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2.
Medicina (B Aires) ; 80(5): 554-556, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-33048801

RESUMO

SARS-CoV-2 causes the disease named COVID-19, which emerged in Wuhan, China, in December 2019 and developed into the current pandemic. The manifestations of SARS-CoV-2 infection are highly variable. The worst outcomes are usually associated with advanced age and known risk factors. Among these, it would be reasonable to consider conditions compromising the immune system, particularly the immunodeficiency associated to HIV. To date, however, there is no evidence of HIV infection worsening the evolution and prognosis of COVID-19. Pneumocystis jirovecii (previously-P. carinii) pneumonia, is a fungal disease that most commonly affects immunocompromised persons and can be life-threatening. Typically, patients at risk are those with any underlying condition altering host immunity. We present the case of a middle-aged woman with Raynaud's syndrome who was admitted with pneumonia. During hospitalization she was simultaneously diagnosed with infection by HIV, COVID-19 and P. jirovecci. The patient evolved favorably upon empirical treatment without requiring invasive maneuvers or ventilatory support. Outpatient follow-up after hospital discharge was uneventful.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por HIV/diagnóstico , Pandemias , Pneumocystis carinii/isolamento & purificação , Pneumonia por Pneumocystis/diagnóstico , Pneumonia Viral , Betacoronavirus , Técnicas de Laboratório Clínico , Coronavirus , Feminino , Humanos , Pessoa de Meia-Idade , Síndrome Respiratória Aguda Grave
4.
PLoS Med ; 17(10): e1003150, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33027246

RESUMO

BACKGROUND: Evidence for the effectiveness of continuous quality improvement (CQI) in resource-poor settings is very limited. We aimed to establish the effects of CQI on quality of antenatal HIV care in primary care clinics in rural South Africa. METHODS AND FINDINGS: We conducted a stepped-wedge cluster-randomised controlled trial (RCT) comparing CQI to usual standard of antenatal care (ANC) in 7 nurse-led, public-sector primary care clinics-combined into 6 clusters-over 8 steps and 19 months. Clusters randomly switched from comparator to intervention on pre-specified dates until all had rolled over to the CQI intervention. Investigators and clusters were blinded to randomisation until 2 weeks prior to each step. The intervention was delivered by trained CQI mentors and included standard CQI tools (process maps, fishbone diagrams, run charts, Plan-Do-Study-Act [PDSA] cycles, and action learning sessions). CQI mentors worked with health workers, including nurses and HIV lay counsellors. The mentors used the standard CQI tools flexibly, tailored to local clinic needs. Health workers were the direct recipients of the intervention, whereas the ultimate beneficiaries were pregnant women attending ANC. Our 2 registered primary endpoints were viral load (VL) monitoring (which is critical for elimination of mother-to-child transmission of HIV [eMTCT] and the health of pregnant women living with HIV) and repeat HIV testing (which is necessary to identify and treat women who seroconvert during pregnancy). All pregnant women who attended their first antenatal visit at one of the 7 study clinics and were ≥18 years old at delivery were eligible for endpoint assessment. We performed intention-to-treat (ITT) analyses using modified Poisson generalised linear mixed effects models. We estimated effect sizes with time-step fixed effects and clinic random effects (Model 1). In separate models, we added a nested random clinic-time step interaction term (Model 2) or individual random effects (Model 3). Between 15 July 2015 and 30 January 2017, 2,160 participants with 13,212 ANC visits (intervention n = 6,877, control n = 6,335) were eligible for ITT analysis. No adverse events were reported. Median age at first booking was 25 years (interquartile range [IQR] 21 to 30), and median parity was 1 (IQR 0 to 2). HIV prevalence was 47% (95% CI 42% to 53%). In Model 1, CQI significantly increased VL monitoring (relative risk [RR] 1.38, 95% CI 1.21 to 1.57, p < 0.001) but did not improve repeat HIV testing (RR 1.00, 95% CI 0.88 to 1.13, p = 0.958). These results remained essentially the same in both Model 2 and Model 3. Limitations of our study include that we did not establish impact beyond the duration of the relatively short study period of 19 months, and that transition steps may have been too short to achieve the full potential impact of the CQI intervention. CONCLUSIONS: We found that CQI can be effective at increasing quality of primary care in rural Africa. Policy makers should consider CQI as a routine intervention to boost quality of primary care in rural African communities. Implementation research should accompany future CQI use to elucidate mechanisms of action and to identify factors supporting long-term success. TRIAL REGISTRATION: This trial is registered at ClinicalTrials.gov under registration number NCT02626351.


