sense of responsibility. Furthermore, if a critical mass of women seek postpartum healthcare as a result of the CHWs bridging function, a 'buzz' for change is created, leading eventually to the acceptability and perceived value of attending for PPC that outweighs the costs of attending the health facility. On the supply side, rigid vertical hierarchies and defined roles for health facility workers (HFWs) impede integration of maternal and infant health services. Additionally, HFWs fear being judged negatively which overrides the self-efficacy that could potentially be gained from PPC training. Instead the main driver of HFWs' motivation to provide comprehensive PPC is dependent on accountability systems for delivering PPC created by other programmes. The realist evaluation offers insights into some of the contextual factors that can be pivotal in enabling the community-level and service-level interventions to be effective.

10.
BMJ Open ; 6(7): e011314, 2016 07 13.
Artigo em Inglês | MEDLINE | ID: mdl-27412103

RESUMO

INTRODUCTION: Community-based voluntary counselling and testing (CBVCT) services for men who have sex with men (MSM) can reach those most-at-risk and provide an environment for gay men that is likely to be non-stigmatising. Longitudinal data on the behaviour of HIV-negative MSM are scarce in Europe. The aim of this protocol, developed during the Euro HIV Early Diagnosis And Treatment (EDAT) project, is to implement a multicentre community-based cohort of HIV-negative MSM attending 15 CBVCT services in 5 European countries. RESEARCH OBJECTIVES: (1) To describe the patterns of CBVCT use, (2) to estimate HIV incidence, and to identify determinants of (3) HIV seroconversion and (4) HIV and/or sexually transmitted infection (STI) test-seeking behaviour. METHODS AND ANALYSIS: All MSM aged 18 years or over and who had a negative HIV test result are invited to participate in the COmmunity-BAsed Cohort (COBA-Cohort). Study enrolment started in February 2015, and is due to continue for at least 12 months at each study site. Follow-up frequency depends on the testing recommendations in each country (at least 1 test per year). Sociodemographic data are collected at baseline; baseline and follow-up questionnaires both gather data on attitudes and perceptions, discrimination, HIV/STI testing history, sexual behaviour, condom use, and pre- and post-exposure prophylaxis. Descriptive, exploratory and multivariate analyses will be performed to address the main research objectives of this study, using appropriate statistical tests and models. These analyses will be performed on the whole cohort data and stratified by study site or country. ETHICS AND DISSEMINATION: The study was approved by the Public Health authorities of each country where the study is being implemented. Findings from the COBA-Cohort study will be summarised in a report to the European Commission, and in leaflets to be distributed to study participants. Articles and conference abstracts will be submitted to peer-reviewed journals and conferences.


Assuntos
Serviços de Saúde Comunitária/estatística & dados numéricos , Infecções por HIV , Homossexualidade Masculina , Programas de Rastreamento , Aceitação pelo Paciente de Cuidados de Saúde , Minorias Sexuais e de Gênero , Adolescente , Adulto , Aconselhamento , Europa (Continente)/epidemiologia , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Projetos de Pesquisa , Fatores de Risco , Comportamento Sexual , Doenças Sexualmente Transmissíveis , Estigma Social , Inquéritos e Questionários , Adulto Jovem
11.
BMJ Open ; 5(5): e007220, 2015 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-25967995

RESUMO

PURPOSE: Newly diagnosed HIV infections among men who have sex with men (MSM) are rising in many European countries. Surveillance tools must be tailored to the current state of the epidemic, and include decentralised prospective monitoring of HIV incidence and behavioural changes in key populations. In this scenario, an open prospective cohort study was assembled--The Lisbon Cohort of MSM--aiming to dynamically monitor the frequency of disease and its predictors. PARTICIPANTS: The Lisbon Cohort of MSM is an ongoing observational prospective study conducted at a community-based voluntary HIV counselling and testing centre in Lisbon, Portugal (CheckpointLX). Men testing negative for HIV, aged 18 or over and reporting having had sex with men are invited to follow-up visits every 6 months. At each evaluation, a face-to-face interview using a structured questionnaire is conducted, and HIV and syphilis rapid tests are performed by trained peer counsellors. From April 2011 to February 2014, 3106 MSM were eligible to the cohort of whom 923 (29.7%) did not participate. The remaining 2183 (70.3%) MSM were enrolled and 804 had at least one follow-up evaluation, for a total of 893 person-years of observation. FUTURE PLANS: The study findings will be disseminated in peer-reviewed journals and presented at national and international conferences. The follow-up of this cohort of HIV-negative MSM will be a valuable tool for monitoring HIV incidence in a setting where limited prospective information existed. Moreover, it will allow for a deeper analytical approach to the study of population time trends and individual changes in risk factors that currently shape the HIV epidemic among MSM.


Assuntos
Infecções por HIV/epidemiologia , Homossexualidade Masculina/estatística & dados numéricos , Sífilis/epidemiologia , Sexo sem Proteção/prevenção & controle , Aconselhamento Diretivo , Seguimentos , Infecções por HIV/diagnóstico , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Homossexualidade Masculina/psicologia , Humanos , Masculino , Portugal/epidemiologia , Estudos Prospectivos , Sistemas de Alerta , Fatores de Risco , Sexo Seguro , Sífilis/diagnóstico , Sífilis/prevenção & controle , Sexo sem Proteção/psicologia , Sexo sem Proteção/estatística & dados numéricos
12.
Eur J Cancer Prev ; 24(6): 529-34, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25494288

RESUMO

Kaposi sarcoma is expressed in four clinical variants, all associated with human herpes virus type 8 infection, namely, classic, endemic, immunosuppression-related and AIDS-related. The latter currently accounts for most of the burden of Kaposi sarcoma in sub-Saharan Africa, reflecting the frequency of HIV infection and its management. We aimed to estimate the incidence of Kaposi sarcoma in Mozambique and in its provinces. We estimated the number of incident cases of Kaposi sarcoma by adding up the expected number of endemic and AIDS-related cases. The former were estimated from the rates observed in Kyandondo, Uganda (1960-1971). The latter were computed from the number of AIDS-related deaths in each region, assuming that the ratio between the AIDS-related Kaposi sarcoma incident cases and the number of AIDS-related deaths observed in the city of Beira applies to all regions. A total of 3862 Kaposi sarcoma cases were estimated to have occurred in Mozambique in 2007, mostly AIDS-related, in the age group 25-49 years, and in provinces from South/Centre. The age-standardized incidence rates were 36.1/100 000 in men and 11.5/100 000 in women, with a more than three-fold variation across provinces. We estimated a high incidence of Kaposi sarcoma in Mozambique, along with large regional differences. These results can be used to improve disease management and to sustain political decisions on health policies.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/virologia , Infecções por HIV/complicações , HIV/patogenicidade , Sarcoma de Kaposi/epidemiologia , Sarcoma de Kaposi/virologia , Infecções Oportunistas Relacionadas com a AIDS/patologia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Moçambique/epidemiologia , Sarcoma de Kaposi/patologia , Adulto Jovem
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