A pre-post quasi-experimental study: effect of an educational intervention on the quality of life, and coping strategies of people living with HIV (PLHIV).

INTRODUCTION: The current study provides people living with human immunodeficiency virus (PLHIV) the support to cope with this disease and to improve their quality of life, since their longevity has significantly increased. AIM: Investigating the effect of an educational intervention on PLHIV's strategies to cope with HIV. METHODOLOGY: Quasi-experimental, before-and-after study type, whose data were collected before and after educational intervention, was carried out with 75 PLHIV at a School Outpatient Clinic. The Brazilian version of the Ways of Coping Scale was herein used. It is a questionnaire comprising 4 disease-coping domains, namely: coping focused on problem, emotion and on seeking social support and religious practices. RESULTS: There was increased use of all coping-strategy domains after the educational intervention, as well as reduced standard deviation, and it pointed out that the recorded values were grouped closer to the mean therefore showing less variability. Coping focused on social support was the strategy mostly used after the educational intervention; it was followed by strategies focused on both emotion and problem. The least used strategy was the one focused on religion/fantasy. DISCUSSION: This study identified the need of introducing a new coping strategy focused on prejudice against patients with HIV.

Patterns of Chlamydia trachomatis and Neisseria gonorrhoeae in different anatomical sites among Pre-Exposure Prophylaxis (PrEP) users in Brazil.

BACKGROUND: The presence of untreated sexually transmitted infections (STIs) significantly increases the chance of acquiring HIV. In Brazil, testing for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) among Pre-Exposure Prophylaxis (PrEP) users is insufficient, and syndromic treatment is a priority in clinical practice. Multi-site testing for CT/NG improves thescreening of asymptomatic cases and ensures timely treatment. Therefore, it is essential for HIV prevention. This study aims to test the importance of two-site testing for better screening of these pathogens and to determine whether the presence of symptoms is an indicator of CT/NG infection. METHODS: This is a cross-sectional study carried out in four public infectious diseases clinics in São Paulo State, Brazil between January of 2022 and March of 2023. All participants had an anal swab and a first-pass or mid-stream urine collected for CT/NG analysis by Polymerase chain reaction (PCR). Data about sociodemographic, sexual behavioural and clinical aspects were collected. Pathway analysis was used to examine the direct and indirect relationships between variables according to the theoretical model. RESULTS: We screened 171 PrEP users which had two samples collected, resulting in 342 samples. Comparing the anatomic sites, the urine samples showed lower sensitivity for CT and NG than anal samples. Gonorrhoea was directly linked to lower age (ß= -0.161, p = 0.001). Time of PrEP use was directly associated with CT infection (ß = 0.202; p = 0.042) and inversely associated with dysuria (ß= -0.121, p = 0.009). Lower occurrence of yellow-green secretion was linked to detection of CT (ß= -0.089, p = 0.005) and NG (ß= -0.048, p = 0.002) infections. Foul-smelling discharge was directly associated with CT (ß = 0.275, p = 0.004) and NG (ß = 0.295, p = 0.037) infection. CONCLUSION: The symptoms are a bad indicator of CT and NG infection, and the screening must be done in more than one site since most of the positive results would be missed if only urines were tested. In the case of testing only one anatomical site, specifically the urethra, the CT/NG incidence and prevalence would be underestimated. The two-sites testing improves detection rates of CT/NG, and PrEP follow-up benefits people offering STI testing.

Human immunodeficiency virus epidemic scenery among brazilian women: a spatial analysis study.

