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1.
Skinmed ; 18(4): 210-212, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33032683

RESUMO

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is an infectious disease of recent origin with high transmissibility and mortality. The resulting COVID-19 pandemic has impacted the United States the most, in terms of the number of confirmed cases and fatalities. How other aspects of public health will be impacted by this disease has yet to be fully realized. Sexually transmitted diseases (STDs), already a major public health crisis, will likely be significantly affected by this pandemic. We address some of the potential implications for STDs in the setting of widespread COVID-19, discussing the sexual transmission of COVID-19 itself, STD co-infection with COVID-19, and changes in STD prevalence secondary to COVID-19. (SKINmed. 2020;18:210-212).


Assuntos
Infecções por Coronavirus/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Saúde Pública , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/epidemiologia , Infecções por Coronavirus/prevenção & controle , Feminino , Humanos , Masculino , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Prevalência , Medição de Risco , Estados Unidos/epidemiologia
2.
Washington, D.C.; OPS; 2020-10-01. (OPS-W/CDE/HT/20-0036).
em Espanhol | PAHO-IRIS | ID: phr-52783

RESUMO

[Extracto]. La carga de morbilidad y mortalidad asociada con la infección por el VIH ha disminuido a lo largo de los últimos diez años a medida que ha aumentado el acceso al tratamiento antirretroviral. A pesar de este progreso, casi la mitad de las personas con infección por el VIH inician su atención con un cuadro avanzado y muchas siguen muriendo por infecciones oportunistas relacionadas con el VIH. La meningitis criptocócica es una infección oportunista grave que constituye una causa primordial de morbilidad y mortalidad en las personas con infección avanzada por el VIH, y representa cerca del 15% de todas las muertes relacionadas con el sida a nivel mundial. Se estima que, cada año, unos 223.100 casos de meningitis criptocócica causan 181.000 defunciones de personas con infección por el VIH. La criptococosis es poco común en los niños con infección por el VIH, incluso en zonas geográficas con una elevada morbilidad en adultos. [...]


Assuntos
HIV , Tuberculose , Doenças Sexualmente Transmissíveis , Doenças Transmissíveis , Criptococose
3.
Top Antivir Med ; 28(2): 439-454, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32886464

RESUMO

At the 2020 Conference on Retroviruses and Opportunistic Infections, held virtually as a result of the emerging COVID-19 pandemic, trends in the HIV epidemic were highlighted, with decreasing HIV incidence reported across several countries, although key regions remain heavily impacted, including the US South. Adolescent girls and young women, men who have sex with men (MSM), transgender persons, and people who inject drugs continue to experience a high burden of new infections. Sexually transmitted infections during pregnancy can lead to a number of adverse outcomes in infants; novel strategies to detect and treat these infections are needed. Innovative HIV testing strategies, including self-testing and assisted partner services, are expanding the reach of testing; however, linkage to care can be improved. Novel preexposure prophylaxis (PrEP) delivery strategies are increasing uptake of PrEP in different groups, although adherence and persistence remain a challenge. Use of on-demand PrEP is increasing among MSM in the US. Strategies are needed to address barriers to PrEP uptake and persistence among cis- and transgender women. Several novel regimens for postexposure prophylaxis show promise.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por Coronavirus/epidemiologia , Infecções por HIV/epidemiologia , Pneumonia Viral/epidemiologia , Profilaxia Pré-Exposição/organização & administração , Saúde Pública , Doenças Sexualmente Transmissíveis/epidemiologia , Congressos como Assunto , Infecções por Coronavirus/diagnóstico , Feminino , Saúde Global , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Prevenção Primária/organização & administração , Projetos de Pesquisa , Infecções por Retroviridae/diagnóstico , Infecções por Retroviridae/epidemiologia , Fatores de Risco , Minorias Sexuais e de Gênero/estatística & dados numéricos , Doenças Sexualmente Transmissíveis/prevenção & controle , Estados Unidos , Interface Usuário-Computador
4.
Artigo em Alemão | MEDLINE | ID: mdl-32930821