Assuntos
Infecções por HIV/prevenção & controle , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Cuidado Pré-Natal/normas , Carga Viral/estatística & dados numéricos , Adulto , Fármacos Anti-HIV/uso terapêutico , Feminino , Infecções por HIV/sangue , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Soropositividade para HIV/diagnóstico , Humanos , Ciência da Implementação , Padrões de Prática em Enfermagem , Gravidez , Atenção Primária à Saúde , Avaliação de Processos em Cuidados de Saúde , Melhoria de Qualidade , Indicadores de Qualidade em Assistência à Saúde , RNA Viral/sangue , População Rural , África do Sul , Gestão da Qualidade Total , Adulto Jovem
5.
BMC Infect Dis ; 20(1): 736, 2020 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-33028232

RESUMO

BACKGROUND: Blood transfusion is associated with potential risks of transfusion-transmitted infections (TTIs). Different strategies are needed to monitor blood safety and screen the donors' efficacy, such as evaluation of the prevalence and trends of TTIs. This study was conducted to evaluate the prevalence and trends of TTIs, including hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and human T-cell lymphotropic virus (HTLV 1/2), and the impact of the donors' characteristics such as age, sex, and donor status on the prevalence of TTIs in blood donors in seven large provinces of Iran from 2010 to 2018. METHODS: This study was conducted on the data collected from all blood donations in seven Iranian Blood Transfusion Centers including Ardabil, Alborz, Guilan, West Azarbaijan, North, Razavi, and South Khorasan from April 2010 to March 2018. Demographic characteristics, number of donations, donor status, and screening and confirmatory serological results of all blood donations were collected from Iranian Blood Transfusion Organizations (IBTO) national database. The prevalence and trend of HBV, HCV, HIV, and HTLV 1/2 infections were reported according to the donation year and donor's characteristics. RESULTS: The analysis of the prevalence and trend of TTIs in 3,622,860 blood donors showed a significant decreasing trend in first-time and regular donors. Additionally, compared to first- time donors, regular donors made safer blood donations with lower risks of HBV, HIV, HCV and HTLV 1/2 (P < 0.0001). Although the prevalence of HTLV 1/2 and HBV was higher in females, TTIs had a significant decreasing trend in males and females. Finally, it was found that the prevalence of HBV and HTLV 1/2 increased with age up to 40-49 years and then decreased thereafter. CONCLUSIONS: The decreasing trends of TTIs in Iranian donors during 9 years may indicate that the various strategies implemented by IBTO have been effective in recent years. Other factors such as a decrease in the prevalence of specific TTIs in the general population might have also contributed to these declines.


Assuntos
Segurança do Sangue , Infecções por HIV/diagnóstico , Infecções por HTLV-I/diagnóstico , Hepatite B/diagnóstico , Hepatite C/diagnóstico , Adolescente , Adulto , Doadores de Sangue/estatística & dados numéricos , Feminino , Infecções por HIV/epidemiologia , Infecções por HTLV-I/epidemiologia , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Reação Transfusional/diagnóstico , Reação Transfusional/epidemiologia , Reação Transfusional/virologia , Adulto Jovem
6.
BMC Infect Dis ; 20(1): 728, 2020 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-33028235