BACKGROUND: Approximately 37.7 million people worldwide are infected with human immunodeficiency virus (HIV). Although HIV detection among women, they still representing 53% of population living with the virus. Spatial analysis techniques are powerful tools for combating HIV allowing the association of the phenomenon with socioeconomic and political factors. Therefore, the main goal of this study was to spatially analyze HIV prevalence among Brazilian women from 2007 to 2020. METHODS: ecological study was conducted using secondary databases of the Notifiable Diseases Information System (SINAN) for HIV and Acquired Immunodeficiency Syndrom (AIDS) in Brazilian women 15 years old and over. Age-adjusted HIV/AIDS incidence rates were analyzed using spatial distribution, autocorrelation, and spatiotemporal risk analysis techniques. RESULTS: During the study period, 119,890 cases of HIV/AIDS were reported among Brazilian women. The southeastern region had a higher age-adjusted HIV/AIDS incidence than other Brazilian regions. Hotspot HIV/AIDS incidence rates decreased in all Brazil. Piauí, Paraná, and Minas Gerais were the only states with an increased number of cold spots. Previous spatiotemporal risk zones were observed in the states of São Paulo, Rio Grande do Sul, and Rio de Janeiro. Belém was a risk zone with a later spatiotemporal risk. CONCLUSIONS: The efficiency of public policies fighting HIV has not been uniform among municipalities, although HIV/AIDS cases have decreased among Brazilian women. The social determinants of health in each municipality should be considered when local health authorities implement policies. Women empowerment should be promoted, and access to preventive, diagnostic, and treatment healthcare places should be expanded and guaranteed.

Increased use of psychoactive substances among Brazilian health care professionals during the COVID-19 pandemic.

This study aimed to estimate the prevalence of increased psychoactive substance use (PSU) and associated factors among health care professionals. A cross-sectional and analytical study with 12,086 Brazilian health professionals was undertaken. An online questionnaire was used to gather data concerning sociodemographic factors, increased consumption of alcoholic beverages, tobacco, and hypnotics or sedatives during the COVID-19 pandemic. The prevalence of tobacco, alcoholic beverages, and hypnotic or sedative consumption were 17.8 %, 69.0 % and 17.1 %, respectively. Regression analyses indicated that having no religion and social isolation were associated with increased PASU during the pandemic. COVID-19 pandemic stressors may increase PASU, and increased PASU may increase the risk of substance use disorders and substance use-related chronic diseases, such as cancer.

Predictors of HIV Status Disclosure to Sexual Partners Among People Living with HIV in Brazil.

The objective of this study was to identify the factors associated with the non-disclosure of HIV seropositivity among people living with HIV/AIDS undergoing antiretroviral treatment. A cross-sectional study was carried out in five HIV clinics in the interior of the state of São Paulo, Brazil. Logistic regression analysis was used to determine independent predictors of HIV status disclosure. It was found that 68.5% revealed their HIV seropositivity to their most recent sexual partner. The variables "casual partner" [OR 19.08, 95% CI (4.08, 20.23), p = 0.001], "sexual partners with negative HIV or unknown HIV" [OR 4.54, 95% CI (1.58, 1.01), p = 0.005], "multiple sexual partners" [OR = 3.17, 95% CI (1.34, 7.35), p = 0.009], and "lack of communication with the partner on HIV prevention"[OR = 8.3, 95% CI (3.88, 16.61), p = 0.001] were independently associated with non-disclosure of the diagnosis. Future HIV prevention interventions should encourage open communication between sexual partners.

RESUMEN: El objetivo de este estudio fue identificar los factores asociados con la no divulgación de la seropositividad al VIH entre las personas que viven con el VIH / SIDA en tratamiento antirretroviral. Se realizó un estudio transversal en cinco clínicas de VIH en el interior del estado de São Paulo, Brasil. Se utilizó un análisis de regresión logística para determinar predictores independientes de la revelación del estado del VIH. Se encontró que el 68,5% reveló su seropositividad al VIH a su pareja sexual más reciente. Las variables "pareja casual" [OR 19,08, IC 95% (4,08, 20,23), p = 0,001], "parejas sexuales con VIH negativo o VIH desconocido" [OR 4,54,95% IC 95% (1,58, 1,01), p = 0,005], "múltiples parejas sexuales" [OR 3,17, IC del 95% (1,34, 7,35), p = 0,009] y "falta de comunicación con la pareja sobre la prevención del VIH" [OR 8,3, IC 95% (3,88, 16,61), p = 0,001] se asociaron de forma independiente con la no divulgación del diagnóstico. Las futuras intervenciones de prevención del VIH deberían fomentar la comunicación abierta entre las parejas sexuales.

