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de Souza IN, Pascom ARP, Spinelli MF, Dias GB, Barreira D, Miranda AE. Demographic and clinical characteristics of people diagnosed with active sexually transmitted infections among monkeypox cases in Brazil: the 2022 outbreak. Rev Inst Med Trop Sao Paulo 2024; 66:e20. [PMID: 38597520 PMCID: PMC11000497 DOI: 10.1590/s1678-9946202466020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/26/2024] [Indexed: 04/11/2024] Open
Abstract
The worldwide monkeypox (mpox) outbreak in 2022 showed a high frequency of sexually transmitted infections (STI). A cross-sectional study was carried out using secondary data from the Brazilian official mpox surveillance systems. A total of 10,169 mpox cases were identified, with a median age of 32 years. Among them, 92.3% were male at birth and 57.5% were men who have sex with other men (MSM). Approximately 11% were diagnosed with STI, including 5.8% with syphilis and 2.5% with genital herpes. Individuals aged from 25 to 34 years, MSM, individuals with HIV-positive status, and those manifesting skin eruptions or penile edema were associated with STI. Laboratory investigation for mpox must be implemented as a priority in STI clinics (especially for MSM) to mitigate neglected cases, ensure appropriate treatments, and prevent misdiagnoses.
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Affiliation(s)
- Isabella Nepomuceno de Souza
- Ministério da Saúde, Secretaria de Vigilância em Saúde e Ambiente, Departamento de HIV/Aids, Tuberculose, Hepatites Virais e Infecções Sexualmente Transmissíveis, Brasília, DF, Brazil
| | - Ana Roberta Pati Pascom
- Ministério da Saúde, Secretaria de Vigilância em Saúde e Ambiente, Departamento de HIV/Aids, Tuberculose, Hepatites Virais e Infecções Sexualmente Transmissíveis, Brasília, DF, Brazil
| | - Matheus Funke Spinelli
- Ministério da Saúde, Secretaria de Vigilância em Saúde e Ambiente, Departamento de HIV/Aids, Tuberculose, Hepatites Virais e Infecções Sexualmente Transmissíveis, Brasília, DF, Brazil
| | - Guilherme Borges Dias
- Ministério da Saúde, Secretaria de Vigilância em Saúde e Ambiente, Departamento de HIV/Aids, Tuberculose, Hepatites Virais e Infecções Sexualmente Transmissíveis, Brasília, DF, Brazil
| | - Draurio Barreira
- Ministério da Saúde, Secretaria de Vigilância em Saúde e Ambiente, Departamento de HIV/Aids, Tuberculose, Hepatites Virais e Infecções Sexualmente Transmissíveis, Brasília, DF, Brazil
| | - Angélica Espinosa Miranda
- Ministério da Saúde, Secretaria de Vigilância em Saúde e Ambiente, Departamento de HIV/Aids, Tuberculose, Hepatites Virais e Infecções Sexualmente Transmissíveis, Brasília, DF, Brazil
- Universidade Federal do Espírito Santo, Programa de Pós-Graduação em Doenças Infecciosas, Vitória, Espírito Santo, Brazil
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Miranda AE, Gaspar PC, Schörner MA, Barazzetti FH, Dias GB, Bigolin A, Pascom ARP, Barreira D, Bazzo ML. Prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Mycoplasma genitalium and risk factors among pregnant women in Brazil: Results from the national molecular diagnosis implementation project. Int J Gynaecol Obstet 2024. [PMID: 38425195 DOI: 10.1002/ijgo.15447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 01/20/2024] [Accepted: 02/09/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Sexually transmitted infections (STIs) are a public health problem. The aim of the present study was to assess the prevalence and risk factors associated with at least one STI (Chlamydia trachomatis [CT], Neisseria gonorrhoeae [NG], Trichomonas vaginalis [TV], and Mycoplasma genitalium [MG]) in Brazil. METHODS A cross-sectional study was conducted using secondary data from the pilot implementation of the National Service for molecular diagnosis of CT, NG, TV, and MG in pregnancy. We obtained Ministry of Health surveillance data from the implementation project. Data encompassing pregnant women aged 15-49 years from public antenatal clinics in Brazil in 2022 were included. RESULTS A total of 2728 data of pregnant women were analyzed. The prevalence of at least one infection was 21.0% (573), with the highest prevalence in the Southeast region (23.3%) and the lowest in the Center-West region (15.4%). The prevalence of CT was 9.9% (270), NG 0.6% (16), TV 6.7% (184), and MG 7.8% (212). Factors associated with any infection were from 15 to 24 years (AOR = 1.93; 95% CI: 1.58-2.35); reported family income up to US$400 (AOR = 1.79; 95% CI: 1.03-3.34); declared not living maritally with their partners (AOR = 1.90, 95% CI: 1.52-2.37) and had more than one sexual partner in their lifetime (AOR = 2.09, 95% CI: 1.55-2.86). CONCLUSION This study showed a high prevalence of at least one STI among pregnant women in Brazil, particularly among younger women. It also provides up-to-date national data on CT, NG, TV, and MG infections in this population. These findings underscore the importance of enhancing access to STI screening for young pregnant women within the Brazilian public health system.
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Affiliation(s)
- Angélica Espinosa Miranda
- Departamento de HIV/AIDS, Tuberculose, Hepatites Virais e Infecções Sexualmente Transmissíveis do Ministério da Saúde, Brasília, Distrito Federal, Brazil
- Programa de Pós-Graduação em Doenças Infecciosas da Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Pâmela Cristina Gaspar
- Departamento de HIV/AIDS, Tuberculose, Hepatites Virais e Infecções Sexualmente Transmissíveis do Ministério da Saúde, Brasília, Distrito Federal, Brazil
- Programa de Pós-Graduação em Saúde Coletiva da Universidade de Brasília, Brasília, Distrito Federal, Brazil
| | - Marcos André Schörner
- Laboratório de Biologia Molecular, Microbiologia e Sorologia do Programa de Pós-Graduação em Farmácia da Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Fernando Hartmann Barazzetti
- Laboratório de Biologia Molecular, Microbiologia e Sorologia do Programa de Pós-Graduação em Farmácia da Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Guilherme Borges Dias
- Departamento de HIV/AIDS, Tuberculose, Hepatites Virais e Infecções Sexualmente Transmissíveis do Ministério da Saúde, Brasília, Distrito Federal, Brazil
| | - Alisson Bigolin
- Departamento de HIV/AIDS, Tuberculose, Hepatites Virais e Infecções Sexualmente Transmissíveis do Ministério da Saúde, Brasília, Distrito Federal, Brazil
| | - Ana Roberta Pati Pascom
- Departamento de HIV/AIDS, Tuberculose, Hepatites Virais e Infecções Sexualmente Transmissíveis do Ministério da Saúde, Brasília, Distrito Federal, Brazil
| | - Dráurio Barreira
- Departamento de HIV/AIDS, Tuberculose, Hepatites Virais e Infecções Sexualmente Transmissíveis do Ministério da Saúde, Brasília, Distrito Federal, Brazil
| | - Maria Luiza Bazzo
- Laboratório de Biologia Molecular, Microbiologia e Sorologia do Programa de Pós-Graduação em Farmácia da Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
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Gaspar PC, Rowley J, Pascom ARP, Korenromp E, Pascual F, Pereira GFM, Miranda AE. Gonorrhea prevalence in adults in Brazil: Spectrum-STI trend estimation, 2000-2020. Rev Soc Bras Med Trop 2023; 56:e02032023. [PMID: 38018565 DOI: 10.1590/0037-8682-0203-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/18/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Gonorrhea is not a notifiable disease in Brazil, and the national health information system does not collect data on reported cases or infection prevalence. METHODS We compiled published data on gonorrhea prevalence in Brazil from cross-sectional surveys and clinical trials between 2000 and 2020. The study entry criteria included a sample size of 50 or more, and Neisseria gonorrhoeae infection detected in urine, urethral, anal, or cervicovaginal specimens using either Nucleic Acid Amplification Test or culture. Gonorrhea prevalence trends between 2000 and 2020 were generated using Spectrum-STI, a statistical trend-fitting model. RESULTS Forty-five studies with 59 gonorrhea prevalence data points were identified. Fifty data points were for women and represented 21,815 individuals, eight for men encompassing a total of 4,587 individuals, and one for transgender people comprising 345 individuals. The Spectrum-STI estimate for the prevalence of urogenital infection with gonorrhea in women 15-49 in 2020 was 0.63% (95% confidence interval (CI): 0.13-2.23) and was lower than the 1.05% estimated value for 2000 (95% CI: 0.36-2.79). The corresponding figures for men were 0.70% (95% CI: 0.16-2.44) and 1.14% (95% CI: 0.34-3.15). Anal prevalence estimates could not be generated because of insufficient data (three data points). CONCLUSIONS These results suggest that the overall prevalence of genitourinary gonococcal infections in Brazil is less than 1%. Data on gonorrhea prevalence in men and in populations at increased STI vulnerability are limited.