RESUMO

In February 2019, the fourth expert meeting on rapid diagnostic tests (RDTs) for sexually transmitted infections (STI) was held at the Robert Koch Institute (RKI) in Berlin. Novel technical developments and new aspects of RDT applications were discussed by representatives from the German STI Society (DSTIG); RKI; the Paul Ehrlich Institute; national reference centers for HIV, HBV, and HCV; and reference laboratories for Chlamydia, gonococci, and Treponema pallidum.As a result of this meeting, we present a revision of the joint statement on STI diagnostics with RDTs from 2017. The Regulation (EU) 2017/746 of the European Parliament and of the Council on in vitro diagnostic medical devices became effective in May 2017 and includes more stringent regulatory requirements for RDTs, mainly concerning conformity of manufacturing processes and performance characteristics of class D in vitro diagnostics (detection of HIV, HBV, HCV, and T. pallidum). Some RDTs for HIV, HCV, and T. pallidum have been evaluated in clinical studies and/or were WHO prequalified and may be used in low-threshold services. Among them are some HIV RDTs available and approved for self-testing. In addition, some HBV RDTs based on detection of HBs antigen (HBsAg) received WHO prequalification. However, false negative results may occur in samples with low HBsAg levels, as for instance in HIV-coinfected patients receiving antiretroviral therapy. For Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), antigen-based RDTs still do not allow reliable detection of infection. Only PCR-based CT/NG RDTs possess sufficient diagnostic accuracy to be used as point-of-care tests. Rapid PCR tests for NG, however, do not provide any information about antimicrobial resistance.


Assuntos
Chlamydia , Infecções por HIV/diagnóstico , Hepatite C/diagnóstico , Doenças Sexualmente Transmissíveis/diagnóstico , Berlim , Alemanha , Vírus da Hepatite B , Humanos , Neisseria gonorrhoeae , Treponema pallidum
5.
Waste Manag ; 118: 122-130, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32892089

RESUMO

There are millions of waste pickers worldwide that are predominantly located in low- and middle-income countries. They survive on sorting and selling reusable orrecyclable materials discarded by society.While sorting, they are exposed to occupational risks and hazards, including cuts from sharp objects and medical wastes, that could be contaminated by infectious diseases. Because of these exposures, a study was conducted to determine the prevalence of syphilis and other sexually transmitted infections (STI's) among waste pickers. A cross-sectional study using a semi-structured questionnaire and blood samples for serological tests were collected. A total of 1,025 waste pickers were interviewed. Most participants were women (67.54%), without a partner (70.11%), were an average of 40 years old, and had between 3 and 4 children. There were 755 samples collected for syphilis, 791 for HIV, 866 for hepatitis B, and 859 for hepatitis C. Of these samples, 28 (3.70%) waste pickers had reagent serology for syphilis, 6 (0.75%) for HIV; 6 (0.69%) for acute hepatitis B and 1 (0.11%) for hepatitis C. Overall, this study identified the serological status of waste pickers; this information can be used to encourage waste pickers to seek health treatment for STIs and receive education to understand the risks associated with being exposed to medical waste or syringes.


Assuntos
Eliminação de Resíduos , Doenças Sexualmente Transmissíveis , Sífilis , Adulto , Brasil/epidemiologia , Criança , Estudos Transversais , Feminino , Humanos , Reciclagem , Doenças Sexualmente Transmissíveis/epidemiologia , Sífilis/epidemiologia
6.
BMC Infect Dis ; 20(1): 683, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32948142