Knowledge of PEP and PrEP among people living with HIV/aids in Brazil.

BACKGROUND: Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP) are key to preventing sexual transmission of HIV, whose sexual partners are at high risk of acquiring HIV. We aimed to determine the factors associated with PrEP and PEP's knowledge as secondary prevention among people living with HIV/AIDS. METHOD: Cross-sectional analytical study carried out among people living with HIV/AIDS treated at five specialized services in the city of Ribeirão Preto, São Paulo, Brazil. Data were collected from July 2016 to July 2017. Individual interviews were conducted. We used multivariable logistic regression to determine factors associated with knowing PrEP and PEP. RESULTS: Of the 397 participants, 140 (35.26%) were heterosexual women aged 40 to 49 years (36.2%).Participants with less than 11 years of study (adjusted odds: 0.29; 95% CI: 0.13-0.60); who did not have a low viral load or did not know their viral load (adjusted odds: 0.29; 95% CI: 0.09-0.83) and those with casual partners (adjusted odds: 0.29; 95% CI: 0.09-0.83) were less likely to know about the PrEP. MSM (adjusted odds: 2.88; 95% CI: 1.59-5.3) and those who used alcohol during sexual intercourse (adjusted odds: 1.7; 95% CI: 1.0-2.8) were more likely to know about the PEP. CONCLUSIONS: The knowledge about PEP and PrEP is low in Brazil. This may undermine secondary prevention efforts. Educational interventions to raise awareness of these prevention methods are needed among people living with HIV and who have HIV-negative sexual partners.

Serodiscordance predictors among couples in the HIV context: implications for health care.

BACKGROUND: After HIV diagnosis, people maintain, reestablish their sexual lives, or build new relationships, often with HIV seronegative partners. Therefore, understanding the factors concerning couple-vulnerability is essential in order to design effective HIV preventive strategies. We examined HIV serodiscordant couples prevalence and their associated factors from a Brazilian city. METHODS: This is a cross-sectional analytical study carried out with people living with HIV (PLHIV) who had an active sex life and were engagement in HIV health care follow-up. Data were collected using a semi-structured questionnaire during individual interviews. We analyzed data using bivariate and multiple logistic regression analyses. RESULTS: There was 72.0% of HIV serodiscordant partnerships. Those who inconsistently used condoms (aOR: 0.3[0.13-0.7]) and/or had HIV detectable viral load (aOR: 0.29 [0.12-0.7]) were less likely to have an HIV serodiscordant sexual partner. On other hand, the lack of HIV transmission counseling by the health service (aOR: 5.08 [2.02-12.76]), or those who had a casual partner (aOR: 8.12 [1.7-38.8]) or a steady and casual one concomitantly (aOR: 24.82 [1.46-420.83]), were more likely to indicate an HIV serodiscordant partnership. CONCLUSION: The findings showed a high prevalence of serodiscordant partnerships in PLHIV. Greater visibility among couples in the health services is needed as well as a reassessment in order to provide PLHIV and their sexual partners with care strategies, by the health professionals.

The HIV epidemic in Colombia: spatial and temporal trends analysis.

