HIV/AIDS health services in Manaus, Brazil: patient perception of quality and its influence on adherence to antiretroviral treatment.

BACKGROUND: Patient satisfaction is an important factor for both assessing the quality of healthcare and predicting positive health outcomes. This study assesses the influence of HIV/AIDS patients' perception of the quality of health services on adherence to antiretroviral treatment using the decentralized care model in Manaus, Brazil. METHODS: We conducted a non-randomized, cross-sectional analysis to explore the relationship between patient satisfaction and adherence to antiretroviral treatment (ART) in Manaus, Amazonas, Brazil. We also compared patient satisfaction levels at the city's main hospital with those at smaller health units established to decentralize HIV/AIDS healthcare. Using survey responses from 812 patients and health data from 713 patients, we conducted descriptive and regression analyses to identify health center characteristics associated with higher patient satisfaction and higher adherence to treatment. RESULTS: We found a clear and positive relationship between patient satisfaction with the quality of health services and adherence to ART. Patients who had better access to their health center and its services -mainly in the form of convenient location, shorter commute times, and shorter wait times- tended to rate the quality of services higher and were also more likely to adhere to ART. We also found higher levels of patient satisfaction and adherence to ART among patients served at decentralized health units than among patients served at the main hospital. CONCLUSIONS: The study's results emphasize the importance of patients' experience at the health center for improved health outcomes. While many of the factors that play a role in whether a patient adheres to ART or not are beyond the control of the health center, our findings highlight that health centers can importantly contribute to increased ART adherence by improving such experience. The study also showcases the potential benefits of decentralizing HIV care to increase patient satisfaction and, with it, adherence to ART.

Evaluation of performance and acceptability of two rapid oral fluid tests for HIV detection in Mozambique.

Simplified HIV testing based on oral fluid (OF) may allow the expansion of HIV infection counseling and testing (CT) while reducing the risk due to exposure to needles and blood collection. This study evaluated the performance and acceptability of two OF tests (the OraQuick Advance Rapid HIV-1/2 and the Chembio DPP HIV-1/2) from May to September 2009 in two CT sites in Maputo City, Mozambique, compared with results for the national testing algorithm. OF testing was conducted in parallel with whole blood-based testing according to the national HIV algorithm. Blood samples were collected as dried blood spot (DBS) specimens from all participants for quality assurance. HIV infection results were delivered according to the national algorithm. According to the national HIV algorithm, 512 (30.5%) samples were reactive, 1,151 (68.7%) were nonreactive, and 13 (0.8%) were discordant. All discordant cases were retested with an enzyme immunoassay followed by Western blotting, and five (38.5%) were confirmed as HIV positive. The OraQuick OF test showed 518 (30.9%) reactive samples and 1,158 (69.1%) nonreactive samples, with a sensitivity and specificity of 99.8% and 99.8%, respectively. The Chembio DPP OF test showed 519 (31.0%) reactive samples and 1,157 (69.0%) nonreactive samples with a sensitivity and specificity of 100% and 99.8%, respectively. The participants perceived blood testing (49.9%) to be more accurate than OF testing (46.8%). The OF tests showed high performance for the diagnosis of HIV infection when examined individually and in an algorithm, compared with results according to the national testing algorithm.

Evaluation of performance and acceptability of two rapid oral fluid tests for HIV detection in Mozambique

Simplified HIV testing based on oral fluid (OF) may allow the expansion of HIV infection counseling and testing (CT) while reducing the risk due to exposure to needles and blood collection. This study evaluated the performance and acceptability of two OF tests (the OraQuick Advance Rapid HIV-1/2 and the Chembio DPP HIV-1/2) from May to September 2009 in two CT sites in Maputo City, Mozambique, compared with results for the national testing algorithm. OF testing was conducted in parallel with whole blood-based testing according to the national HIV algorithm. Blood samples were collected as dried blood spot (DBS) specimens from all participants for quality assurance. HIV infection results were delivered according to the national algorithm. According to the national HIV algorithm, 512 (30.5%) samples were reactive, 1,151 (68.7%) were nonreactive, and 13 (0.8%) were discordant. All discordant cases were retested with an enzyme immunoassay followed by Western blotting, and five (38.5%) were confirmed as HIV positive. The OraQuick OF test showed 518 (30.9%) reactive samples and 1,158 (69.1%) nonreactive samples, with a sensitivity and specificity of 99.8% and 99.8%, respectively. The Chembio DPP OF test showed 519 (31.0%) reactive samples and 1,157 (69.0%) nonreactive samples with a sensitivity and specificity of 100% and 99.8%, respectively. The participants perceived blood testing (49.9%) to be more accurate than OF testing (46.8%). The OF tests showed high performance for the diagnosis of HIV infection when examined individually and in an algorithm, compared with results according to the national testing algorithm.