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Affiliation(s)
- Pâmela Cristina Gaspar
- Ministério da Saúde, Departamento de HIV/aids, tuberculose, hepatites virais e infecções sexualmente transmissíveis, Brasília, Distrito Federal, Brasil
- Universidade de Brasília, Programa de Pós-Graduação em Saúde Coletiva, Brasília, Distrito Federal, Brasil
| | - Jane Rowley
- World Health Organization, Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, Geneva, Switzerland
| | - Ana Roberta Pati Pascom
- Ministério da Saúde, Departamento de HIV/aids, tuberculose, hepatites virais e infecções sexualmente transmissíveis, Brasília, Distrito Federal, Brasil
| | - Eline Korenromp
- Avenir Health, Geneva, Switzerland
- United Nations Programme on HIV/AIDS, Data for Impact Department, Geneva, Switzerland
| | | | - Gerson Fernando Mendes Pereira
- Ministério da Saúde, Departamento de HIV/aids, tuberculose, hepatites virais e infecções sexualmente transmissíveis, Brasília, Distrito Federal, Brasil
| | - Angelica Espinosa Miranda
- Ministério da Saúde, Departamento de HIV/aids, tuberculose, hepatites virais e infecções sexualmente transmissíveis, Brasília, Distrito Federal, Brasil
- Universidade Federal do Espírito Santo, Programa de Pós-Graduação em Doenças Infecciosas, Vitória, Espírito Santo, Brasil
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Szwarcwald CL, Pascom ARP, de Souza Júnior PRB, Damacena GN, Castilho EA. Sexual behavior and self-declaration of sexual orientation among people 18-64 years in Brazil: results from the Knowledge, Attitudes, and Practices survey, 2013 and the National Health Survey, 2019. BMC Public Health 2023; 23:1476. [PMID: 37533022 PMCID: PMC10399013 DOI: 10.1186/s12889-023-16420-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/29/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Population surveys involving the monitoring of high-risk sexual behavior have been recognized as important public health tools to control the HIV epidemic and other sexually transmitted infections (STIs). METHODS Using data from the Knowledge, Attitudes, and Practices survey (PCAP-2013) and from the National Health Survey (PNS-2019), indicators of sexual behavior were compared according to sociodemographic characteristics among individuals aged 18-64 years, including size (%) estimates of men who have sex with men (MSM) and women who have sex with women (WSW). Specifically, the PNS-2019 prevalence estimates of homosexual, bisexual, heterosexual males and females were compared with those from the PCAP-2013. To compare PCAP and PNS proportional distributions, the Pearson's chi-square test, adjusted by the Rao-Scott's correction, was applied. RESULTS Size (%) estimates of MSM and WSW obtained by direct questions from the PCAP-2013, showed higher homosexuality prevalence estimates than those resulting from the PNS-2019 self-declared sexual orientation. Significant differences were found between the MSM proportions according to the PCAP-2013 (3.7%; 95% CI 3.1-4.4%) and to the PNS-2019 (2.2%; 95% CI 1.9-2.5), and between the WSW proportions (4.6%; 95% CI 4.0-5.4%) and (2.1%; 95% CI 1.8-2.4), respectively. Results from both surveys showed MSM and WSW prevalence estimates increase with educational level, decrease with age, and is larger among people who do not live with partner, live in urban areas and in state capitals. Regarding condom use at last sexual intercourse, no differences between the PCAP-2013 and the PNS-2019 estimates were found at the national level, but significant improvements were found for MSM, people aged 18-24 and 25-34 years, and individuals not living with a partner. CONCLUSIONS The underestimation of MSM and WSW prevalence by self-declared sexual orientation suggests that sexual minorities face many difficulties related to disclosing their sexuality and reinforces the importance of developing public health interventions for changing population attitudes and promoting sexual orientation disclosure. Moreover, the low use of condoms in both surveys (PCAP-2013 and PNS-2019) carried out 6 years apart highlights the need of public policies to expand prevention strategies for HIV infection and other STIs.
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Affiliation(s)
- Célia Landmann Szwarcwald
- Fundação Oswaldo Cruz, Instituto de Comunicação E Informação Científica E Tecnológica Em Saúde, Rio de Janeiro, RJ, Brasil.
| | | | | | - Giseli Nogueira Damacena
- Fundação Oswaldo Cruz, Instituto de Comunicação E Informação Científica E Tecnológica Em Saúde, Rio de Janeiro, RJ, Brasil
| | - Euclides Ayres Castilho
- Departamento de Medicina Preventiva, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
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Pascom ARP, de Souza IN, Krummenauer A, Duarte MMS, Sallas J, Rohlfs DB, Pereira GM, de Medeiros AC, Miranda AE. Epidemiological and clinical characteristics of monkeypox cases in Brazil in 2022: a cross-sectional study. Epidemiol Serv Saude 2022; 31:e2022851. [PMID: 36542047 PMCID: PMC9887958 DOI: 10.1590/s2237-96222022000300036] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/11/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE to describe epidemiological and clinical characteristics of monkeypox (MPX) in Brazil, from the identification of the first case, on June 7, 2022, to Epidemiological Week (EW) 39, ending on October 1, 2022. METHODS this was a descriptive study of cases notified to the Ministry of Health; trends were analyzed based on the number of confirmed and probable cases per EW; the cases were also described according to demographic and clinical variables. RESULTS out of 31,513 notifications, 23.8% were confirmed; 91.8% were male; 70.6% were cis men; and median age was 32 years. Fever (58.0%), adenomegaly (42.4%), headache (39.9%) and rash (37.0%) were the most frequent symptoms; 27.5% reported being immunosuppressed, 34.6% were living with HIV and 10.5% had a sexually transmitted infection; three deaths were recorded. CONCLUSION the MPX case profile was similar to that of other countries; surveillance actions must be strengthened to control the outbreak.
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Affiliation(s)
| | | | - Amanda Krummenauer
- Ministério da Saúde, Secretaria de Vigilância em Saúde,
Brasília, DF, Brazil
| | | | - Janaina Sallas
- Ministério da Saúde, Secretaria de Vigilância em Saúde,
Brasília, DF, Brazil
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Szwarcwald CL, Souza Júnior PRBD, Pascom ARP, Coelho RDA, Ribeiro RA, Damacena GN, Malta DC, Pimenta MC, Pereira GFM. HIV incidence estimates by sex and age group in the population aged 15 years or over, Brazil, 1986-2018. Rev Soc Bras Med Trop 2022; 55:e0231. [PMID: 35107522 PMCID: PMC9009433 DOI: 10.1590/0037-8682-0231-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/30/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION HIV incidence estimates are essential to monitor the progress of prevention
and control interventions. METHODS Data collected by Brazilian surveillance systems were used to derive HIV
incidence estimates by age group (15-24; 25+) and sex from 1986 to 2018.
