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Carcamo CP, Velasquez C, Rocha SC, Centurion-Lara A, Lopez-Torres L, Parveen N. Sociodemographic and clinical characteristics associated with maternal and congenital syphilis - A prospective study in Peru. Int J Infect Dis 2024; 143:107041. [PMID: 38583824 PMCID: PMC11109506 DOI: 10.1016/j.ijid.2024.107041] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/09/2024] Open
Abstract
OBJECTIVES The objective of this study was to explore the factors and outcomes associated with gestational syphilis in Peru. METHODS Women from the miscarriage, vaginal delivery, and C-section wards from a large maternity hospital in Lima with or without syphilis diagnosis were enrolled and their pregnancy outcomes compared. Maternal syphilis status using maternal blood and child serostatus using cord blood were determined by rapid plasma reagin (RPR) and rapid syphilis tests. The newborns' clinical records were used to determine congenital syphilis. RESULTS A total of 340 women were enrolled, 197 were positive and 143 were negative for RPR/rapid syphilis tests. Antibody titers in sera from cord and maternal blood were comparable with RPR titers and were highly correlated (rho = 0.82, P <0.001). Young age (P = 0.009) and lower birth weight (P = 0.029) were associated with gestational syphilis. Of the women with gestational syphilis, 76% had received proper treatment. Mothers of all newborns with congenital syphilis also received appropriate treatment. Treatment of their sexual partners was not documented. CONCLUSIONS Syphilis during pregnancy remains a major cause of the fetal loss and devastating effects of congenital syphilis in newborns.
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Affiliation(s)
- Cesar P Carcamo
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | | | - Sandra C Rocha
- Department of Microbiology, Biochemistry and Molecular Genetics, Rutgers New Jersey Medical School, Newark, USA
| | - Arturo Centurion-Lara
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Lorena Lopez-Torres
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Nikhat Parveen
- Department of Microbiology, Biochemistry and Molecular Genetics, Rutgers New Jersey Medical School, Newark, USA.
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Torres-Slimming PA, Carcamo CP, Wright CJ, Lancha G, Zavaleta-Cortijo C, King N, Ford JD, Garcia PJ, Harper SL. Diarrheal disease and associations with water access and sanitation in Indigenous Shawi children along the Armanayacu River basin in Peru. Rural Remote Health 2023; 23:7198. [PMID: 37726000 DOI: 10.22605/rrh7198] [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] [Indexed: 09/21/2023] Open
Abstract
INTRODUCTION Diarrheal disease, particularly in children under 5 years old, remains a global health challenge due to its high prevalence and chronic health consequences. Public health interventions that reduce diarrheal disease risk include improving access to water, sanitation, and hygiene. Although Peru achieved the 2015 Millennium Development Goal (MDG) indicators for water access, less progress was achieved on sanitation. Furthermore, many Indigenous Peoples were overlooked in the MDG indicators, resulting in a prioritization of Indigenous Peoples in the 2030 Sustainable Development Goals (SDGs). This study aimed to estimate the prevalence of childhood diarrhea, characterize access to water and sanitation, and determine the association of childhood diarrhea with water access and sanitation indicators in 10 Shawi Indigenous communities along the Armanayacu River in the Peruvian Amazon. METHODS A cross-sectional survey (n=82) that captured data on diarrheal disease, sociodemographic variables, and water and sanitation exposures was conducted in 10 Shawi communities. Nutritional status of children under 5 was also assessed via physical examination. Descriptive and comparative statistics were conducted. RESULTS A small proportion (n=7; 8.54%) of participating children reported an episode of diarrhea in the previous month. Almost half (46.30%) of participating children had stunting, wasting, or both. Although not statistically significant, children living in households that used latrines were 4.29 times (95% confidence interval (CI) 1.01-18.19) more likely to report an episode of diarrhea than children living in households that practiced open defecation. Although not statistically significant, children living in households that used water treatment methods were 4.25 times (95%CI 0.54-33.71) more likely to report an episode of diarrhea than children living in households that did not. CONCLUSION The prevalence of childhood diarrhea was lower for Shawi than for other Amazon areas. The higher prevalence of childhood diarrhea in households that used latrines and water treatments warrants further investigation into local risk and protective factors. These Shawi communities scored low for the WHO/UNICEF Joint Monitoring Programme indicators for water and sanitation, indicating that they should be prioritized in future water, sanitation, and hygiene initiatives. Research will be required to understand and incorporate local Indigenous values and cultural practices into water, sanitation, and hygiene initiatives to maximize intervention uptake and effectiveness.