RESUMO

BACKGROUND: External genital lesions (EGL) are the most common sexually transmitted infections (STIs). We aimed to evaluate the prevalence, determinants and sex differences in EGL among young adults from Brazil. METHODS: Overall, 7694 participants (aged 16 to 25 years) underwent an interview, genital examination and sampling for HPV genotyping. RESULTS: The prevalence of EGL was 4.08% (234) and is more frequent in men (5.72%) than women (2.31%) (p <  0.001). Genital lesions were significantly associated with male sex, infection by high-risk and multiple HPV types, having more than two sexual partners in the last year, smoking status and the presence of other STI. While alcohol use was associated with a higher prevalence of EGL in women, same-sex sexual relationship increase the prevalence in men. In the EGL group, 67.79% (p = 0.032) were positive for HPV infection and the types HPV6 and HPV11 were the most prevalent ones. CONCLUSION: The prevalence of EGL in young adults was consistently high, and most cases were associated with genital HPV infection and STIs. Although men have a higher prevalence, both sexes share most genital lesion determinants. The promotion of sexual education and vaccination especially focus in young men, who are usually outside the targets of primary health care programmes, can prevent EGL in Brazilian young adults.


Assuntos
Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/patologia , Doenças Sexualmente Transmissíveis/epidemiologia , Adolescente , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Genitália/patologia , Genitália/virologia , Papillomavirus Humano 11/patogenicidade , Humanos , Masculino , Prevalência , Fatores de Risco , Fatores Sexuais , Parceiros Sexuais , Doenças Sexualmente Transmissíveis/patologia , Adulto Jovem
7.
PLoS Med ; 17(9): e1003297, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32931504

RESUMO

BACKGROUND: The psychological health of female sex workers (FSWs) has emerged as a major public health concern in many low- and middle-income countries (LMICs). Key risk factors include poverty, low education, violence, alcohol and drug use, human immunodeficiency virus (HIV), and stigma and discrimination. This systematic review and meta-analysis aimed to quantify the prevalence of mental health problems among FSWs in LMICs, and to examine associations with common risk factors. METHOD AND FINDINGS: The review protocol was registered with PROSPERO, number CRD42016049179. We searched 6 electronic databases for peer-reviewed, quantitative studies from inception to 26 April 2020. Study quality was assessed with the Centre for Evidence-Based Management (CEBM) Critical Appraisal Tool. Pooled prevalence estimates were calculated for depression, anxiety, post-traumatic stress disorder (PTSD), and suicidal behaviour. Meta-analyses examined associations between these disorders and violence, alcohol/drug use, condom use, and HIV/sexually transmitted infection (STI). A total of 1,046 studies were identified, and 68 papers reporting on 56 unique studies were eligible for inclusion. These were geographically diverse (26 countries), representing all LMIC regions, and included 24,940 participants. All studies were cross-sectional and used a range of measurement tools; none reported a mental health intervention. Of the 56 studies, 14 scored as strong quality, 34 scored as moderate, and 8 scored as weak. The average age of participants was 28.9 years (age range: 11-64 years), with just under half (46%) having up to primary education or less. The pooled prevalence rates for mental disorders among FSWs in LMICs were as follows: depression 41.8% (95% CI 35.8%-48.0%), anxiety 21.0% (95% CI: 4.8%-58.4%), PTSD 19.7% (95% CI 3.2%-64.6%), psychological distress 40.8% (95% CI 20.7%-64.4%), recent suicide ideation 22.8% (95% CI 13.2%-36.5%), and recent suicide attempt 6.3% (95% CI 3.4%-11.4%). Meta-analyses found significant associations between violence experience and depression, violence experience and recent suicidal behaviour, alcohol use and recent suicidal behaviour, illicit drug use and depression, depression and inconsistent condom use with clients, and depression and HIV infection. Key study limitations include a paucity of longitudinal studies (necessary to assess causality), non-random sampling of participants by many studies, and the use of different measurement tools and cut-off scores to measure mental health problems and other common risk factors. CONCLUSIONS: In this study, we found that mental health problems are highly prevalent among FSWs in LMICs and are strongly associated with common risk factors. Study findings support the concept of overlapping vulnerabilities and highlight the urgent need for interventions designed to improve the mental health and well-being of FSWs.