BACKGROUND: Colombia has the fourth highest incidence rate of HIV/AIDS among all Latin American countries and it has been increasing since the 1980s. However, the number of studies that addresses this trend is limited. Here, we employed spatial and temporal trend analyses to study the behaviour of the epidemic in the Colombian territory. METHODS: Our sample included 72,994 cases of HIV/AIDS and 21,898 AIDS-related deaths reported to the National Ministry of Health between 2008 and 2016. We employed the joinpoint regression model to analyse the annual HIV/AIDS incidence and AIDS mortality rates. In the spatial analysis, we used univariate autocorrelation techniques and the Kernel density estimator. RESULTS: While the HIV/AIDS incidence had an increasing trend in Colombia, the AIDS mortality rate was stable. HIV/AIDS incidence and AIDS mortality showed a downward trend in the 0-14 age group. An upward trend was observed for HIV/AIDS incidence in people older than 15 years and with the highest trend in the 65 years and above group. AIDS mortality showed an increasing trend among people aged 65 years or older. The comparison between the sexes showed an upward trend of HIV/AIDS incidence in all age groups and AIDS-mortality rates in 65 years and above in men, while in women, the incidence was upward among those aged 45 years and above, and concerning the AIDS-mortality rate in the 45-64 group. The high-high clusters of HIV/AIDS incidence and AIDS mortality were located in the Andean and Caribbean regions. CONCLUSION: Our study found an upward trend in HIV/AIDS incidence and a stable trend in the AIDS mortality rate in Colombia. The downward trend in HIV/AIDS incidence and AIDS mortality rate in the 0-14 age group reflects the downwards mother-to-child HIV transmission. The upward trend in HIV/AIDS incidence in older women and AIDS mortality in younger women rates, compared with men, may be due to late diagnosis and treatment. The Caribbean and the 'coffee belt' regions were the most impacted by the HIV epidemic, most likely due to sexual tourism. Our results provide crucial information that may help Colombian health authorities fight HIV transmission.

Factors associated with self-reported non-completion of the hepatitis B vaccine series in men who have sex with men in Brazil.

BACKGROUND: The objective of the present study was to analyze the factors associated with non-completion of the hepatitis B vaccine series among men who have sex with men and use geosocial dating apps in Brazil. METHODS: This was a cross-sectional, population survey-based, analytical study, conducted exclusively online in all the regions of Brazil, with a sample of 1855 men who have sex with men. The data was collected between November 2016 and February 2017, using the social networking website Facebook. RESULTS: Univariate, bivariate and multivariate analyses showed that 4.7% of the participants reported receiving one dose of the vaccine, 12.5% two doses, 19.4% three doses, and 45.8% did not know. Multivariate analysis showed that level of education (OR = 0.31; CI 95% 0.14-0.72; p = 0.007), identification as bisexual (OR = 0.6; CI 95% 0.38-0.95; p = 0.030), HIV serological status (OR:2.3; CI 95% 1.58-3.34; p = < 0.001) and frequency of access to health services (OR = 2.38; CI 95% 1.53-3.72; p = < 0.001) were associated with not completing the vaccine series. Low completion of the hepatitis B vaccine series was detected in the population studied. CONCLUSION: Completion of the hepatitis B vaccine series was low among men who have sex with men and use geosocial dating apps in Brazil. The factors associated with non-completion were related to social, individual and healthcare (programmatic) vulnerabilities.

Factors related to the perceived stigmatization of people living with HIV.

OBJECTIVE: Analyzing the factors related to perceived stigmatization of people living with HIV. METHOD: A cross-sectional study conducted from September of 2014 to December 2015 with users from a specialized service in Minas Gerais. Data were collected through individual instrument application, organized in Microsoft Office Excel(r) 2010 spreadsheets and processed on IBM(r) SPSS 23.0. Descriptive statistics and multiple linear regression method were used for data analysis, adopting statistical significance set at 5.0% (p≤0.05). The study development met research ethics standards. RESULTS: 258 users participated in the study. Most were males between 40 and 49 years of age, single, with low educational level and income. Being between 40 and 49 years of age and having been hospitalized for complications related to HIV were positively associated predictors to increased stigmatization; while not having comorbidities and not being aware of exposure to HIV were predictors associated to reduced stigmatization. CONCLUSION: Given these results, we highlight that stigmatization can have an impact on the lives of people living with HIV, strengthening their feelings of guilt and shame, which can lead to depression, social isolation and abandoning treatment and clinical follow-up.