This study used a back-calculation method based on the first CD4 count among
treatment-naïve cases. Incidence estimates for the population aged 15 years
or over were compared to Global Burden of Disease Study (GBD) estimates from
2000 to 2018. RESULTS Among young men (15-24 years), HIV incidence increased from 6,400 (95% CI:
4,900-8,400), in 2000, to 12,800 (95% CI: 10,800-15,900), in 2015, reaching
incidence rates higher than 70/100,000 inhabitants and an annual growth rate
of 3.7%. Among young women, HIV incidence decreased from 5,000 (95% CI:
4,200-6,100) to 3,200 (95% CI: 3,000-3,700). Men aged ≥25 years and both
female groups showed significant annual decreases in incidence rates from
2000 to 2018. In 2018, the estimated number of new infections was 48,500
(95% CI: 45300-57500), 34,800 (95% CI: 32800-41500) men, 13,600 (95% CI:
12,500-16,000) women. Improvements in the time from infection to diagnosis
and in the proportion of cases receiving antiretroviral therapy immediately
after diagnosis were found for all groups. Comparison with GBD estimates
shows similar rates for men with overlapping confidence intervals. Among
women, differences are higher mainly in more recent years. CONCLUSIONS The results indicate that efforts to control the HIV epidemic are having an
impact. However, there is an urgent need to address the vulnerability of
young men.
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Johnson LF, Kariminia A, Trickey A, Yiannoutsos CT, Ekouevi DK, Minga AK, Pascom ARP, Han WM, Zhang L, Althoff KN, Rebeiro PF, Murenzi G, Ross J, Hsiao NY, Marsh K. Achieving consistency in measures of HIV-1 viral suppression across countries: derivation of an adjustment based on international antiretroviral treatment cohort data. J Int AIDS Soc 2021; 24 Suppl 5:e25776. [PMID: 34546623 PMCID: PMC8454679 DOI: 10.1002/jia2.25776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 07/14/2021] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION The third of the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets is to achieve a 90% rate of viral suppression (HIV viral load <1000 HIV-1 RNA copies/ml) in patients on antiretroviral treatment (ART) by 2020. However, some countries use different thresholds when reporting viral suppression, and there is thus a need for an adjustment to standardize estimates to the <1000 threshold. We aim to propose such an adjustment, to support consistent monitoring of progress towards the "third 90" target. METHODS We considered three possible distributions for viral loads in ART patients: Weibull, Pareto and reverse Weibull (imposing an upper limit but no lower limit on the log scale). The models were fitted to data on viral load distributions in ART patients in the International epidemiology Databases to Evaluate AIDS (IeDEA) collaboration (representing seven global regions) and the ART Cohort Collaboration (representing Europe), using separate random effects models for adults and children. The models were validated using data from the World Health Organization (WHO) HIV drug resistance report and the Brazilian national ART programme. RESULTS Models were calibrated using 921,157 adult and 37,431 paediatric viral load measurements, over 2010-2019. The Pareto and reverse Weibull models provided the best fits to the data, but for all models, the "shape" parameters for the viral load distributions differed significantly between regions. The Weibull model performed best in the validation against the WHO drug resistance survey data, while the Pareto model produced uncertainty ranges that were too narrow, relative to the validation data. Based on these analyses, we recommend using the reverse Weibull model. For example, if a country reports an 80% rate of viral suppression at <200 copies/ml, this model estimates the proportion virally suppressed at <1000 copies/ml is 88.3% (0.800.56 ), with uncertainty range 85.5-90.6% (0.800.70 -0.800.44 ). CONCLUSIONS Estimates of viral suppression can change substantially depending on the threshold used in defining viral suppression. It is, therefore, important that viral suppression rates are standardized to the same threshold for the purpose of assessing progress towards UNAIDS targets. We have proposed a simple adjustment that allows this, and this has been incorporated into UNAIDS modelling software.
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Affiliation(s)
- Leigh F Johnson
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Azar Kariminia
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Adam Trickey
- Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Didier K Ekouevi
- Département de Santé Publique, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo.,Institut de Santé Publique, Epidémiologie et Développement (ISPED), Université de Bordeaux & Centre INSERM U1219 - Bordeaux Population Health, Bordeaux, France
| | | | - Ana Roberta Pati Pascom
- Department of Diseases of Chronic Condition and Sexually Transmitted Infections, Ministry of Health, Brasilia, Brazil
| | - Win Min Han
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Lei Zhang
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Keri N Althoff
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Peter F Rebeiro
- Department of Medicine and Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Gad Murenzi
- Rwanda Military Hospital and Research for Development-Rwanda, Kigali, Rwanda
| | - Jonathan Ross
- Division of General Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Nei-Yuan Hsiao
- Division of Virology, University of Cape Town, Cape Town, South Africa.,National Health Laboratory Service, Cape Town, South Africa
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Pereira IO, Pascom ARP, Mosimann G, Barros Perini F, Coelho RA, Rick F, Benzaken A, Avelino‐Silva VI. Post‐exposure prophylaxis following consented sexual exposure: impact of national recommendations on user profile, drug regimens and estimates of averted HIV infections. HIV Med 2020; 21:240-245. [DOI: 10.1111/hiv.12825] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2019] [Indexed: 11/29/2022]
Affiliation(s)
- IO Pereira
- Department of Chronic Conditions and Sexually Transmitted Infections Ministry of Health of Brazil Brasilia Brazil
| | - ARP Pascom
- Department of Chronic Conditions and Sexually Transmitted Infections Ministry of Health of Brazil Brasilia Brazil
| | - G Mosimann
- Department of Chronic Conditions and Sexually Transmitted Infections Ministry of Health of Brazil Brasilia Brazil
| | - F Barros Perini
- Department of Chronic Conditions and Sexually Transmitted Infections Ministry of Health of Brazil Brasilia Brazil
| | - RA Coelho
- Department of Chronic Conditions and Sexually Transmitted Infections Ministry of Health of Brazil Brasilia Brazil
| | - F Rick
- Department of Chronic Conditions and Sexually Transmitted Infections Ministry of Health of Brazil Brasilia Brazil
- Aids Health Care Foundation Global Programm Sao Paulo Brazil
| | - A Benzaken
- Aids Health Care Foundation Global Programm Sao Paulo Brazil
- Tropical Medicine Foundation Heitor Vieira Dourado Manaus Brazil
| | - VI Avelino‐Silva
- Department of Infectious and Parasitic Diseases University of Sao Paulo Medical School Sao Paulo Brazil
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Damacena GN, Szwarcwald CL, Souza Júnior PRBD, Ferreira Júnior ODC, Almeida WDSD, Pascom ARP, Pimenta MC. Application of the Respondent-Driven Sampling methodology in a biological and behavioral surveillance survey among female sex workers, Brazil, 2016. Rev Bras Epidemiol 2019; 22Suppl 1:e190002. [PMID: 31576978 DOI: 10.1590/1980-549720190002.supl.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 07/03/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Respondent-Driven Sampling (RDS) has been used in surveys with key populations at risk of HIV infection, such as female sex workers (FSW). This article describes the application of the RDS method among FSW in 12 Brazilian cities, during a survey carried out in 2016. METHODOLOGY A biological and behavioral surveillance study carried out in 12 Brazilian cities, with a minimum sample of 350 FSW in each city. Tests were performed for HIV, syphilis, and hepatitis B and C infections. A social-behavioral questionnaire was also applied. RESULTS The sample was comprised of 4,328 FSW. For data analysis, the sample was weighted according to each participant's network size (due consideration to the implications of RDS complex design and to the effects of homophilia are recommended). DISCUSSION Although RDS methods for obtaining a statistical sample are based on strong statistical assumptions, allowing for an estimation of statistical parameters, with each new application the method has been rethought. In the analysis of whole-sample data, estimators were robust and compatible with those found in 2009. However, there were significant variations according to each city. CONCLUSION The achieved sample size was of great relevance for assessing progress and identifying problems regarding the prevention and treatment of Sexually Transmitted Infections. New RDS studies with more time and operational resources should be envisaged. This could further network development.