Assuntos
Profissionais do Sexo/psicologia , Profissionais do Sexo/estatística & dados numéricos , Adolescente , Adulto , Ansiedade , Transtornos de Ansiedade , Criança , Estudos Transversais , Países em Desenvolvimento , Feminino , Infecções por HIV/epidemiologia , Humanos , Saúde Mental , Pessoa de Meia-Idade , Pobreza , Prevalência , Fatores de Risco , Sexo Seguro , Comportamento Sexual , Doenças Sexualmente Transmissíveis/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Ideação Suicida , Tentativa de Suicídio , Violência
8.
Adv Exp Med Biol ; 1255: 203-220, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32949402

RESUMO

Human genital infections are one of the most concerning issues worldwide and can be categorized into sexually transmitted, urinary tract and vaginal infections. These infections, if left untreated, can disseminate to the other parts of the body and cause more complicated illnesses such as pelvic inflammatory disease, urethritis, and anogenital cancers. The effective treatment against these infections is further complicated by the emergence of antimicrobial resistance in the genital infection causing pathogens. Furthermore, the development and applications of single-cell sequencing technologies have open new possibilities to study the drug resistant clones, cell to cell variations, the discovery of acquired drug resistance mutations, transcriptional diversity of a pathogen across different infection stages, to identify rare cell types and investigate different cellular states of genital infection causing pathogens, and to develop novel therapeutical strategies. In this chapter, I will provide a complete review of the applications of single-cell sequencing in human genital infections before discussing their limitations and challenges.


Assuntos
Análise de Sequência , Doenças Sexualmente Transmissíveis/genética , Análise de Célula Única , Infecções Urinárias/genética , Vagina/microbiologia , Feminino , Humanos , Masculino
9.
BMC Infect Dis ; 20(1): 577, 2020 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-32758172

RESUMO

BACKGROUND: Despite the significant decline in the prevalence of HIV in Tanzania, the prevalence rates in Mbeya, Iringa, and Njombe regions are higher than the national average and have remained stable for years. The current stable HIV prevalence may be driven by factors such as a high incidence of sexually transmitted infections (STIs) and high-risk behaviours. In sub-Saharan Africa, it has previously been observed that up to 50% of HIV cases were attributed to herpes simplex type 2 (HSV-2) among low-risk populations. Because the proportion of sexually transmitted HSV-1 is rising, it is essential to study the interaction between HSV-1 and HIV infections. METHODS: We conducted a study in Mbeya region using the archived blood sera of participants from the recently completed EU-funded EMINI project. A specially designed questionnaire was used to obtain the social and demographic characteristics of the study participants in the database. We tested archived participants' sera for herpes simplex virus type 1 using Virotech HSV-1 (gG1) IgG ELISA (Enzygnost, Behring, Germany). Univariate and multivariate Poisson regression models were used to identify factors associated with HSV-1. RESULTS: A total of 640 adults were randomly recruited after stratification by HIV status (318 were HIV positive), age, and sex. The overall seroprevalence of HSV-1 in the study population was 92.1%. The extrapolated seroprevalence estimate of herpes simplex virus type 1 in the general population was 95.0% (96.0% in males versus 94.0% in females). Males and females were equally affected by HSV-1. HSV-1 was less prevalent in HIV-positive individuals than in HIV-negative individuals. CONCLUSION: People living with HIV were less likely to be HSV-1 seropositive. Further prospective studies are necessary to conclude a causal association.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , HIV-1 , Herpes Simples/epidemiologia , Herpesvirus Humano 1/imunologia , Doenças Sexualmente Transmissíveis/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/sangue , Infecções Oportunistas Relacionadas com a AIDS/virologia , Adolescente , Adulto , Anticorpos Antivirais/sangue , Estudos de Coortes , Estudos Transversais , Feminino , Herpes Simples/sangue , Herpes Simples/virologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Estudos Soroepidemiológicos , Comportamento Sexual , Doenças Sexualmente Transmissíveis/sangue , Doenças Sexualmente Transmissíveis/virologia , Tanzânia/epidemiologia , Adulto Jovem
12.
JAMA ; 324(7): 682-699, 2020 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-32809007