Adherence to antiretroviral therapy by people living with HIV/AIDS in a municipality of São Paulo. / Adesão à terapêutica antirretroviral de pessoas vivendo com HIV/aids em um município do interior paulista.

OBJECTIVE: To assess adherence to antiretroviral drugs by people living with HIV/AIDS and identify its association with sociodemographic and clinical variables. METHODS: Cross-sectional analytical study using a sociodemographic instrument and CEAT-HIV, with data collected in the period from 2014-2015. RESULTS: A 75.0% was identified as having a good/proper adhesion. It was found that individuals between ages 40 and 59 (p = 0.029) and with morethan eight years of formal education (p = 0.043) had a higher level of compliance, as well as those diagnosed with HIV/AIDS for more than 10 years (p = 0.002), CD4 count >350 cells/mm3 (p<0,001) and an undetectable viral load (p=0,025). CONCLUSION: In this study, a good adhesion between the subjects was identified and it was observed that individuals of older age, higher level of education, delayed diagnosis, high CD4 cell counts and undetectable viral load were associated with higher treatment adherence.

Nursing Assessment Tool for People With Liver Cirrhosis.

The aim of this study was to describe the process of developing a nursing assessment tool for hospitalized adult patients with liver cirrhosis. A descriptive study was carried out in three stages. First, we conducted a literature review to develop a data collection tool on the basis of the Conceptual Model of Wanda Horta. Second, the data collection tool was assessed through an expert panel. Third, we conducted the pilot testing in hospitalized patients. Most of the comments offered by the panel members were accepted to improve the tool. The final version was in the form of a questionnaire with open-closed questions. The panel members concluded that the tool was useful for accurate nursing diagnosis. Horta's Conceptual Model assisted with the development of this data collection tool to help nurses identify accurate nursing diagnosis in hospitalized patients with liver cirrhosis. We hope that the tool can be used by all nurses in clinical practice.

[Clinical treatment adherence of health care workers and students exposed to potentially infectious biological material]. / Seguimento clínico de profissionais e estudantes da área da saúde expostos a material biológico potencialmente contaminado.

OBJECTIVE: To assess adherence to clinical appointments by health care workers (HCW) and students who suffered accidents with potentially infectious biological material. METHOD: A retrospective cross-sectional study that assessed clinical records of accidents involving biological material between 2005 and 2010 in a specialized unit. RESULTS: A total of 461 individuals exposed to biological material were treated, of which 389 (84.4%) were HCWs and 72 (15.6%) students. Of the 461 exposed individuals, 307 (66.6%) attended a follow-up appointment. Individuals who had suffered an accident with a known source patient were 29 times more likely to show up to their scheduled follow-up appointments (OR: 29.98; CI95%: 16.09-55.83). CONCLUSION: The predictor in both univariate and multivariate analyses for adherence to clinical follow-up appointment was having a known source patient with nonreactive serology for the human immunodeficiency virus and/or hepatitis B and C.

Demographic, social, and clinical aspects associated with access to COVID-19 health care in Pará province, Brazilian Amazon.

Internal social disparities in the Brazilian Amazon became more evident during the COVID-19 pandemic. The aim of this work was to examine the demographic, social and clinical factors associated with access to COVID-19 health care in Pará Province in the Brazilian Amazon. This was an observational, cross-sectional, analytical study using a quantitative method through an online survey conducted from May to August 2023. People were eligible to participate if they were current residents of Pará, 18-years-old or older, with self-reported diagnoses of COVID-19 through rapid or laboratory tests. Participants completed an electronic survey was developed using Research Electronic Data Capture (REDCap) software-The adapted questionnaire "COVID-19 Global Clinical Platform: Case Report Form for Post-COVID Condition". Questions focused on access to COVID-19 treatment, demographic characteristics, COVID-19 vaccine and clinical characteristics. Respondent-driven sampling was applied to recruit participants. Multiple logistic regression was utilized to identify the associated factors. Overall, a total of 638 participants were included. The average age was 31.1 years. Access to COVID-19 health care was 68.65% (438/638). The participants most likely to access health care were those with moderate or severe COVID-19 (p = 0.000; OR: 19.8) and females (p = 0.001; OR: 1.99). Moreover, participants who used homemade tea or herbal medicines were less likely to receive health care for COVID-19 in health services (p = 0.002; OR: 0.54). Ensuring access to healthcare is important in a pandemic scenario.