RESUMO

BACKGROUND: Late presentation (LP), defined as a CD4 count < 350/mm3 or an AIDS-event at HIV-diagnosis, remains a significant problem across Europe. Linking cohort and surveillance data, we assessed the country-specific burden of LP during 2010-2016 and the occurrence of new AIDS events or deaths within 12 months of HIV-diagnosis believed to be attributable to LP. METHODS: Country-specific percentages of LP and AIDS-events/death rates (assessed with Poisson regression) observed in The Collaboration of Observational HIV Epidemiological Research Europe (COHERE) and EuroSIDA cohorts, were applied to new HIV-diagnoses reported to the European Centre for Disease Prevention and Control. The estimated number of LP in the whole population was then calculated, as was the number of excess AIDS-events/deaths in the first 12 months following HIV-diagnosis assumed to be attributable to LP (difference in estimated events between LP and non-LP). RESULTS: Thirty-nine thousand two hundred four persons were included from the COHERE and EuroSIDA cohorts, of whom 18,967 (48.4%; 95% Confidence Interval [CI] 47.9-48.9) were classified as LP, ranging from 36.9% in Estonia (95%CI 25.2-48.7) and Ukraine (95%CI 30.0-43.8) to 64.2% in Poland (95%CI 57.2-71.3). We estimated a total of > 320,000 LP and 12,050 new AIDS-events/deaths attributable to LP during 2010-2016, with the highest estimated numbers of LP and excess AIDS-events/deaths in Eastern Europe. Country-level estimates of excess events ranged from 17 AIDS-events/deaths (95%CI 0-533) in Denmark to 10,357 (95%CI 7768-147,448) in Russia. CONCLUSIONS: Across countries in Europe, the burden of LP was high, with the highest estimated number of LP and excess AIDS-events/deaths being in Eastern Europe. Effective strategies are needed to reduce LP and the attributable morbidity and mortality that could be potentially avoided.


Assuntos
Infecções por HIV/diagnóstico , Adulto , Contagem de Linfócito CD4 , Estudos de Coortes , Diagnóstico Tardio , Europa (Continente)/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/mortalidade , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Morbidade , Análise de Sobrevida
7.
J Int AIDS Soc ; 23(9): e25622, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32996705

RESUMO

INTRODUCTION: The COVID-19 pandemic has impacted global health service delivery, including provision of HIV services. Countries with high HIV burden are balancing the need to minimize interactions with health facilities to reduce the risk of COVID-19 transmission, while delivering uninterrupted essential HIV prevention, testing and treatment services. Many of these adaptations in resource-constrained settings have not adequately accounted for the needs of pregnant and breastfeeding women, infants, children and adolescents. We propose whole-family, tailored programme adaptations along the HIV clinical continuum to protect the programmatic gains made in services. DISCUSSION: Essential HIV case-finding services for pregnant and breastfeeding women and children should be maintained and include maternal testing, diagnostic testing for infants exposed to HIV, index testing for children whose biological parents or siblings are living with HIV, as well as for children/adolescents presenting with symptoms concerning for HIV and comorbidities. HIV self-testing for children two years of age and older should be supported with caregiver and provider education. Adaptations include bundling services in the same visit and providing testing outside of facilities to the extent possible to reduce exposure risk to COVID-19. Virtual platforms can be used to identify vulnerable children at risk of HIV infection, abuse, harm or violence, and link them to necessary clinical and psychosocial support services. HIV treatment service adaptations for families should focus on family based differentiated service delivery models, including community-based ART initiation and multi-month ART dispensing. Viral load monitoring should not be a barrier to transitioning children and adolescents experiencing treatment failure to more effective ART regimens, and viral load monitoring for pregnant and breastfeeding women and children should be prioritized and bundled with other essential services. CONCLUSIONS: Protecting pregnant and breastfeeding women, infants, children and adolescents from acquiring SARS-CoV-2 while sustaining essential HIV services is an immense global health challenge. Tailored, family friendly programme adaptations for case-finding, ART delivery and viral load monitoring for these populations have the potential to limit SARS-CoV-2 transmission while ensuring the continuity of life-saving HIV case identification and treatment efforts.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Assistência à Saúde , Infecções por HIV/tratamento farmacológico , Pneumonia Viral/epidemiologia , Adolescente , Aleitamento Materno , Criança , Pré-Escolar , Infecções por Coronavirus/prevenção & controle , Família , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/prevenção & controle , Recursos em Saúde , Humanos , Lactente , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Carga Viral
8.
Sante Publique ; 32(1): 103-111, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32985967