RESUMO

Importance: Increasing rates of preventable sexually transmitted infections (STIs) in the US pose substantial burdens to health and well-being. Objective: To update evidence for the US Preventive Services Task Force (USPSTF) on effectiveness of behavioral counseling interventions for preventing STIs. Data Sources: Studies from the previous USPSTF review (2014); literature published January 2013 through May 31, 2019, in MEDLINE, PubMed (for publisher-supplied records only), PsycINFO, and Cochrane Central Register of Controlled Trials. Ongoing surveillance through May 22, 2020. Study Selection: Good- and fair-quality randomized and nonrandomized controlled intervention studies of behavioral counseling interventions for adolescents and adults conducted in primary care settings were included. Studies with active comparators only or limited to individuals requiring specialist care for STI risk-related comorbidities were excluded. Data Extraction and Synthesis: Dual risk of bias assessment, with inconsistent ratings adjudicated by a third team member. Study data were abstracted into prespecified forms. Pooled odds ratios (ORs) were estimated using the DerSimonian and Laird method or the restricted maximum likelihood method with Knapp-Hartung adjustment. Main Outcomes and Measures: Differences in STI diagnoses, self-reported condom use, and self-reported unprotected sex at 3 months or more after baseline. Results: The review included 37 randomized trials and 2 nonrandomized controlled intervention studies (N = 65 888; 13 good-quality, 26 fair-quality) recruited from primary care settings in the US. Study populations were composed predominantly of heterosexual adolescents and young adults (12 to 25 years), females, and racial and ethnic minorities at increased risk for STIs. Nineteen trials (n = 52 072) reported STI diagnoses as outcomes (3 to 17 months' follow-up); intervention was associated with reduced STI incidence (OR, 0.66 [95% CI, 0.54-0.81; I2 = 74%]). Absolute differences in STI acquisition between groups varied widely depending on baseline population STI risk and intervention effectiveness, ranging from 19% fewer to 4% more people acquiring STI. Thirty-four trials (n = 21 417) reported behavioral change outcomes. Interventions were associated with self-reported behavioral change (eg, increased condom use) that reduce STI risk (OR, 1.31 [95% CI, 1.10-1.56; I2 = 40%, n = 5253). There was limited evidence on persistence of intervention effects beyond 1 year. No harms were identified in 7 studies (n = 3458) reporting adverse outcomes. Conclusions and Relevance: Behavioral counseling interventions for individuals seeking primary health care were associated with reduced incidence of STIs. Group or individual counseling sessions lasting more than 2 hours were associated with larger reductions in STI incidence, and interventions of shorter duration also were associated with STI prevention, although evidence was limited on whether the STI reductions associated with these interventions persisted beyond 1 year.


Assuntos
Terapia Comportamental , Aconselhamento , Comportamento Sexual , Doenças Sexualmente Transmissíveis/prevenção & controle , Adolescente , Adulto , Fatores Etários , Terapia Comportamental/métodos , Aconselhamento/métodos , Feminino , Humanos , Masculino , Razão de Chances , Guias de Prática Clínica como Assunto , Gravidez , Atenção Primária à Saúde , Comportamento de Redução do Risco , Adulto Jovem
13.
JAMA ; 324(7): 674-681, 2020 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-32809008

RESUMO

Importance: Approximately 20 million new cases of bacterial or viral sexually transmitted infections (STIs) occur each year in the US, and about one-half of these cases occur in persons aged 15 to 24 years. Rates of chlamydial, gonococcal, and syphilis infection continue to increase in all regions. Sexually transmitted infections are frequently asymptomatic, which may delay diagnosis and treatment and lead persons to unknowingly transmit STIs to others. Serious consequences of STIs include pelvic inflammatory disease, infertility, cancer, and AIDS. Objective: To update its 2014 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a review of the evidence on the benefits and harms of behavioral counseling interventions for preventing STI acquisition. Population: This recommendation statement applies to all sexually active adolescents and to adults at increased risk for STIs. Evidence Assessment: The USPSTF concludes with moderate certainty that behavioral counseling interventions reduce the likelihood of acquiring STIs in sexually active adolescents and in adults at increased risk, including for example, those who have a current STI, do not use condoms, or have multiple partners, resulting in a moderate net benefit. Recommendation: The USPSTF recommends behavioral counseling for all sexually active adolescents and for adults at increased risk for STIs. (B recommendation).