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Affiliation(s)
- Paola A Torres-Slimming
- Graduate School, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Urbanización Ingeniería, San Martín de Porres, Lima, Peru
| | - Cesar P Carcamo
- Indigenous Health Adaptation to Climate Change Research Team (IHACC); and School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Urbanización Ingeniería, San Martín de Porres, Lima, Peru
| | - Carlee J Wright
- School of Public Health, University of Alberta, 116 St & 85 Avenue, Edmonton, AB T6G 2R3, Canada
| | - Guillermo Lancha
- Puesto de Salud Nuevo Tocache, Red de Salud Lamas, San Martin, Peru
| | - Carol Zavaleta-Cortijo
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Urbanización Ingeniería, San Martín de Porres, Lima, Peru
| | - Nia King
- School of Public Health, University of Alberta, 116 St & 85 Avenue, Edmonton, AB T6G 2R3, Canada; and School of Medicine, Queen's University, 15 Arch Street, Kingston, ON K7L 3L4, Canada
| | - James D Ford
- Indigenous Health Adaptation to Climate Change Research Team (IHACC); and Priestley International Centre for Climate, University of Leeds, Leeds LS2 9JT, UK
| | - Patricia J Garcia
- Indigenous Health Adaptation to Climate Change Research Team (IHACC); and School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Urbanización Ingeniería, San Martín de Porres, Lima, Peru
| | - Sherilee L Harper
- Indigenous Health Adaptation to Climate Change Research Team (IHACC); and School of Public Health, University of Alberta, 116 St & 85 Avenue, Edmonton, AB T6G 2R3, Canada
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Rios-Blancas MJ, Pando-Robles V, Razo C, Carcamo CP, Mendoza W, Pacheco-Barrios K, Miranda JJ, Lansingh VC, Demie TG, Saha M, Okonji OC, Yigit A, Cahuana-Hurtado L, Chacón-Uscamaita PR, Bernabe E, Culquichicon C, Chirinos-Caceres JL, Cárdenas R, Alcalde-Rabanal JE, Barrera FJ, Quintanilla BPA, Shorofi SA, Wickramasinghe ND, Ferreira N, Almidani L, Gupta VK, Karimi H, Alayu DS, Benziger CP, Fukumoto T, Mostafavi E, Redwan EMM, Gebrehiwot M, Khatab K, Koyanagi A, Krapp F, Lee S, Noori M, Qattea I, Rosenthal VD, Sakshaug JW, Wagaye B, Zare I, Ortega-Altamirano DV, Murillo-Zamora E, Vervoort D, Silva DAS, Oulhaj A, Herrera-Serna BY, Mehra R, Amir-Behghadami M, Adib N, Cortés S, Dang AK, Nguyen BT, Mokdad AH, Hay SI, Murray CJL, Lozano R, García PJ. Estimating mortality and disability in Peru before the COVID-19 pandemic: a systematic analysis from the Global Burden of the Disease Study 2019. Front Public Health 2023; 11:1189861. [PMID: 37427272 PMCID: PMC10325574 DOI: 10.3389/fpubh.2023.1189861] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/25/2023] [Indexed: 07/11/2023] Open
Abstract
Background Estimating and analyzing trends and patterns of health loss are essential to promote efficient resource allocation and improve Peru's healthcare system performance. Methods Using estimates from the Global Burden of Disease (GBD), Injuries, and Risk Factors Study (2019), we assessed mortality and disability in Peru from 1990 to 2019. We report demographic and epidemiologic trends in terms of population, life expectancy at birth (LE), mortality, incidence, prevalence, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) caused by the major diseases and risk factors in Peru. Finally, we compared Peru with 16 countries in the Latin American (LA) region. Results The Peruvian population reached 33.9 million inhabitants (49.9% women) in 2019. From 1990 to 2019, LE at birth increased from 69.2 (95% uncertainty interval 67.8-70.3) to 80.3 (77.2-83.2) years. This increase was driven by the decline in under-5 mortality (-80.7%) and mortality from infectious diseases in older age groups (+60 years old). The number of DALYs in 1990 was 9.2 million (8.5-10.1) and reached 7.5 million (6.1-9.0) in 2019. The proportion of DALYs due to non-communicable diseases (NCDs) increased from 38.2% in 1990 to 67.9% in 2019. The all-ages and age-standardized DALYs rates and YLLs rates decreased, but YLDs rates remained constant. In 2019, the leading causes of DALYs were neonatal disorders, lower respiratory infections (LRIs), ischemic heart disease, road injuries, and low back pain. The leading risk factors associated with DALYs in 2019 were undernutrition, high body mass index, high fasting plasma glucose, and air pollution. Before the COVID-19 pandemic, Peru experienced one of the highest LRIs-DALYs rates in the LA region. Conclusion In the last three decades, Peru experienced significant improvements in LE and child survival and an increase in the burden of NCDs and associated disability. The Peruvian healthcare system must be redesigned to respond to this epidemiological transition. The new design should aim to reduce premature deaths and maintain healthy longevity, focusing on effective coverage and treatment of NCDs and reducing and managing the related disability.