RESUMO

BACKGROUND: Outreach HIV testing strategies have significantly contributed to the increase in the number of people knowing their HIV status in sub-Saharan Africa. This article analyzes the articulation of donor and field constraints on the implementation of outreach HIV testing strategies in Côte d’Ivoire. METHODS: Qualitative research was conducted in three health districts (Man, Cocody-Bingerville and Aboisso) in Côte d’Ivoire in 2015-2016, through in-depth interviews with community providers, local leaders and people tested and through observation of outreach HIV testing activities. RESULTS: Implementing organizations feel “under pressure” to meet donors’ objectives that are deemed unattainable, as well as the lack of training and funding. As a result, providers do not observe systematically the rules of the “three Cs” (counselling, informed consent, confidentiality), and propose testing to individuals who are “off-target” (in terms of locations and populations). DISCUSSION: Implementing NGOs experience two types of constraints those resulting from the functioning of international aid (inadequate funding compared to actual costs, objectives too high, the important chain of intermediaries) and those related to the local context (spaces not adapted to guarantee confidentiality and the professional activity of target populations). CONCLUSION: The pressure that is exerted at different levels on implementing NGOs is detrimental to the quality of HIV testing. It is now essential to develop a more qualitative approach in defining strategies and evaluation criteria.


Assuntos
Agentes Comunitários de Saúde , Aconselhamento , Infecções por HIV/diagnóstico , Programas de Rastreamento/métodos , Serviços Preventivos de Saúde/organização & administração , Fortalecimento Institucional , Costa do Marfim , Infecções por HIV/prevenção & controle , Humanos , Entrevistas como Assunto , Pesquisa Qualitativa
9.
Sante Publique ; 32(2): 229-237, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32985839

RESUMO

OBJECTIVE: The HIV self-test has been on sale in France since September 2015. What is the point of view of pharmacists and key populations with regard to accessing self-tests in community pharmacies ? METHOD: One year after the HIV self-test came onto the market, the points of view of pharmacists and key populations with regard to HIV were collected during six focus groups: the pharmacists themselves; people who had already used HIV self-tests; potential users from two key populations with regard to HIV: migrants from sub-Saharan Africa and men who have sex with men; potential users from populations with active sex lives but not particularly vulnerable with regard to HIV: young adults (<25 years of age), multi-partner heterosexual adults. RESULTS: The HIV self-test in community pharmacies is perceived by all participants as a significant step forward for accessing screening for HIV. However, issues around discretion and anonymity were seen to create significant tensions with regard to accessing the test itself, but also the information necessary to use it correctly both at a technical level and above all concerning how to interpret test results. CONCLUSION: Although the present study underlines the role of the pharmacist as a significant public health actor in the dispensation of the self-test, the sales price and questions of anonymity are seen as major obstacles. Priority actions include renewing communication campaigns concerning the existence and the use of the product for the upcoming generations of young people but also specific campaigns targeting more vulnerable populations.


Assuntos
Atitude do Pessoal de Saúde , Infecções por HIV/diagnóstico , Programas de Rastreamento/métodos , Farmacêuticos/psicologia , Adulto , Feminino , Grupos Focais , França , Humanos , Masculino , Farmácias , Autocuidado , Adulto Jovem
10.
PLoS One ; 15(9): e0237469, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32870911