Assuntos
Terapia Comportamental , Aconselhamento , Comportamento Sexual , Doenças Sexualmente Transmissíveis/prevenção & controle , Adolescente , Adulto , Terapia Comportamental/métodos , Aconselhamento/métodos , Feminino , Humanos , Masculino , Atenção Primária à Saúde , Comportamento de Redução do Risco
14.
BMC Infect Dis ; 20(1): 636, 2020 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-32854638

RESUMO

BACKGROUND: Key populations - men who have sex with men (MSM), female sex workers (FSW) and people who inject drugs (PWID) - are at high risk for sexually transmitted infections (STI) given their sexual risk behaviours along with social, legal and structural barriers to prevention, care and treatment services. The purpose of this secondary analysis is to assess the prevalence of self-reported STIs and to describe associated risk factors among participations of the first Biological Behavioural Surveillance (BBS) in Mozambique. METHODS: Responses from the first BBS surveys conducted in 2011-2014 were aggregated across survey-cities to produce pooled estimates for each population. Aggregate weighted estimates were computed to analyse self-reported STI prevalence. Unweighted pooled estimates were used in multivariable logistic regression to identify risk factors associated with self-reported STI. RESULTS: The prevalence of self-reported STI was 11.9% (95% CI, 7.8-16.0), 33.6% (95% CI, 29.0-41.3), and 22.0% (95% CI, 17.0-27.0) among MSM, FSW and PWID, respectively. MSM who were circumcised, had HIV, reported drug use, reported receptive anal sex, and non-condom use with their last male partner had greater odds of STI self-report. STI-self report among FSW was associated with living in Beira, being married, employment aside from sex work, physical violence, sexual violence, drug use, access to comprehensive HIV prevention services, non-condom use with last client, and sexual relationship with a non-client romantic partner. Among PWID, risk factors for self-reported STI included living in Nampula/Nacala, access to HIV prevention services, and sex work. CONCLUSION: The high-burden of STIs among survey participants requires integrated HIV and STI prevention, treatment, and harm reduction services that address overlapping risk behaviours, especially injection drug use and sex work. A robust public health response requires the creation of a national STI surveillance system for better screening and diagnostic procedures within these vulnerable populations.


Assuntos
Doenças Sexualmente Transmissíveis/epidemiologia , Adolescente , Adulto , Feminino , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Moçambique/epidemiologia , Prevalência , Fatores de Risco , Assunção de Riscos , Autorrelato , Trabalho Sexual , Profissionais do Sexo/estatística & dados numéricos , Parceiros Sexuais , Minorias Sexuais e de Gênero , Inquéritos e Questionários , Adulto Jovem
17.
N Engl J Med ; 383(8): 794, 2020 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-32813964
19.
Cochrane Database Syst Rev ; 8: CD013680, 2020 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-32779730