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Affiliation(s)
- Maria Jesus Rios-Blancas
- School of Public Health of Mexico, National Institute of Public Health, Cuernavaca, Mexico
- Carlos Slim Foundation, Mexico City, Mexico
| | - Victoria Pando-Robles
- Infectious Disease Research Center, National Institute of Public Health, Cuernavaca, Mexico
| | - Christian Razo
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
| | - Cesar P. Carcamo
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Walter Mendoza
- Peru Country Office, United Nations Population Fund (UNFPA), Lima, Peru
| | - Kevin Pacheco-Barrios
- Spaulding Rehabilitation Hospital, Harvard University, Boston, MA, United States
- Universidad San Ignacio de Loyola (University of Saint Ignatius of Loyola), Lima, Peru
| | - J. Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia (Cayetano Heredia Peruvian University), Lima, Peru
- Department of Medicine, Universidad Peruana Cayetano Heredia (Cayetano Heredia Peruvian University), Lima, Peru
| | - Van Charles Lansingh
- HelpMeSee, New York, NY, United States
- Mexican Institute of Ophthalmology, Queretaro, Mexico
| | - Takele Gezahegn Demie
- School of Public Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Manika Saha
- Department of Humanities and Social Sciences, Deakin University, Melbourne, VIC, Australia
- Department of Human-Centred Computing, Monash University, Melbourne, VIC, Australia
| | | | - Arzu Yigit
- Department of Health Management, Süleyman Demirel Üniversitesi (Süleyman Demirel University), Isparta, Türkiye
| | - Lucero Cahuana-Hurtado
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Pamela R. Chacón-Uscamaita
- Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Eduardo Bernabe
- Faculty of Dentistry, Oral and Craniofacial Sciences, King’s College London, London, United Kingdom
| | - Carlos Culquichicon
- Universidad Privada Norbert Wiener, Centro de Investigación Epidemiológica en Salud Global, Lima, Peru
| | | | - Rosario Cárdenas
- Department of Health Care, Metropolitan Autonomous University, Mexico City, Mexico
| | | | | | | | - Seyed Afshin Shorofi
- Medical-Surgical Nursing, Mazandaran University of Medical Sciences, Sari, Iran
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | | | - Nuno Ferreira
- Department of Social Sciences, University of Nicosia, Nicosia, Cyprus
| | - Louay Almidani
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- Doheny Image Reading and Research Lab (DIRRL) - Doheny Eye Institute, University of California, Los Angeles, Los Angeles, CA, United States
| | - Vivek Kumar Gupta
- Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Hanie Karimi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Daniel Shewaye Alayu
- Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
| | | | | | - Ebrahim Mostafavi
- Department of Medicine, Stanford University, Palo Alto, CA, United States
- Stanford Cardiovascular Institute, Stanford University, Palo Alto, CA, United States
| | - Elrashdy Moustafa Mohamed Redwan
- Department Biological Sciences, King Abdulaziz University, Jeddah, Egypt
- Department of Protein Research, Research and Academic Institution, Alexandria, Egypt
| | - Mesfin Gebrehiwot
- Department of Environmental Health, Wollo University, Dessie, Ethiopia
| | - Khaled Khatab
- Health and Wellbeing, Sheffield Hallam University, Sheffield, United Kingdom
| | - Ai Koyanagi
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Sant Boi de Llobregat, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Fiorella Krapp
- Instituto de Medicina Tropical Alexander von Humboldt (Alexander von Humboldt Institute for Tropical Medicine), Cayetano Heredia University, Lima, Peru
- Doctoral School of Biomedical Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Seung Lee
- Department of Precision Medicine, Sungkyunkwan University, Suwon-si, Republic of Korea
| | - Maryam Noori
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | - Ibrahim Qattea
- Department of Neonatology, Case Western Reserve University, Cleveland, OH, United States
| | - Victor Daniel Rosenthal
- International Nosocomial Infection Control Consortium, Independent Consultant, Buenos Aires, Argentina