RESUMO

BACKGROUND: It is estimated that approximately half of new HIV diagnoses among heterosexual migrants in Victoria, Australia, were acquired post-migration. We investigated the characteristics of phylogenetic clusters in notified cases of HIV among heterosexual migrants. METHODS: Partial HIV pol sequences obtained from routine clinical genotype tests were linked to Victorian HIV notifications with the following exposures listed on the notification form: heterosexual sexual contact, injecting drug use, bisexual sexual contact, male-to male sexual contact or heterosexual sexual contact in combination with injecting drug use, unknown exposure. Those with heterosexual sexual contact as the only exposure were the focus of this study, with the other exposures included to better understand transmission networks. Additional reference sequences were extracted from the Los Alamos database. Maximum likelihood methods were used to infer the phylogeny and the robustness of the resulting tree was assessed using bootstrap analysis. Phylogenetic clusters were defined on the basis of bootstrap and genetic distance. RESULTS: HIV pol sequences were available for 332 of 445 HIV notifications attributed to only heterosexual sexual contact in Victoria from 2005-2014. Forty-three phylogenetic clusters containing at least one heterosexual migrant were detected, 30 (70%) of which were pairs. The characteristics of these phylogenetic clusters varied considerably by cluster size. Pairs were more likely to be composed of people living with HIV from a single country of birth (p = 0.032). Larger clusters (n≥3) were more likely to contain people born in Australian/New Zealand (p = 0.002), migrants from more than one country of birth (p = 0.013) and viral subtype-B, the most common subtype in Australia (p = 0.006). Pairs were significantly more likely to contain females (p = 0.037) and less likely to include HIV diagnoses with male-to-male sexual contact reported as a possible exposure (p<0.001) compared to larger clusters (n≥3). CONCLUSION: Migrants appear to be at elevated risk of HIV acquisition, in part due to intimate relationships between migrants from the same country of origin, and in part due to risks associated with the broader Australian HIV epidemic. However, there was no evidence of large transmission clusters driven by heterosexual transmission between migrants. A multipronged approach to prevention of HIV among migrants is warranted.


Assuntos
Infecções por HIV/epidemiologia , HIV/genética , Filogenia , Adulto , Austrália/epidemiologia , Análise por Conglomerados , Feminino , HIV/isolamento & purificação , Infecções por HIV/diagnóstico , HIV-1/genética , HIV-1/isolamento & purificação , Heterossexualidade , Humanos , Masculino , Pessoa de Meia-Idade , Migrantes , Produtos do Gene pol do Vírus da Imunodeficiência Humana/genética
11.
BMC Infect Dis ; 20(1): 660, 2020 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-32894102

RESUMO

INTRODUCTION: Although women comprise 33% of the HIV-1-carriers in Israel, they have not previously been considered a risk group requiring special attention. Immigration waves from countries in Africa and in East Europe may have changed the local landscape of women diagnosed with HIV-1. Here, we aimed to assess viral and demographic characteristics of HIV-1-positive women identified in Israel between 2010 and 2018. METHODS: All > 16 year-old, HIV-1-infected women, diagnosed in Israel in 2010-2018, (n = 763) registered in the National HIV reference laboratory were included in this cross-sectional study. Demographic and clinical characteristics were extracted from the database. Viral subtypes and transmitted drug resistance mutations (TDRM) were determined in 337 (44.2%) randomly selected samples collected from treatment-naive women. RESULTS: Median age at diagnosis was 38 years. Most (73.3%) women were immigrants from the former Soviet Union (FSU) (41.2%, 314) or sub-Saharan Africa (SSA) (32.2%, 246) and carried subtype A (79.7%) or C (90.3%), respectively. Only 11.4% (87) were Israeli-born women. Over the years, the prevalence of women from SSA decreased while that of women from FSU increased significantly (p < 0.001). The median CD4+ cell count was 263 cells/mm3, and higher (391 cells/mm3) in Israeli-born women. TDRM were identified in 10.4% of the tested samples; 1.8, 3 and 7.1% had protease inhibitors (PI), nucleotide reverse transcriptase inhibitors (NRTI) and non-nucleoside reverse transcriptase inhibitors (NNRTI) TDRM, respectively. The prevalence of women with NNRTI TDRM significantly increased from 4.9% in 2010-2012 to 13.3% in 2016-2018. Israeli-born women had the highest prevalence (16.3%) of NNRTI TDRM (p = 0.014). NRTI A62 (5.6%), NNRTI E138 and K103 (5.6 and 4.2%, respectively) were the most prominent mutated sites. CONCLUSIONS: Most HIV-1-positive women diagnosed in Israel in 2010-2018 were immigrants, with the relative ratio of FSU immigrants increasing in recent years. The high proportion of women diagnosed with resistance mutations, particularly, the yearly increase in the frequency of NNRTI mutations, support the national policy of resistance testing at baseline.