RESUMO

BACKGROUND: The burden of poor sexual and reproductive health (SRH) worldwide is substantial, disproportionately affecting those living in low- and middle-income countries. Targeted client communication (TCC) delivered via mobile devices (MD) (TCCMD) may improve the health behaviours and service use important for sexual and reproductive health. OBJECTIVES: To assess the effects of TCC via MD on adolescents' knowledge, and on adolescents' and adults' sexual and reproductive health behaviour, health service use, and health and well-being. SEARCH METHODS: In July/August 2017, we searched five databases including The Cochrane Central Register of Controlled Trials, MEDLINE and Embase. We also searched two trial registries. A search update was carried out in July 2019 and potentially relevant studies are awaiting classification. SELECTION CRITERIA: We included randomised controlled trials of TCC via MD to improve sexual and reproductive health behaviour, health service use, and health and well-being. Eligible comparators were standard care or no intervention, non-digital TCC, and digital non-targeted communication. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures recommended by Cochrane, although data extraction and risk of bias assessments were carried out by one person only and cross-checked by a second. We have presented results separately for adult and adolescent populations, and for each comparison. MAIN RESULTS: We included 40 trials (27 among adult populations and 13 among adolescent populations) with a total of 26,854 participants. All but one of the trials among adolescent populations were conducted in high-income countries. Trials among adult populations were conducted in a range of high- to low-income countries. Among adolescents, nine interventions were delivered solely through text messages; four interventions tested text messages in combination with another communication channel, such as emails, multimedia messaging, or voice calls; and one intervention used voice calls alone. Among adults, 20 interventions were delivered through text messages; two through a combination of text messages and voice calls; and the rest were delivered through other channels such as voice calls, multimedia messaging, interactive voice response, and instant messaging services. Adolescent populations TCCMD versus standard care TCCMD may increase sexual health knowledge (risk ratio (RR) 1.45, 95% confidence interval (CI) 1.23 to 1.71; low-certainty evidence). TCCMD may modestly increase contraception use (RR 1.19, 95% CI 1.05 to 1.35; low-certainty evidence). The effects on condom use, antiretroviral therapy (ART) adherence, and health service use are uncertain due to very low-certainty evidence. The effects on abortion and STI rates are unknown due to lack of studies. TCCMD versus non-digital TCC (e.g. pamphlets) The effects of TCCMD on behaviour (contraception use, condom use, ART adherence), service use, health and wellbeing (abortion and STI rates) are unknown due to lack of studies for this comparison. TCCMD versus digital non-targeted communication The effects on sexual health knowledge, condom and contraceptive use are uncertain due to very low-certainty evidence. Interventions may increase health service use (attendance for STI/HIV testing, RR 1.61, 95% CI 1.08 to 2.40; low-certainty evidence). The intervention may be beneficial for reducing STI rates (RR 0.61, 95% CI 0.28 to 1.33; low-certainty evidence), but the confidence interval encompasses both benefit and harm. The effects on abortion rates and on ART adherence are unknown due to lack of studies. We are uncertain whether TCCMD results in unintended consequences due to lack of evidence. Adult populations TCCMD versus standard care For health behaviours, TCCMD may modestly increase contraception use at 12 months (RR 1.17, 95% CI 0.92 to 1.48) and may reduce repeat abortion (RR 0.68 95% CI 0.28 to 1.66), though the confidence interval encompasses benefit and harm (low-certainty evidence). The effect on condom use is uncertain. No study measured the impact of this intervention on STI rates. TCCMD may modestly increase ART adherence (RR 1.13, 95% CI 0.97 to 1.32, low-certainty evidence, and standardised mean difference 0.44, 95% CI -0.14 to 1.02, low-certainty evidence). TCCMD may modestly increase health service utilisation (RR 1.17, 95% CI 1.04 to 1.31; low-certainty evidence), but there was substantial heterogeneity (I2 = 85%), with mixed results according to type of service utilisation (i.e. attendance for STI testing; HIV treatment; voluntary male medical circumcision (VMMC); VMMC post-operative visit; post-abortion care). For health and well-being outcomes, there may be little or no effect on CD4 count (mean difference 13.99, 95% CI -8.65 to 36.63; low-certainty evidence) and a slight reduction in virological failure (RR 0.86, 95% CI 0.73 to 1.01; low-certainty evidence). TCCMD versus non-digital TCC No studies reported STI rates, condom use, ART adherence, abortion rates, or contraceptive use as outcomes for this comparison. TCCMD may modestly increase in service attendance overall (RR: 1.12, 95% CI 0.92-1.35, low certainty evidence), however the confidence interval encompasses benefit and harm. TCCMD versus digital non-targeted communication No studies reported STI rates, condom use, ART adherence, abortion rates, or contraceptive use as outcomes for this comparison. TCCMD may increase service utilisation overall (RR: 1.71, 95% CI 0.67-4.38, low certainty evidence), however the confidence interval encompasses benefit and harm and there was considerable heterogeneity (I2 = 72%), with mixed results according to type of service utilisation (STI/HIV testing, and VMMC). Few studies reported on unintended consequences. One study reported that a participant withdrew from the intervention as they felt it compromised their undisclosed HIV status. AUTHORS' CONCLUSIONS: TCCMD may improve some outcomes but the evidence is of low certainty. The effect on most outcomes is uncertain/unknown due to very low certainty evidence or lack of evidence. High quality, adequately powered trials and cost effectiveness analyses are required to reliably ascertain the effects and relative benefits of TCC delivered by mobile devices. Given the sensitivity and stigma associated with sexual and reproductive health future studies should measure unintended consequences, such as partner violence or breaches of confidentiality.