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Affiliation(s)
- Giseli Nogueira Damacena
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation - Rio de Janeiro (RJ), Brazil
| | - Célia Landmann Szwarcwald
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation - Rio de Janeiro (RJ), Brazil
| | | | | | - Wanessa da Silva de Almeida
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation - Rio de Janeiro (RJ), Brazil
| | - Ana Roberta Pati Pascom
- Department of Chronic Condition Diseases and Sexually Transmitted Infections, Ministry of Health - Brasília (DF), Brazil
| | - Maria Cristina Pimenta
- Department of Chronic Condition Diseases and Sexually Transmitted Infections, Ministry of Health - Brasília (DF), Brazil
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Mangal TD, Pascom ARP, Vesga JF, Meireles MV, Benzaken AS, Hallett TB. Estimating HIV incidence from surveillance data indicates a second wave of infections in Brazil. Epidemics 2019; 27:77-85. [PMID: 30772250 PMCID: PMC6543066 DOI: 10.1016/j.epidem.2019.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 01/31/2019] [Accepted: 02/04/2019] [Indexed: 12/25/2022] Open
Abstract
Emerging evidence suggests that HIV incidence rates in Brazil, particularly among men, may be rising. Here we use Brazil's integrated health systems data to develop a mathematical model, reproducing the complex surveillance systems and providing estimates of HIV incidence, number of people living with HIV (PLHIV), reporting rates and ART initiation rates. An age-structured deterministic model with a flexible spline was used to describe the natural history of HIV along with reporting and treatment rates. Individual-level surveillance data for 1,077,295 cases (HIV/AIDS diagnoses, ART dispensations, CD4 counts and HIV/AIDS-related deaths) were used to calibrate the model using Bayesian inference. The results showed a second wave of infections occurring after 2001 and 56,000 (95% Credible Interval 43,000-71,000) new infections in 2015, 37,000 (95% CrI 28,000-54,000) infections in men and 16,000 (95% CrI 10,000-23,000) in women. The estimated number of PLHIV by end-2015 was 838,000 (95% CrI 675,000-1,083,000), with 80% (95% CrI 62-98%) of those individuals reported to the Ministry of Health. Women were more likely to be diagnosed and reported than men; 86.8% of infected women had been reported compared with 75.7% of men. Likewise, ART initiation rates for women were higher than those for men. The second wave contradicts previous estimates of HIV incidence trends in Brazil and there were persistent differences in the rates of accessing care between men and women. Nevertheless, the Brazilian HIV program has achieved high rates of detection and treatment, making considerable progress over the past ten years.
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Affiliation(s)
- Tara D Mangal
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, United Kingdom.
| | - Ana Roberta Pati Pascom
- Ministry of Health, Department of STI, HIV/AIDS and Viral Hepatitis, SRTVN Quadra 701, Lote D, Edifício PO700, CEP: 70719-040, Brasilia, Distrito Federal, Brazil
| | - Juan F Vesga
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, United Kingdom
| | - Mariana Veloso Meireles
- Ministry of Health, Department of STI, HIV/AIDS and Viral Hepatitis, SRTVN Quadra 701, Lote D, Edifício PO700, CEP: 70719-040, Brasilia, Distrito Federal, Brazil
| | - Adele Schwartz Benzaken
- Ministry of Health, Department of STI, HIV/AIDS and Viral Hepatitis, SRTVN Quadra 701, Lote D, Edifício PO700, CEP: 70719-040, Brasilia, Distrito Federal, Brazil
| | - Timothy B Hallett
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, United Kingdom
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Kendall C, Kerr L, Mota RS, Guimarães MDC, Leal AF, Merchan-Hamann E, Dourado IC, Veras MA, Brito AMD, Pontes AK, Castro ARCM, Macena RHM, Knauth D, Linda LC, Oliveira LC, Cavalcante S, Camillo AC, Bermudez XPD, Moreira RC, Benzaken AS, Pereira G, Pascom ARP, Pimenta C, Grazina Johnston L. The 12 city HIV Surveillance Survey among MSM in Brazil 2016 using respondent-driven sampling: a description of methods and RDS diagnostics. Rev Bras Epidemiol 2019; 22:e190004. [PMID: 30892467 DOI: 10.1590/1980-549720190004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 05/15/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION This paper details the methods used in the second national Biological and Behavioral Surveillance Survey (BBSS) of HIV, syphilis, and hepatitis B and C among men who have sex with men in Brazil. METHODS Respondent-driven sampling (RDS) was used in 12 cities in 2016. The targeted sample size was initiated with five to six seeds in each city. HIV, syphilis, and Hepatitis B and C rapid tests were offered to participants. RDS Analyst with Gile's successive sampling (SS) estimator was used to adjust results as recommended and a weight for each individual was generated for further analysis. Data for the 12 cities were merged and analyzed using Stata 14.0 complex survey data tools with each city treated as its own stratum. RESULTS Duration of data collection varied from 5.9 to 17.6 weeks. 4,176 men were recruited in the 12 cities. Two sites failed to achieve targeted sample size due to a six-month delay in local IRB approval. No city failed to reach convergence in our major outcome variable (HIV). CONCLUSION The comprehensive BBSS was completed as planned and on budget. The description of methods here is more detailed than usual, due to new diagnostic tools and requirements of the new STROBE-RDS guidelines.