Assuntos
Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , HIV-1/genética , Adulto , Antivirais/uso terapêutico , Contagem de Linfócito CD4 , Estudos de Coortes , Estudos Transversais , Farmacorresistência Viral/genética , Emigrantes e Imigrantes , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Israel/epidemiologia , Pessoa de Meia-Idade , Mutação , Prevalência , Inibidores da Transcriptase Reversa/uso terapêutico
12.
Rev Saude Publica ; 54: 82, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32876301

RESUMO

OBJECTIVE To characterize recent HIV infections among newly diagnosed men who have sex with men and transgender women in Tijuana. METHODS Limiting Antigen (LAg)-Avidity testing was performed to detect recent HIV infection within a cohort of newly-diagnosed men who have sex with men and transgender women in Tijuana. Logistic regression was used to determine characteristics associated with recent infection. A partial transmission network was inferred using HIV-1 pol sequences. Tamura-Nei 93 genetic distances were measured between all pairs of sequences, and the network was constructed by inferring putative transmission links (genetic distances ≤ 1.5%). We assessed whether recent infection was associated with clustering within the inferred network. RESULTS Recent infection was detected in 11% (22/194) of newly-diagnosed participants. Out of the participants with sequence data, 60% (9/15) with recent infection clustered compared with 31% (43/139) with chronic infection. Two recent infections belonged to the same cluster. In adjusted analyses, recent infection was associated with years of residence in Tijuana (OR = 1.5; 95%CI 1.01-1.09), cocaine use (past month) (OR = 8.50; 95%CI 1.99-28.17), and ever experiencing sexual abuse (OR = 2.85; 95%CI 1.03-7.85). DISCUSSION A total of 11% of men newly diagnosed with HIV who have sex with men and transgender women in Tijuana were recently infected. The general lack of clustering between participants with recent infection suggests continued onward HIV transmission rather than an outbreak within a particular cluster.


Assuntos
Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Homossexualidade Masculina , Pessoas Transgênero , Brasil/epidemiologia , Feminino , Humanos , Masculino , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
13.
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
14.
Top Antivir Med ; 28(2): 455-458, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32886465

RESUMO

Due to COVID-19, this year marked the first virtual Conference on Retroviruses and Opportunistic Infections (CROI) in the conference's 27-year history. There were important studies presented that provided new insights into the prevention, diagnosis, and treatment of tuberculosis (TB) and other HIV coinfections. Highlights related to TB and HIV coinfections from this year's meeting are reviewed below.


Assuntos
Coinfecção/epidemiologia , Infecções por HIV/epidemiologia , Infecções Oportunistas/epidemiologia , Saúde Pública , Tuberculose/epidemiologia , Adulto , Fármacos Anti-HIV/uso terapêutico , Antituberculosos/uso terapêutico , Coinfecção/diagnóstico , Coinfecção/tratamento farmacológico , Controle de Doenças Transmissíveis/organização & administração , Congressos como Assunto , Criptococose/diagnóstico , Criptococose/tratamento farmacológico , Criptococose/epidemiologia , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Humanos , Lactente , Masculino , Micoses/diagnóstico , Micoses/tratamento farmacológico , Micoses/epidemiologia , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/tratamento farmacológico , Gravidez , Prevalência , Prevenção Primária/métodos , Medição de Risco , Análise de Sobrevida , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Interface Usuário-Computador , Adulto Jovem
15.
S Afr Med J ; 110(6): 514-518, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32880564