Assuntos
Telefone Celular , Comunicação , Saúde Reprodutiva/normas , Saúde Sexual/normas , Aborto Legal/estatística & dados numéricos , Adolescente , Anticoncepção/estatística & dados numéricos , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Melhoria de Qualidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Doenças Sexualmente Transmissíveis , Envio de Mensagens de Texto , Incerteza , Adulto Jovem
20.
PLoS One ; 15(8): e0237649, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32797118

RESUMO

INTRODUCTION: Understanding the current epidemiology of human immunodeficiency virus (HIV) infection in Thailand will facilitate more effective national HIV prevention programs. This study aimed to determine the prevalence and risk factors for HIV infection among young Thai men. METHODS: A total survey was conducted of Royal Thai Army new conscripts, participating in the national HIV surveillance in November 2010 and May 2011. Behavioral risk factors for HIV infection were determined using a standardized survey questionnaire in the total study population and men who have sex with men (MSM) subgroup. RESULTS: A total of 301 (0.5%) HIV infected young Thai men were identified from the total study population (63,667). Independent risk factors associated with HIV infection among the total study population included being single (adjusted Odds Ratio [AOR] 1.6, 95% Confidence Interval [CI] 1.1-2.2), having no formal education (AOR 6.5, 95% CI 2.3-18.4) or a bachelor's degree (AOR 1. 8, 95% CI 1.0-3.0), engaging in bisexual (AOR 3.7, 95% CI 2.4-5. 6) or exclusively homosexual activity (AOR 14.4, 95% CI 10.4-19.8), having a history of Sexually Transmitted Infection (STI) (AOR 2.3, 95% CI 1.6-3.3) and having sex in exchange for gifts/money (AOR 2.0, 95% CI 1. 5-2.8). A total of 4,594 (7.9%) MSM were identified, of which 121 (2.6%) were HIV infected. The prevalence of HIV infection among MSM in urban (2.8%) and rural (2.4%) areas were relatively comparable (p-value = 0.44). Of the identified MSM, 82.5% reported having sexual desire with females only. Risk factors associated with HIV infection in the MSM subgroup included living in the western region (AOR 3.5, 95% CI 1.2-10.4), having a bachelor's degree (AOR 2.7, 95% CI 1.2-5.7), having a history of exclusive receptive (AOR 3.6, 95% CI 1.6-7.7) or versatile anal sex (AOR 4.7, 95% CI 3.0-7.5) and history of having sex in exchange for gifts/money (AOR 2.3, 95% CI 1.5-3.5). CONCLUSION: The prevalence of HIV infection among young Thai men has continued to be below 0.5% in 2010 and 2011. High risk sexual activity, including MSM, played a major role in the HIV epidemic among this population. Effective HIV prevention programs should cover MSM who have heterosexual desire as well as having sex in exchange for gifts/money and be implemented in both urban and rural areas.


Assuntos
Infecções por HIV/epidemiologia , Adulto , Bissexualidade , Escolaridade , Homossexualidade Masculina , Humanos , Masculino , Prevalência , Fatores de Risco , Fatores Sexuais , Comportamento Sexual , Parceiros Sexuais , Doenças Sexualmente Transmissíveis/epidemiologia , Tailândia/epidemiologia , Adulto Jovem
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