| | - Joseph W. Sakshaug
- Institute for Employment Research, University of Warwick, Coventry, United Kingdom
- Department of Statistics, Ludwig Maximilians University, Munich, Germany
| | - Birhanu Wagaye
- Department of Public Health Nutrition, Wollo University, Dessie, Ethiopia
- Infection Prevention and Control and Water, Sanitation and Hygiene Unit, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Iman Zare
- Research and Development Department, Sina Medical Biochemistry Technologies Co. Ltd., Shiraz, Iran
| | | | - Efrén Murillo-Zamora
- Clinical Epidemiology Research Unit, Mexican Institute of Social Security, Villa de Alvarez, Mexico
- Postgraduate in Medical Sciences, Universidad de Colima, Colima, Mexico
| | - Dominique Vervoort
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, MD, United States
| | | | - Abderrahim Oulhaj
- Department of Epidemiology and Population Health, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Brenda Yuliana Herrera-Serna
- Departamento de Salud Oral (Department of Oral Health), Universidad Autónoma de Manizales (Autonomous University of Manizales), Manizales, Colombia
| | - Rahul Mehra
- Food Science and Technology, Maharishi Markandeshwar (Deemed to be University), Ambala, Haryana, India
| | - Mehrdad Amir-Behghadami
- Road Traffic Injury Research Center, Iranian International Safe Community Support Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Health Service Management, Iranian Center of Excellence in Health Management, Tabriz, Iran
| | - Nasrin Adib
- Department of Veterinary Pathobiology, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Sandra Cortés
- Department of Public Health, Pontifical Catholic University of Chile, Santiago, Chile
- Research Line in Environmental Exposures and Health Effects at Population Level, Centro de Desarrollo Urbano Sustentable (CEDEUS), Advanced Center for Chronic Diseases (ACCDIS), Santiago, Chile
| | - Anh Kim Dang
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
| | - Binh Thanh Nguyen
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Ali H. Mokdad
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Simon I. Hay
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Christopher J. L. Murray
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Rafael Lozano
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Patricia J. García
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
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Bussalleu A, King N, Pizango P, Ford J, Carcamo CP, Harper SL. Nuya kankantawa (we are feeling healthy): Understandings of health and wellbeing among Shawi of the Peruvian Amazon. Soc Sci Med 2021; 281:114107. [PMID: 34153933 DOI: 10.1016/j.socscimed.2021.114107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/19/2021] [Accepted: 06/02/2021] [Indexed: 11/25/2022]
Abstract
Promoting and supporting Indigenous health includes ensuring health services reflect local concepts of health. There is, therefore, a need to better understand context-specific Indigenous understandings of health in order to design culturally appropriate health services. To this end, this study characterized two Shawi communities' understandings of what it means to be healthy. Using a community-based participatory research approach, 40 semi-structured interviews and a series of informal interviews were conducted and analysed thematically, using a constant comparative method. The Shawi definition of health extended beyond individual physical welfare and focused on emotional, collective, and environmental wellbeing. The primary factors underlying Shawi perceptions of health and wellbeing included providing for the family, ensuring the welfare of others, maintaining positive social relationships, preserving traditional values and practices, and living harmoniously with the natural environment. Conversely, Shawi classified illnesses according to their cause or treatment. These included illnesses caused by sorcery, those caused by spirits of the forest, and 'new diseases,' that first appeared in the communities when they were contacted by the Western civilization, for which no traditional remedies existed. Consequently, according to Shawi, sociocultural, environmental, and climatic changes are posing imminent health threats. This study highlights the differences between biomedical and Indigenous Shawi health understandings, and therefore emphasizes the importance of acknowledging and embracing Shawi culture and beliefs within the formal healthcare system.