RESUMO

BACKGROUND: HIV testing rates have increased in recent years. Repeat testing is recommended to identify and treat new HIV infections timeously. However, there are limited data on repeat HIV testing, especially in South Africa (SA). OBJECTIVES: To provide data on repeat HIV testing rates in males and females in a district in SA. METHODS: A sexual and reproductive health (SRH) service integration model was implemented in seven healthcare facilities in eThekwini District, KwaZulu-Natal Province, SA, between 2009 and 2011. HIV testing data were collected from male and female clients attending these facilities, prior to (baseline) and after the implementation (endline) of the 3-year health services integration intervention. RESULTS: There were 230 clients at baseline (195 female, 35 male) and 200 at endline (169 female, 31 male). High ever-tested rates were reported at baseline (females 95.4%, males 74.3%) and endline (females 91.7%, males 87.1%), with large increases in male testing rates over time. In addition, high increases were seen between baseline and endline among those who had tested more than once and more than twice in their lifetime. Increases between baseline and endline testing rates were highest in HIV testing services (HTS) (37.0 - 93.3% for clients who had tested more than once, and 11.1 - 53.3% for those who had tested more than twice). CONCLUSIONS: HIV testing and repeat testing increased over time, especially in males and in HTS. Promotion and integration of SRH services are critical to facilitate improved health-seeking behaviour and HIV testing of both male and female clients. They are also important for continued access to HTS at multiple service delivery points.


Assuntos
Infecções por HIV/diagnóstico , Programas de Rastreamento/estatística & dados numéricos , Serviços de Saúde Reprodutiva , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Retratamento , África do Sul/epidemiologia
16.
Artigo em Alemão | MEDLINE | ID: mdl-32897408

RESUMO

BACKGROUND: Estimating the number of persons tested for HIV in Germany is challenging. HIV testing can be reimbursed by statutory health insurance (SHI) under certain circumstances. This study aimed to use SHI physician claims data to determine the number of persons tested in the outpatient sector. METHODS: The Central Research Institute for Ambulatory Health Care in Germany (Zi) aggregated a dataset of persons tested for HIV among all SHI insurees. Descriptive analysis differentiated between screening and confirmatory HIV tests. Time trends were explored using linear regression. Insurees with confirmatory tests were compared to newly diagnosed HIV (ndHIV) cases. RESULTS: Between 2010 and 2015, 1.7% of insurees were annually screened by SHI physicians. Screening tests increased significantly between 2010 and 2015. Among persons screened, 82.5% were women and of those 81.2% had a screening test during pregnancy. Confirmatory tests were performed on 16,034 insurees (0.3% with screening test; 51.2% men). A total of 18,446 (82.8% men) ndHIV cases were notified between 2010 and 2015. CONCLUSIONS: For the first time, the number of persons with HIV tests in the SHI sector was estimated. The high number of screened women is due to tests during pregnancy. The higher number of ndHIV cases indicates an unknown number of persons tested at other testing sites.


Assuntos
Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Pacientes Ambulatoriais , Assistência à Saúde , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Programas Nacionais de Saúde
17.
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
18.
Artigo em Alemão | MEDLINE | ID: mdl-32970170

RESUMO

BACKGROUND: The Robert Koch Institute (RKI) annually publishes an estimate of the number of new HIV diagnoses and the total number of people diagnosed with HIV in Germany. So far, only medication prescription data have served as secondary data as a basis for such estimates. OBJECTIVES: In this study, we used billing data from the outpatient sector to estimate the number of patients with newly diagnosed HIV, the overall number of patients with HIV, and the HIV test rates in those with statutory health insurance in Germany. MATERIALS AND METHODS: We analyzed billing data from the outpatient sector for all persons covered by statutory health insurance between 2009 and 2018. We designed annual cohorts of patient for the years 2011 to 2017 and analyzed the number of HIV diagnoses, the number of HIV-related care services, and HIV testing rates. RESULTS: Every year, about 6000 new patients with HIV are treated in outpatient care. The total number of patients with HIV in 2011 was about 59,300 (0.106%), which increased to 80,800 (0.141%) in 2017. The average increase in the total number of patients per year of about 3600 was significantly below the estimated number of newly treated patients for each year. CONCLUSION: The results may provide an indication of patients receiving HIV care in the outpatient sector. The secondary data provide the possibility of developing another epidemiological data source for population-based representation of the administrative prevalence of HIV. To clarify over-representation, there is a need for further research on patients who are using outpatient care for the first time.