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Affiliation(s)
- Carl Kendall
- Tulane University, Global Community Health and Behavioral Sciences - New Orleans (LA), United States.,Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará - Fortaleza (CE), Brazil
| | - Ligia Kerr
- Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará - Fortaleza (CE), Brazil
| | - Rosa Salani Mota
- Departamento de Estatística e Matemática Aplicada, Universidade Federal do Ceará - Fortaleza (CE), Brazil
| | | | - Andrea Fachel Leal
- Departamento de Sociologia, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
| | - Edgar Merchan-Hamann
- Faculdade de Ciências da Saúde, Saúde Coletiva, Universidade de Brasília - Brasília (DF), Brazil
| | - Inês Costa Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia - Salvador (BA), Brazil
| | - Maria Amélia Veras
- Departamento de Saúde Coletiva, Faculdade de Ciências Médicas da Santa Casa de São Paulo - São Paulo (SP), Brazil
| | - Ana Maria de Brito
- Departamento de Saúde Coletiva, Centro de Pesquisas Aggeu Magalhães - Recife, PE, Brazil
| | - Alexandre Kerr Pontes
- Instituto de Psicologia, Universidade Federal do Rio de Janeiro - Rio de Janeiro (RJ), Brazil
| | | | | | - Daniela Knauth
- Departamento de Medicina Social, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
| | | | | | | | | | | | | | - Adele Schwartz Benzaken
- Departamento de Vigilância, Prevenção e Controle das IST, do HIV/Aids e das Hepatites Virais, Ministério da Saúde - Brasília (DF), Brazil
| | - Gerson Pereira
- Departamento de Vigilância, Prevenção e Controle das IST, do HIV/Aids e das Hepatites Virais, Ministério da Saúde - Brasília (DF), Brazil
| | - Ana Roberta Pati Pascom
- Departamento de Vigilância, Prevenção e Controle das IST, do HIV/Aids e das Hepatites Virais, Ministério da Saúde - Brasília (DF), Brazil
| | - Cristina Pimenta
- Departamento de Vigilância, Prevenção e Controle das IST, do HIV/Aids e das Hepatites Virais, Ministério da Saúde - Brasília (DF), Brazil
| | - Lisa Grazina Johnston
- Tulane University, Global Community Health and Behavioral Sciences - New Orleans (LA), United States
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Mangal TD, Meireles MV, Pascom ARP, de Almeida Coelho R, Benzaken AS, Hallett TB. Determinants of survival of people living with HIV/AIDS on antiretroviral therapy in Brazil 2006-2015. BMC Infect Dis 2019; 19:206. [PMID: 30819120 PMCID: PMC6396460 DOI: 10.1186/s12879-019-3844-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 02/21/2019] [Indexed: 11/10/2022] Open
Abstract
Background We compared AIDS-related mortality rates in people living with HIV (PLHIV) starting antiretroviral therapy (ART) in Brazil during 2006–2015 and examined associated risk factors . Methods Data on ART use in PLHIV and AIDS mortality in Brazil was analysed with piecewise constant exponential models. Mortality rates and hazard ratios were estimated for 0–6, 6–12, 13–24, 25–36 and > 36 months of ART use and adjusted for region, age, sex, baseline CD4 cell count and calendar year of ART initiation. An additional analysis restricted to those with data on risk group was also performed. Results 269,076 individuals were included in the analysis, 165,643 (62%) males and 103,433 (38%) females, with 1,783,305 person-years of follow-up time. 21,749 AIDS deaths were reported and 8898 deaths occurred in the first year of ART. The risk of death in the first six months decreased with early ART initiation; those starting treatment early with CD4 > 500 cells per μL had a hazard ratio of 0.06 (95% CI 0.05–0.07) compared with CD4 < 200 cells per μL. Older age, male sex, intravenous drug use and starting treatment in earlier calendar years were associated with higher mortality rates. People living in the North, Northeast and South of Brazil experienced significantly higher AIDS mortality rates than those in the Southeast (HR 1.44, [95% CI 1.35–1.54], 1.10 [1.05–1.16] and 1.22 [1.17–1.28] respectively). Conclusions Early treatment is likely to have contributed to the improved survival in PLHIV on ART, with the greatest benefits observed in women, younger age-groups and those living in the North. Electronic supplementary material The online version of this article (10.1186/s12879-019-3844-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tara D Mangal
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.
| | - Mariana Veloso Meireles
- Ministry of Health, Department of STI, HIV/AIDS and Viral Hepatitis, SRTVN Quadra 701, Lote D, Edifício PO700 CEP, Brasília, Distrito Federal, 70719-040, Brazil.
| | - Ana Roberta Pati Pascom
- Ministry of Health, Department of STI, HIV/AIDS and Viral Hepatitis, SRTVN Quadra 701, Lote D, Edifício PO700 CEP, Brasília, Distrito Federal, 70719-040, Brazil
| | - Ronaldo de Almeida Coelho
- Ministry of Health, Department of STI, HIV/AIDS and Viral Hepatitis, SRTVN Quadra 701, Lote D, Edifício PO700 CEP, Brasília, Distrito Federal, 70719-040, Brazil
| | - Adele Schwartz Benzaken
- Ministry of Health, Department of STI, HIV/AIDS and Viral Hepatitis, SRTVN Quadra 701, Lote D, Edifício PO700 CEP, Brasília, Distrito Federal, 70719-040, Brazil
| | - Timothy B Hallett
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK
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Abstract
The aim of this study was to identify sociodemographic factors associated with attrition in the 3 steps of the HIV continuum of care related to the 90-90-90 targets - access to diagnosis, treatment initiation, and virologic suppression, in Brazilian adults (15 years or older), in 2016.Programmatic data were obtained from 2 information systems from the Brazilian Ministry of Health, which register all antiretroviral therapy (ART) dispensations and all CD4 and viral load counts (VL) performed within the country's public health system. The 3 attrition indicators were late presentation to care, defined as a first CD4 count <350 cells/mm among ART-naive individuals who performed a first CD4 count in 2016; not being on ART, defined as having no recorded dispensation within the last 100 days of the year, among those who were linked to care in 2016; and not being virologically suppressed, defined as having the last recorded VL >200 copies/mL in 2016, among those with a recorded VL count who were on treatment for at least 6 months. Association of sociodemographic factors with these indicators was analyzed by unconditional logistic regression analysis.Lower educational level and black/brown/indigenous race/color were associated with worse outcomes in the 3 indicators. Environmental indicators, namely the region, size, and social vulnerability index of the municipality of residence, also played an important role in the models. Younger age was strongly associated with not being on ART and not showing virological suppression.Our findings help identify the barriers in the different stages of the HIV continuum of care, which need to be addressed in order to progress toward the achievement of the 90-90-90 targets.
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Kerr L, Kendall C, Guimarães MDC, Salani Mota R, Veras MA, Dourado I, Maria de Brito A, Merchan-Hamann E, Pontes AK, Leal AF, Knauth D, Castro ARCM, Macena RHM, Lima LNC, Oliveira LC, Cavalcantee MDS, Benzaken AS, Pereira G, Pimenta C, Pascom ARP, Bermudez XPD, Moreira RC, Brígido LFM, Camillo AC, McFarland W, Johnston LG. HIV prevalence among men who have sex with men in Brazil: results of the 2nd national survey using respondent-driven sampling. Medicine (Baltimore) 2018; 97:S9-S15. [PMID: 29794604 PMCID: PMC5991534 DOI: 10.1097/md.0000000000010573] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 04/05/2018] [Indexed: 12/11/2022] Open
Abstract
This paper reports human immuno-deficiency virus (HIV) prevalence in the 2nd National Biological and Behavioral Surveillance Survey (BBSS) among men who have sex with men (MSM) in 12 cities in Brazil using respondent-driven sampling (RDS).Following formative research, RDS was applied in 12 cities in the 5 macroregions of Brazil between June and December 2016 to recruit MSM for BBSS. The target sample size was 350 per city. Five to 6 seeds were initially selected to initiate recruitment and coupons and interviews were managed online. On-site rapid testing was used for HIV screening, and confirmed by a 2nd test. Participants were weighted using Gile estimator. Data from all 12 cities were merged and analyzed with Stata 14.0 complex survey data analysis tools in which each city was treated as its own strata. Missing data for those who did not test were imputed HIV+ if they reported testing positive before and were taking antiretroviral therapy.A total of 4176 men were recruited in the 12 cities. The average time to completion was 10.2 weeks. The longest chain length varied from 8 to 21 waves. The sample size was achieved in all but 2 cities.A total of 3958 of the 4176 respondents agreed to test for HIV (90.2%). For results without imputation, 17.5% (95%CI: 14.7-20.7) of our sample was HIV positive. With imputation, 18.4% (95%CI: 15.4-21.7) were seropositive.HIV prevalence increased beyond expectations from the results of the 2009 survey (12.1%; 95%CI: 10.0-14.5) to 18.4%; CI95%: 15.4 to 21.7 in 2016. This increase accompanies Brazil's focus on the treatment to prevention strategy, and a decrease in support for community-based organizations and community prevention programs.