Saúde e nutriçäo de mulheres adolescentes no Brasil: I- aspectos sócio-econômicos / Health and nutrition of adolescent women in Brasil: I- socio-economics aspects

Estuda-se, a partir do banco de dados da Pesquisa Nacional de Saúde e Nutriçäo (PNSN) o contexto de vida de uma amostra de 6.921 mulheres adolescentes (10-19 anos) no Brasil, considerando-se principalmente, a renda domiciliar, o grau de escolaridade, as condiçöes de saneamento básico e a ocorrência de vícios psicos-sociais. O trabalho, primeiro de uma série de quatro artigos, resulta de uma tese de mestrado sobre o estado nutricional e saúde reprodutiva de mulheres no Brasil.

Aids: o que pensam os jovens; políticas e práticas educativas / Aids: what the youngers are thinking. Educational politics and practices

More than half of todayÆs newly HIV infections are amongyoung people. More than two decades after the first AIDS case in the world, youngsters still remain uninformed about their own sexuality, not to mention sexually transmitted diseases. Although they know or have heard something about aids they do not believe they are really at risk. How to contribute to include the young people on the aids debate, and make them more aware that they are co-responsible for mitigating the epidemic impact? This publication is the result of the project funded by JointUnited Nations Programme on HIV/Aids - UNAIDS, Young People Commitment and Co-responsibility in Preventing HIV/Aids Spread which main objective was to include the youth perception in the formulation and implementation of HIV/AIDS policies, strengthening the involvement of youngsters in the containment of the epidemic. This initiative gathered seven youngsters from the civilsociety, of different Brazilian geographic regions and social contexts. During two years they discussed their perceptions on relevant issues regarding the epidemic. The core of the debates was on youth leadership, sexuality, education, drugs, public health system, AIDS at schools, AIDS at workplaces and many others. It is important to highlight that the Youth Working Group, the first in his kind in Latin America, was based on interventions that seek the development of youth life skills. This publication intends to raise awareness by promoting strategies in response to the HIV/AIDS epidemic taking into account youth participation in the policy making process, as well as the implementation of preventive actions

Aids: o que pensam os jovens. Políticas e práticas educativas / Aids: what the youngers are thinking. Educational politics and practices

More than half of todayÆs newly HIV infections are amongyoung people. More than two decades after the first AIDS case in the world, youngsters still remain uninformed about their own sexuality, not to mention sexually transmitted diseases. Although they know or have heard something about aids they do not believe they are really at risk. How to contribute to include the young people on the aids debate, and make them more aware that they are co-responsible for mitigating the epidemic impact? This publication is the result of the project funded by JointUnited Nations Programme on HIV/Aids - UNAIDS, Young People Commitment and Co-responsibility in Preventing HIV/Aids Spread which main objective was to include the youth perception in the formulation and implementation of HIV/AIDS policies, strengthening the involvement of youngsters in the containment of the epidemic. This initiative gathered seven youngsters from the civilsociety, of different Brazilian geographic regions and social contexts. During two years they discussed their perceptions on relevant issues regarding the epidemic. The core of the debates was on youth leadership, sexuality, education, drugs, public health system, AIDS at schools, AIDS at workplaces and many others. It is important to highlight that the Youth Working Group, the first in his kind in Latin America, was based on interventions that seek the development of youth life skills. This publication intends to raise awareness by promoting strategies in response to the HIV/AIDS epidemic taking into account youth participation in the policy making process, as well as the implementation of preventive actions

Aids: o que pensam os jovens: políticas e práticas educativas / Aids: what the youngers are thinking: educational politics and practices

More than half of todayÆs newly HIV infections are amongyoung people. More than two decades after the first AIDS case in the world, youngsters still remain uninformed about their own sexuality, not to mention sexually transmitted diseases. Although they know or have heard something about aids they do not believe they are really at risk. How to contribute to include the young people on the aids debate, and make them more aware that they are co-responsible for mitigating the epidemic impact? This publication is the result of the project funded by JointUnited Nations Programme on HIV/Aids - UNAIDS, Young People Commitment and Co-responsibility in Preventing HIV/Aids Spread which main objective was to include the youth perception in the formulation and implementation of HIV/AIDS policies, strengthening the involvement of youngsters in the containment of the epidemic. This initiative gathered seven youngsters from the civilsociety, of different Brazilian geographic regions and social contexts. During two years they discussed their perceptions on relevant issues regarding the epidemic. The core of the debates was on youth leadership, sexuality, education, drugs, public health system, AIDS at schools, AIDS at workplaces and many others. It is important to highlight that the Youth Working Group, the first in his kind in Latin America, was based on interventions that seek the development of youth life skills. This publication intends to raise awareness by promoting strategies in response to the HIV/AIDS epidemic taking into account youth participation in the policy making process, as well as the implementation of preventive actions.