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Affiliation(s)
- Alejandra Bussalleu
- Faculty of Public Health and Administration, Universidad Peruana Cayetano Heredia, Honorio Delgado 430, Lima, Peru
| | - Nia King
- School of Medicine, Queen's University, 15 Arch Street, Kingston, Ontario, Canada; School of Public Health, University of Alberta, 116 St & 85 Ave, Edmonton, Alberta, Canada.
| | - Pedro Pizango
- Communidad Nativa Balsapuerto, Alto Amazonas, Loreto, Peru
| | - James Ford
- Priestly International Centre for Climate, University of Leeds, Leeds, UK; Indigenous Health Adaptation to Climate Change Research Team: Lea Berrang-Ford Cesar Carcamo Patricia Garcia Shuaib Lwasa Didacus B. Namanya, Canada
| | - Cesar P Carcamo
- Faculty of Public Health and Administration, Universidad Peruana Cayetano Heredia, Honorio Delgado 430, Lima, Peru; Indigenous Health Adaptation to Climate Change Research Team: Lea Berrang-Ford Cesar Carcamo Patricia Garcia Shuaib Lwasa Didacus B. Namanya, Canada
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- Indigenous Health Adaptation to Climate Change Research Team: Lea Berrang-Ford Cesar Carcamo Patricia Garcia Shuaib Lwasa Didacus B. Namanya, Canada
| | - Sherilee L Harper
- School of Public Health, University of Alberta, 116 St & 85 Ave, Edmonton, Alberta, Canada; Indigenous Health Adaptation to Climate Change Research Team: Lea Berrang-Ford Cesar Carcamo Patricia Garcia Shuaib Lwasa Didacus B. Namanya, Canada
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Garcia PJ, Mundaca H, Ugarte-Gil C, Leon P, Malaga G, Chaccour C, Carcamo CP. Randomized clinical trial to compare the efficacy of ivermectin versus placebo to negativize nasopharyngeal PCR in patients with early COVID-19 in Peru (SAINT-Peru): a structured summary of a study protocol for randomized controlled trial. Trials 2021; 22:262. [PMID: 33836826 PMCID: PMC8033091 DOI: 10.1186/s13063-021-05236-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 03/29/2021] [Indexed: 11/10/2022] Open
Abstract
Objectives The primary objective is to determine the effect of a daily dose of ivermectin administered in three consecutive days to non-severe COVID-19 patients with no more than 96 hours of symptoms, on the detection of SARS-CoV-2 RNA by PCR from nasopharyngeal swabs at day seven post-treatment initiation. The secondary objectives are:
To assess the efficacy of ivermectin to reduce the SARS-CoV-2 viral load in the nasopharyngeal swab on days 4, 7, 14 and 21 post-treatment initiation To assess the efficacy of ivermectin on the improvement of symptoms To assess the proportion of seroconversions at day 21 To assess the safety of ivermectin at the proposed dose To determine the magnitude of the immune response against SARS-CoV-2 To assess correlation of the presence of intestinal helminths on participants on baseline and day 14 with COVID-19 progression and treatment.