[Working Education Program in Health: transforming experience of nursing teaching and practice]. / Programa de Educação pelo Trabalho para Saúde: experiência de transformação do ensino e prática de enfermagem.

This is an experience report of tutors from nursing Working Education Program in Health ( PET- Saúde ) from the Federal University of Alagoas, from May 2009 to April 2010. The objective of the nursing PET-Saúde was to develop health education actions aimed at the needs of the communities attended by the Family Health Units in Maceio, Alagoas. We conducted a health planning guided by the problem-based methodology. The activities resulted in changes in student learning and in the practice of nurses PET-Saúde , indicating the importance of this program for teaching and practice of nursing.

Barriers to Pre-Exposure Prophylaxis (PrEP) use for HIV: an integrative review.

OBJECTIVES: to identify and synthesize scientific evidence on the barriers and difficulties for Pre-exposure Prophylaxis (PrEP) use and compliance for HIV. METHODS: an integrative literature review, using the MEDLINE/PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Academic Search Premier and Scopus (Elsevier) databases. RESULTS: all (100%) the articles included identified that PrEP users experience some type of structural barrier related to health services such as long distance from the units, suboptimal logistics for taking pills and professional resistance to prescribing PrEP. Furthermore, 63.21% identified social barriers, such as stigma about sexuality and HIV, in addition to individual barriers such as alcohol use, adverse effects, and concerns about long-term toxicity. CONCLUSIONS: the barriers to PrEP use are multifactorial. Effective interventions are needed to support PrEP users in accessing, complying with, and retaining health services.

Amplified HIV Transmission Risk Among People Living With HIV in Southeast Brazil.

ABSTRACT: This study investigated the factors associated with amplified HIV transmission risk among people living with HIV from a city in southeast Brazil. A cross-sectional study was conducted with 397 people living with HIV recruited in infectious diseases clinics. Data on risk of HIV transmission, sociodemographic characteristics, sexual behaviors, professional counseling, serological HIV status, HIV-related clinical data, and beliefs about risk of HIV transmission were collected through interviews and medical records. Hierarchical ordered multinomial regression analyses were performed. Amplified HIV risk transmission was associated with lower age, alcohol consumption before having sex, illicit drug use before sexual intercourse, and not receiving professional counseling about HIV transmission. The belief that HIV can be transmitted to a partner not living with HIV was associated with lower likelihood of amplified risk for HIV transmission. Our findings suggest the importance of minimizing substance use before having sex, professional counseling, and beliefs about HIV transmission on amplified HIV risk transmission.

Cultural Adaptation and Validation of the Barriers to HIV Testing Scale-Karolinska Version for Brazilian Men Who Have Sex With Men.

ABSTRACT: The aim of this study was to perform the cultural adaptation and validation of the Barriers to HIV testing scale-Karolinska version for Brazilian men who have sex with men. A methodological study was conducted for cultural adaptation and validation of the scale. Reliability analyses, exploratory factor analysis, confirmatory factor analysis, and convergent and discriminant validity tests were performed. Four factors were extracted: F1, personal consequences; F2, structural barriers; F3, confidentiality; F4, economic consequences and individual concerns. Good fit indexes were obtained: (χ 2 )/GL (2.71); goodness of fit index (0.94); root-mean-square error of approximation (0.052; 90% CI [0.045-0.059]); Tucker-Lewis index (0.94); normed fit index (0.93); IFI (0.95); comparative fit index (0.95). Convergent validity results were greater than 0.7 for the four factors. The adapted version of the scale showed satisfactory reliability and validity for assessing barriers to HIV testing among men who have sex with men.