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Affiliation(s)
- Ligia Kerr
- Faculdade de Medicina, Universidade Federal do Ceará, Departamento de Saúde Comunitária, Fortaleza, CE, Brasil
| | - Carl Kendall
- Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, LA, USA, Faculdade de Medicina da Universidade Federal do Ceará, Saúde Comunitária, Fortaleza, CE
| | | | - Rosa Salani Mota
- Departamento de Estatística e Matemática Aplicada, Universidade Federal do Ceará, Fortaleza, CE
| | - Maria Amélia Veras
- Departamento de Saúde Coletiva, Faculdade de Ciências Medicas da Santa Casa de São Paulo, São Paulo, SP
| | - Inês Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, BA
| | | | - Edgar Merchan-Hamann
- Centro de Ciências da Saúde – Departamento de Saúde Coletiva, Universidade de Brasília Faculdade de Ciências da Saúde, Brasília
| | | | | | - Daniela Knauth
- Departamento de Medicina Social, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS
| | | | | | | | | | | | | | - Gerson Pereira
- Departamento de IST e HIV/AIDS e Hepatites Virais, Ministério da Saúde, Brasília
| | - Cristina Pimenta
- Departamento de IST e HIV/AIDS e Hepatites Virais, Ministério da Saúde, Brasília
| | | | | | | | | | | | - Willi McFarland
- Center for Global Health, University of California, San Francisco, CA
| | - Lisa G. Johnston
- Tulane School of Public Health and Tropical Medicine, Department of Global Community Health and Behavioral Sciences, New Orleans, LA, USA
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Abstract
In 2015, a community-wide intervention was launched in the city of Curitiba to evaluate the uptake of multiple HIV testing. A three-stage cluster sampling of 4800 men aged 15-64 years was selected in Curitiba. Logistic regression models were used to establish driving factors of HIV testing over the past 12 months. In the total sample, 49.5% have tested for HIV once in lifetime and 18.7% in the last 12 months. Among MSM, the proportions were much higher: 75.9% and 47.8% respectively. In the multivariate analysis, a significantly higher likelihood of HIV testing was found for young men (15-24 years), men with better educational level, those with more than 6 casual partners, and MSM compared to heterosexual men. The results indicate that the intervention to increase HIV diagnosis has substantially expanded MSM access to HIV testing.
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Affiliation(s)
- Celia Landmann Szwarcwald
- a Institute of Communication and Information Science and Technology in Health , Oswaldo Cruz Foundation , Rio de Janeiro , Brazil
| | - Giseli Nogueira Damacena
- a Institute of Communication and Information Science and Technology in Health , Oswaldo Cruz Foundation , Rio de Janeiro , Brazil
| | - Raquel Lima Miranda
- b Division of Global HIV & TB , Centers for Disease Control and Prevention , Brasília , Brazil
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de Freitas MA, Miranda AE, Pascom ARP, de Oliveira SB, Mesquita F, Ford N. Antiretroviral therapy status among people who died of AIDS-related causes from 2009 to 2013 in Brazil: a population-based study. Trop Med Int Health 2016; 21:1452-1457. [PMID: 27696635 DOI: 10.1111/tmi.12778] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the antiretroviral therapy status of people living with HIV (PLHIV) who died of AIDS-related causes between 2009 and 2013. METHODS We conducted a cross-sectional, population-based study. Data were obtained by linking the mortality information system and the national ART dispensing database. Trends were modelled using linear regression analysis. RESULTS A total of 61 425 AIDS-related deaths were registered in Brazil between 2009 and 2013. Median age at death was 41 years (IQR: 33-49), and 65.7% (40 337) of deaths were among men; 47.2% (29 004) of PLHIV who died during the study period had never started treatment, 7.0% (4274) had discontinued it, 15.9% (9775) were on ART for 6 months or less and 29.9% (18 372) were on ART for more than 6 months. Only 1.3% of PLHIV were on third-line ARV regimens when they died. CONCLUSIONS AIDS-related mortality remains a challenge even in a context of sustained universal access to antiretroviral treatment due to failure of service provision, not to therapy failure. Robust health policies closing gaps in the HIV continuum of care are crucial to further reduce mortality.
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Affiliation(s)
| | | | | | | | | | - Nathan Ford
- World Health Organization, Geneva, Switzerland
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Pascom ARP, Dutra de Barros CH, Lobo TDDM, Pasini EN, Comparini RA, Caldas de Mesquita F. Point-of-care HIV tests done by peers, Brazil. Bull World Health Organ 2016; 94:626-30. [PMID: 27516641 PMCID: PMC4969986 DOI: 10.2471/blt.15.162461] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 02/25/2016] [Accepted: 03/10/2016] [Indexed: 01/30/2023] Open
Abstract
Problem Early diagnosis of infections with human immunodeficiency virus (HIV) is needed – especially among key populations such as sex workers, transgender people, men who have sex with men and people who use drugs. Approach The Brazilian Ministry of Health developed a strategy called Viva Melhor Sabendo (“live better knowing”) to increase HIV testing among key populations. In partnership with nongovernmental organizations (NGOs), a peer point-of-care testing intervention, using an oral fluid rapid test, was introduced at social venues for key populations at different times of the day. Local setting Key populations in Brazil can have 40 times higher HIV prevalence than the general population (14.8% versus 0.4%). Relevant changes Legislation was reinterpreted, so that oral fluid rapid tests could be administered by any person trained in rapid testing by the health ministry. Between January 2014 and March 2015, 29 723 oral fluid tests were administered; 791 (2.7%) were positive. Among the key populations, transgender people had the greatest proportion of positive results (10.7%; 172/1612), followed by men who declared themselves as commercial sex workers (8.7%; 165/1889) and men who have sex with men (4.8%; 292/6055). Lessons learnt The strategy improved access to HIV testing. Testing done by peers at times and locations suitable for key populations increased acceptance of testing. Working with relevant NGOs is a useful approach when reaching out to these key populations.
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Affiliation(s)
- Ana Roberta Pati Pascom
- STI, AIDS and Viral Hepatitis Department, Health Surveillance Secretariat, Ministry of Health, Setor Administrativo Federal Sul (SAFS) 02 - Bloco F - Ed. Premium Torre I, Sala 4, 70.070-600, Brasília, DF, Brazil
| | - Clarissa Habckost Dutra de Barros
- STI, AIDS and Viral Hepatitis Department, Health Surveillance Secretariat, Ministry of Health, Setor Administrativo Federal Sul (SAFS) 02 - Bloco F - Ed. Premium Torre I, Sala 4, 70.070-600, Brasília, DF, Brazil
| | - Tainah Dourado de Miranda Lobo
- STI, AIDS and Viral Hepatitis Department, Health Surveillance Secretariat, Ministry of Health, Setor Administrativo Federal Sul (SAFS) 02 - Bloco F - Ed. Premium Torre I, Sala 4, 70.070-600, Brasília, DF, Brazil
| | - Elisiane Nelcina Pasini
- STI, AIDS and Viral Hepatitis Department, Health Surveillance Secretariat, Ministry of Health, Setor Administrativo Federal Sul (SAFS) 02 - Bloco F - Ed. Premium Torre I, Sala 4, 70.070-600, Brasília, DF, Brazil
| | - Regina Aparecida Comparini
- STI, AIDS and Viral Hepatitis Department, Health Surveillance Secretariat, Ministry of Health, Setor Administrativo Federal Sul (SAFS) 02 - Bloco F - Ed. Premium Torre I, Sala 4, 70.070-600, Brasília, DF, Brazil
| | - Fábio Caldas de Mesquita
- STI, AIDS and Viral Hepatitis Department, Health Surveillance Secretariat, Ministry of Health, Setor Administrativo Federal Sul (SAFS) 02 - Bloco F - Ed. Premium Torre I, Sala 4, 70.070-600, Brasília, DF, Brazil
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de Oliveira SB, Sabidó M, Pascom ARP, Gisiviez JM, Benzaken AS, Mesquita F. State of viral hepatitis knowledge and testing uptake in Brazil: Findings from the National Survey of Knowledge, Attitudes and Practices (PCAP-2013). Hepatol Med Policy 2016; 1:3. [PMID: 30288306 PMCID: PMC5898510 DOI: 10.1186/s41124-016-0003-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 03/16/2016] [Indexed: 12/14/2022]
Abstract
Background Data were obtained from the third National Survey of Knowledge, Attitudes and Practices of HIV and other Sexually Transmitted Infections (STI) (PCAP-2013) and used to describe the current state of viral hepatitis (VH) knowledge and screening as well as the prevalence of viral hepatitis B (HBV) vaccination in Brazil and to assess the factors associated with testing uptake. Methods A probability sample survey of 12,000 individuals (50 % men) aged between 15 and 64 years was conducted between October and December of 2013. The participants completed the survey in their own homes through computer-assisted face-to-face interviews and self-interviews. We analysed data related to self-reported knowledge of VH routes and screening uptake after weighting the variables to account for unequal selection probabilities and correct for differences in sex, age and region according to 2010 census figures. Results The levels of correct knowledge regarding HBV and HCV transmission through unprotected sex were 33.1 and 34.3 %, respectively. The levels of correct knowledge regarding HBV and HCV transmission through tattooing/piercing were 26.4 and 24.5 %, respectively. Overall, 29 % of the respondents reported having underwent VH screening and 73.9 % reported prior HBV vaccination. VH screening was associated with the following factors: age between 25 and 49 years (adjusted male odds ratio (OR): 2.29, [95 % confidence interval (CI): 1.83–2.87]; female OR: 1.36, [95 % CI: 1.10-1.67]); age between 50 and 64 years (male OR: 1.52, [CI: 1.13–2.03]; female OR: 1.29, [CI: 1.02–1.63]); initial sexual intercourse before the age of 15 years in men (OR: 1.32, [CI: 1.10–1.57]); higher socioeconomic statuses of group A (male OR: 2.38, [CI: 1.81–3.13]; female OR: 2.10, [CI: 1.66–2.68]) and B (female OR: 1.56, [CI: 1.27–1.93]); and having ever been tested for HIV (male OR: 7.50, [CI: 5.82–8.53]; female OR: 7.13, [CI: 5.97–8.54]). Conclusions This study revealed low levels of knowledge regarding VH transmission and screening practices in the general Brazilian population, especially among younger individuals and those with lower socioeconomic status. Efforts to enhance awareness campaigns and expand testing sites are needed to remove barriers to testing.