Trial design SAINT PERU is a triple-blinded, randomized, placebo-controlled trial with two parallel arms to evaluate the efficacy of ivermectin in negativizing nasopharyngeal PCR in patients with SARS-CoV-2 infection. Participants The trial is conducted in two national hospitals in Lima-Peru. The study population is patients with a positive PCR test for SARS-CoV-2 in a nasopharyngeal specimen, symptomatic for 96 hours or less, with non-severe COVID-19 disease at baseline, regardless of the presence of risk factors for progression to severity. The study will not include pregnant women or minors (17 years old or younger). Inclusion criteria
COVID-19 symptomatology (cough, fever, anosmia, etc.) lasting no more than 96 hours, with a positive nasopharyngeal swab PCR test for SARS-CoV-2. 18 years or older. No use of ivermectin in the month prior to the visit. No known history of ivermectin allergy. Capable to give informed consent. Not current use of CYP 3A4 or P-gp inhibitor drugs such as quinidine, amiodarone, diltiazem, spironolactone, verapamil, clarithromycin, erythromycin, itraconazole, ketoconazole, cyclosporine, tacrolimus, indinavir, ritonavir, cobicistat or critical CYP3A4 substrate drugs such as warfarin.
Exclusion criteria
COVID-19 pneumonia diagnosed by the attending physician (oxygen saturation < 95% or lung examination) Positive pregnancy test for women at childbearing age. Positive IgG against SARS-CoV-2 by rapid diagnostic test at screening.
Participants will be recruited by the investigators at the emergency services of the study sites. They are expected to remain in the trial for a period of 21 days. Follow-up visits will be conducted by the trial medical staff at the participant's home or at a hospital in case of hospitalization. Follow-up visits will assess clinical and laboratory parameters of the patients. Intervention and comparator Ivermectin (300 mcg/kg) or placebo will be administered in one daily dose for three consecutive days. Currently, there is no solid data on the efficacy of ivermectin against the virus in vivo; therefore the use of placebo in the control group is ethically justified. Main outcomes Primary Proportion of patients with a positive SARS-CoV-2 PCR from a nasopharyngeal swab at day 7 post-treatment. Secondary
Mean viral load as determined by PCR cycle threshold (Ct) on days 4, 7, 14, and 21 2. Proportion of patients with fever and cough at days 4, 7, 14, and 21 as well as proportion of patients progressing to severe disease or death during the trial Proportion of patients with a positive rapid diagnostic test at day 21 Proportion of drug-related adverse events during the trial Median levels of IgG, IgM, IgA measured by Luminex
Randomization Participants will be randomized to receive one dose of 300 mcg/kg ivermectin or placebo daily for three consecutive days. The epidemiologist will generate a list of correlative numbers, in randomized blocks of size 4, with the assignment to the treatment groups (a and b). The randomization list will be kept in an encrypted file accessible only to the trial statistician. This list will be handed directly to the pharmacist. Independently, the principal investigator will randomly assign the intervention (ivermectin) to one of the two groups (a or b) by tossing a coin, and will inform the pharmacist of the result of this process. The pharmacist will prepare and label the treatment vials according to the randomization list prepared by the epidemiologist and the treatment assignment given by the principal investigator. Eligible patients will be allocated in a 1:1 ratio using this randomization list. Blinding (masking) The clinical trial team, the statistician, and the patients will be blinded as to arm allocation. The vials with placebo will be visibly identical to the ones with the active drug. Treatment will be administered by staff not involved in the clinical care or participant’s follow up. Numbers to be randomized (sample size) The planned sample size is 186 SARS-CoV-2 PCR positive patients: 93 patients to treatment and 93 to the placebo group. Trial Status Current protocol version: 2.0 dated January 15th, 2021. Recruitment started on Aug 29th, 2020. Recruitment is expected to be completed April 30th 2021. Trial registration “Ensayo Clínico aleatorizado de Fase IIa para comparar la efectividad de la ivermectina versus placebo en la negativización del PCR en pacientes en fase temprana de COVID-19” Peru National Health Institute REPEC with number: PER-034-20, registered July 17th 2020 (National Peruvian Registration before the first participant enrolled). “Randomized Phase IIA Clinical Trial to Evaluate the Efficacy of Ivermectin to Obtain Negative PCR Results in Patients With Early Phase COVID-19” Clinicaltrials.gov: NCT04635943, retrospectively registered in November 19th 2020 Full protocol The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest of expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05236-2.