Assuntos
Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Pacientes Ambulatoriais , Assistência Ambulatorial , Alemanha/epidemiologia , Humanos , Prevalência
19.
Curr Opin HIV AIDS ; 15(6): 341-344, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32969977

RESUMO

PURPOSE OF REVIEW: Due to the stringent measures including quarantine of infected individuals and social distancing, the COVID-19 pandemic has posted great challenges for HIV-1 care in China. In this mini-review, I will discuss the situation in Shenzhen city as a window of China to reflect our strategies in fighting the concurrent HIV/AIDS and COVID-19 pandemics. RECENT FINDINGS: Prevention of nosocomial infection, minimizing the follow-up visits to the hospital, maintaining the delivery of PreP/PEP services and testing for SARS-Cov-2 and HIV when someone have fever or respiratory symptoms were the four major approaches to maintain uninterrupted HIV care in Shenzhen. None of 15 000 PLWH seeking HIV care at Shenzhen were diagnosed with COVID-19 during this pandemic. SUMMARY: This article share the experience unprecedented from Shenzhen. We have to adapt our care and service to continue to engage PLWH to avoid poor outcomes. More research is needed to know the long-term implications of pandemic for the health of PLWH.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por HIV/tratamento farmacológico , Pneumonia Viral/epidemiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Infecções por HIV/diagnóstico , Recursos em Saúde , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Profilaxia Pós-Exposição , Profilaxia Pré-Exposição
20.
PLoS One ; 15(9): e0238314, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32886693

RESUMO

BACKGROUND: Globally, the prevalence of HIV among transgender women remains much higher than that of the general population, and a large proportion of them are unaware of their HIV status. Transgender women are exposed to gender-based violence and social stigma and discrimination in different settings that may create significant barriers to receiving HIV prevention and care services. This study aimed to identify factors associated with recent HIV testing among transgender women in Cambodia. METHODS: We conducted a cross-sectional survey in 2016 among 1375 transgender women recruited from 13 provinces using a peer-based social network recruitment method. We used a structured questionnaire for face-to-face interviews and performed rapid HIV/syphilis testing onsite. We used a multiple logistic regression analysis to identify factors associated with recent HIV testing. RESULTS: Of the total, 49.2% of the participants reported having an HIV test in the past six months. After controlling for other covariates, the odds of having an HIV test in the past six months was significantly lower among students (AOR 0.36, 95% CI 0.20-0.65), participants who perceived that they were unlikely to be HIV infected (AOR 0.50, 95% CI 0.32-0.78), and participants who reported always using condoms with male non-commercial partners in the past three months (AOR 0.65, 95% CI 0.49-0.85) relative to their respective reference group. The odds of having an HIV test in the past six months was significantly higher among participants who had been reached by community-based HIV services (AOR 5.01, 95% CI 3.29-7.65) and received HIV education (AOR 1.65, 95% CI 1.06-2.58) in the past six months relative to their respective reference group. CONCLUSIONS: Despite the widely available free HIV testing services, more than half of transgender women in this study had not received an HIV test in the past six months. Our findings suggest that a tailored and comprehensive combination prevention program, in which HIV testing is linked to care continuum and beyond, maybe an essential next step. Social media may have the potential to be promoted and utilized among transgender women populations in order to improve HIV testing and other prevention measures.


Assuntos
Infecções por HIV/diagnóstico , HIV/isolamento & purificação , Programas de Rastreamento/estatística & dados numéricos , Comportamento Sexual , Parceiros Sexuais/psicologia , Inquéritos e Questionários , Pessoas Transgênero/psicologia , Adolescente , Adulto , Camboja/epidemiologia , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , Acesso aos Serviços de Saúde , Humanos , Masculino , Prevalência , Fatores de Risco , Estigma Social , Pessoas Transgênero/estatística & dados numéricos , Adulto Jovem
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