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Affiliation(s)
| | - Meritxell Sabidó
- 2Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Avenida Pedro Teixeira 25, CEP: 69040-000 Manaus, AM Brazil
| | - Ana Roberta Pati Pascom
- 1Department of STI, AIDS, and Viral Hepatitis, Brazil Ministry of Health, Brasília, DF Brazil
| | | | - Adele Schwartz Benzaken
- 1Department of STI, AIDS, and Viral Hepatitis, Brazil Ministry of Health, Brasília, DF Brazil.,2Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Avenida Pedro Teixeira 25, CEP: 69040-000 Manaus, AM Brazil
| | - Fábio Mesquita
- 1Department of STI, AIDS, and Viral Hepatitis, Brazil Ministry of Health, Brasília, DF Brazil
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Szwarcwald CL, de Souza Júnior PRB, Pascom ARP, Ferreira Junior ODC. Results from a Method for Estimating HIV Incidence Based on the First Cd4 Count among Treatment-Naïve Cases: Brazil, 2004-2013. ACTA ACUST UNITED AC 2016. [DOI: 10.4172/2155-6113.1000627] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Fazito E, Cuchi P, Fat DM, Ghys PD, Pereira MG, Vasconcelos AMN, Pascom ARP. Identifying and quantifying misclassified and under-reported AIDS deaths in Brazil: a retrospective analysis from 1985 to 2009. Sex Transm Infect 2013; 88 Suppl 2:i86-94. [PMID: 23172349 PMCID: PMC3512438 DOI: 10.1136/sextrans-2012-050632] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND A retrospective analysis of deaths registered in the Brazilian Mortality System was conducted to quantify the under-reporting of HIV/AIDS deaths and those misclassified to AIDS-related conditions in the 15-49 years old population in Brazil. METHODS Death rates for AIDS-related diseases were calculated by age and sex for 1985-2009. Changes in the age-sex-specific death rates over time were used to identify conditions likely to be misclassified AIDS deaths and to quantify the corresponding number of misclassified deaths. Deaths due to ill-defined causes were redistributed across all other natural causes of death. The resulting total number of AIDS deaths was further adjusted for incompleteness of the mortality reporting system. RESULTS Out of the 28 potential causes of death investigated, five increased in the same distinct age pattern as AIDS: pneumonia, Kaposi's sarcoma, other immunodeficiencies, other septicaemia and toxoplasmosis. 18 490 deaths due to these five causes were recoded to HIV/AIDS from 1985 to 2009. 38 145 deaths due to ill-defined causes were redistributed to AIDS and 15 485 were added to the number of AIDS deaths to correct for completeness of the mortality system in Brazil. Altogether, 72 120 deaths were recoded to AIDS between 1985 and 2009 and added to the reported 194 445 AIDS related deaths in the country, representing 27% misclassification of AIDS deaths in Brazil. CONCLUSIONS This study demonstrated that AIDS mortality is underestimated by the official mortality information system in Brazil. Efforts need to be made to reduce misclassification of causes of death in the future and identify ways in which the confidentiality of information regarding cause of death can be maintained.
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Affiliation(s)
- Erika Fazito
- Faculty of Health Sciences, University of Brasília, Brazil.
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Pascom ARP, Szwarcwald CL. Sex inequalities in HIV-related practices in the Brazilian population aged 15 to 64 years old, 2008. CAD SAUDE PUBLICA 2011; 27 Suppl 1:S27-35. [PMID: 21503521 DOI: 10.1590/s0102-311x2011001300004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Accepted: 04/19/2010] [Indexed: 11/21/2022] Open
Abstract
The objective of this study is to analyze gender differences in HIV-related practices in the Brazilian population. A national survey was carried out in 2008 with a sample size of 8,000 individuals aged 15-64 years old. The sampling was stratified by macro geographical region and urban/rural areas. Logistic regression models were used to investigate the main predictors of consistent condom use. The results showed that women have less sexy, start sexual life later than men, have fewer casual sexual partners, but use condom less frequently than men. On the other hand, the coverage of HIV testing is significantly greater among women. Significant differences by gender were seen in all HIV-related risky practices. The greater vulnerability was always associated with women, with exception of HIV testing. The low proportion of condom use in infidelity situations was a problem for box sexes and deserves special consideration when developing prevention strategies.
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Barbosa Júnior A, Pascom ARP, Szwarcwald CL, Kendall C, McFarland W. Transfer of sampling methods for studies on most-at-risk populations (MARPs) in Brazil. CAD SAUDE PUBLICA 2011; 27 Suppl 1:S36-44. [DOI: 10.1590/s0102-311x2011001300005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Accepted: 04/19/2010] [Indexed: 11/21/2022] Open
Abstract
The objective of this paper was to describe the process of transferring two methods for sampling most-at-risk populations: respondent-driven sampling (RDS) and time-space sampling (TSS). The article describes steps in the process, the methods used in the 10 pilot studies, and lessons learned. The process was conducted in six steps, from a state-of-the-art seminar to a workshop on writing articles with the results of the pilot studies. The principal investigators reported difficulties in the fieldwork and data analysis, independently of the pilot sampling method. One of the most important results of the transfer process is that Brazil now has more than 100 researchers able to sample MARPs using RDS or TSS. The process also enabled the construction of baselines for MARPS, thus providing a broader understanding of the dynamics of HIV infection in the country and the use of evidence to plan the national response to the epidemic in these groups.
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Szwarcwald CL, Andrade CLTD, Pascom ARP, Fazito E, Pereira GFM, Penha ITD. HIV-related risky practices among Brazilian young men, 2007. CAD SAUDE PUBLICA 2011; 27 Suppl 1:S19-26. [DOI: 10.1590/s0102-311x2011001300003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Accepted: 03/08/2010] [Indexed: 11/22/2022] Open
Abstract
Behavioral surveillance surveys have been carried among military conscripts, in Brazil, since 1996. This paper presents the results of the 2007 survey and compares actual findings with those obtained in previous studies carried out in the period 1999-2002. The conscripts were selected with a two stage sampling stratified by geographical region. The study included a self-reported questionnaire and blood collection for HIV and syphilis testing. Data from 35,432 conscripts aged 17-20 years old were analyzed. The findings show a reduction in regular condom use, with fixed and casual partners, mainly among those with poor educational level. The proportion of conscripts that have sex with other men was maintained (3.2%), but the index of risky sexual behavioral showed worsening results in this group. Also, the HIV prevalence rate increased from 9 to 11.3 per 10,000 in 2007, though the increase was not statistically significant. In conclusion, the evidences found in this paper indicate the need of reformulate policy among young adults.
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Pascom ARP, Szwarcwald CL, Barbosa Júnior A. Sampling studies to estimate the HIV prevalence rate in female commercial sex workers. Braz J Infect Dis 2010. [DOI: 10.1590/s1413-86702010000400014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Pascom ARP, Feraz DADS, Arruda MRD, Brito I. Knowledge and HIV risk related practices in the Brazilian population aged to 15 to 64 years old, 2008. TEMPUS 2010. [DOI: 10.18569/tempus.v4i2.795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
O artigo tem por objetivo apresentar os principais resultados da Pesquisa de Conhecimentos, Atitudes e Práticas na população brasileira, realizado em 2008. Foi realizado inquérito domiciliar de âmbito nacional com amostra probabilística stratificada cada por macrorregião geográfica e situação urbana e rural. Os achados apresentados apontam para a necessidade de investimento contínuo e sistemático em ações que assegurem à população em geral o acesso à informação, aos insumos de prevenção e ao diagnóstico precoce. 97% da população sabe que o preservativo é a melhor maneira de evitar a infecção pelo HIV. Quase 27% tiveram a primeira relação antes dos 15 anos e 59% usaram preservativo na última relação sexual com parceiro casual. O tamanho dos grupos sob maior risco foi estimado em: HSH=3,1%; mulheres trabalhadoras do sexo = 1,2%; UDI=0,5%. A cobertura de teste de HIV foi de 37%.
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Pascom ARP, Szwarcwald CL, Barbosa Júnior A. Sampling studies to estimate the HIV prevalence rate in female commercial sex workers. Braz J Infect Dis 2010; 14:385-397. [PMID: 20963326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Accepted: 03/20/2010] [Indexed: 05/30/2023] Open
Abstract
INTRODUCTION We investigated sampling methods being used to estimate the HIV prevalence rate among female commercial sex workers. METHODS The studies were classified according to the adequacy or not of the sample size to estimate HIV prevalence rate and according to the sampling method (probabilistic or convenience). RESULTS We identified 75 studies that estimated the HIV prevalence rate among female sex workers. Most of the studies employed convenience samples. The sample size was not adequate to estimate HIV prevalence rate in 35 studies. DISCUSSION The use of convenience sample limits statistical inference for the whole group. It was observed that there was an increase in the number of published studies since 2005, as well as in the number of studies that used probabilistic samples. This represents a large advance in the monitoring of risk behavior practices and HIV prevalence rate in this group.
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Barbosa Júnior A, Szwarcwald CL, Pascom ARP, Souza Júnior PBD. [Trends in the AIDS epidemic in groups at highest risk in Brazil, 1980-2004]. CAD SAUDE PUBLICA 2009; 25:727-37. [PMID: 19347198 DOI: 10.1590/s0102-311x2009000400003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Accepted: 12/19/2008] [Indexed: 11/22/2022] Open
Abstract
The objective of this paper was to present the trends in the AIDS epidemic in the population groups at highest risk in Brazil. Discriminant analysis was used to reclassify cases with unknown risk into one of the three groups: IDU (injecting drug users), MSM (men who have sex with men), and heterosexuals. AIDS incidence rates by gender and exposure category were estimated for the period 1980-2004. In 1980-1988, 63.6% of AIDS cases were homosexual or bisexual males and 10% were females. Since 1988, there has been a decrease in the proportion of MSM and an increase in the other categories. Despite the incidence trends observed by exposure category, when the incidence rates were compared, the risk was much higher among MSM as compared to heterosexuals. Analysis of the AIDS epidemic dynamics in Brazil emphasizes the importance of MSM and male IDU as higher-risk groups.
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Barbosa Junior A, Pascom ARP, Szwarcwald CL, Dhalia CDBC, Monteiro L, Simão MBG. Indicadores propostos pela UNGASS e o monitoramento da epidemia de Aids no Brasil. Rev Saude Publica 2006; 40 Suppl:94-100. [PMID: 16729164 DOI: 10.1590/s0034-89102006000800013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O objetivo do estudo foi analisar o processo de monitoramento de indicadores centrais propostos pela UNGASS, em nível nacional, vis-à-vis aos indicadores do Programa Nacional de DST e Aids. Foram avaliados os dois conjuntos de indicadores propostos, respectivamente, em 2002 e 2005, para o monitoramento de progresso da Declaração de Compromisso da UNGASS. Foram analisadas a disponibilidade de informações e as limitações para o cálculo dos indicadores propostos no Brasil, incluindo discussão sobre a adequação dos indicadores propostos para o monitoramento da epidemia brasileira. Dos 13 indicadores quantitativos inicialmente propostos pela UNGASS, cinco não estão incluídos no sistema de monitoramento do Programa Pacional. Um deles não foi incluído por ser um indicador qualitativo. Dois dos indicadores foram considerados de pouca utilidade e dois não foram contemplados pela falta de dados disponíveis para o seu cálculo. Como o Brasil é caracterizado por ter uma epidemia concentrada, no segundo conjunto de indicadores propostos pela UNGASS, prioriza-se o acompanhamento da epidemia entre as populações sob maior risco. Destacou-se que o Programa Nacional centra seus esforços no desenvolvimento, adaptação e transferência de metodologias de amostragem em populações de difícil acesso. Tais ações são voltadas para a estimação do tamanho dos grupos vulneráveis, bem como para obter mais informações sobre seu comportamento, atitudes e práticas. Concluiu-se que, pela possibilidade de comparações internacionais dos avanços conseguidos, a proposição de indicadores supranacionais estimula os países a discutir e viabilizar sua construção. De maneira complementar, os sistemas nacionais de monitoramento devem ser focados na melhoria do programa, cobrindo áreas que permitam avaliar as ações de controle e intervenções específicas.
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Abstract
The aim of the present study was to characterize the utilization of medicines by the Brazilian population, using data from the Brazilian World Health Survey. Medicines were grouped according to the active pharmaceutical ingredient based on an adaptation of the World Health Organization standard list of essential medicines. The analysis included the characteristics of individuals who keep medicines at home and who had used them within the reference period (within two weeks prior to the interview), according to presence of medical prescription. Nearly half of the participants (49.0%) reported use of medicines during the reference period. Older and wealthier individuals and those with chronic diseases or disabilities and with poor self-rated health keep and use medicines more frequently. For 25.0% of the individuals that had used medicines during the reference period, none of the drugs had been prescribed by a health professional. Among the individuals who had medicines prescribed in the last appointment, 13.0% were unable to obtain the prescribed medication (of these, 55.0% could not afford it). The most widely utilized group was that of the analgesics (22.0%), and only 51.0% of the individuals using this type of medicine had received a medical prescription for it.
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