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Affiliation(s)
- Patricia J Garcia
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | | | - Cesar Ugarte-Gil
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.,Tropical Medicine Institute Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - German Malaga
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.,Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Carlos Chaccour
- Instituto de Salud Global (ISGlobal), Barcelona, Spain.,Facultad de Medicina, Universidad de Navarra, Pamplona, Spain
| | - Cesar P Carcamo
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
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Ochoa TJ, Zegarra J, Bellomo S, Carcamo CP, Cam L, Castañeda A, Villavicencio A, Gonzales J, Rueda MS, Turin CG, Zea-Vera A, Guillen D, Campos M, Ewing-Cobbs L. Randomized Controlled Trial of Bovine Lactoferrin for Prevention of Sepsis and Neurodevelopment Impairment in Infants Weighing Less Than 2000 Grams. J Pediatr 2020; 219:118-125.e5. [PMID: 32037149 PMCID: PMC7096260 DOI: 10.1016/j.jpeds.2019.12.038] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 11/25/2019] [Accepted: 12/17/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To determine the effect of bovine lactoferrin on prevention of late-onset sepsis (LOS) and neurodevelopment delay. STUDY DESIGN Randomized, double-blind, controlled trial in neonates with a birth weight of 500-2000 g in 3 neonatal units in Lima, Peru, comparing bovine lactoferrin 200 mg/kg/day with placebo administered for 8 weeks. The primary outcome was the first episode of culture-proven LOS or sepsis-associated death. Neurodevelopment delay was assessed by the Mullen Scales at 24 months corrected age. RESULTS Of the 414 infants enrolled, 209 received bovine lactoferrin and 205 received placebo. LOS or sepsis-associated death occurred in 22 infants (10.5%) in the bovine lactoferrin group vs 30 (14.6%) in the placebo group; there was no difference after adjusting for hospital and birth weight; hazard ratio 0.73 (95% CI, 0.42-1.26). For infants with birth weights of <1500 g the hazard ratio was 0.69 (95% CI, 0.39-1.25). The mean age-adjusted normalized Mullen composite score at 24 months was 83.3 ± 13.6 in the bovine lactoferrin group vs 82.6 ± 13.1 in the placebo group. Growth outcomes and rehospitalization rates during the 2-year follow-up were similar in both groups, except for significantly less bronchiolitis in the bovine lactoferrin group (rate ratio, 0.34; 95% CI, 0.14-0.86). CONCLUSIONS Supplementation with bovine lactoferrin did not decrease the incidence of sepsis in infants with birth weights of <2000 g. Growth and neurodevelopment outcomes at 24 months of age were similar. Neonatal bovine lactoferrin supplementation had no adverse effects. TRIAL REGISTRATION ClinicalTrials.gov: NCT01525316.
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Affiliation(s)
- Theresa J. Ochoa
- Department of Pediatrics, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru,Instituto de Medicina Tropical “Alexander von Humboldt”, Universidad Peruana Cayetano Heredia, Lima, Peru,Center for Infectious Diseases, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, United States
| | - Jaime Zegarra
- Department of Pediatrics, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru,Hospital Cayetano Heredia, Lima, Peru
| | - Sicilia Bellomo
- Department of Pediatrics, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru,Hospital Cayetano Heredia, Lima, Peru
| | - Cesar P. Carcamo
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Luis Cam
- Hospital Nacional Alberto Sabogal, Lima, Peru
| | | | - Aasith Villavicencio
- Department of Pediatrics, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jorge Gonzales
- Department of Pediatrics, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Maria S. Rueda
- Department of Pediatrics, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Christie G. Turin
- Department of Pediatrics, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Alonso Zea-Vera
- Department of Pediatrics, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Daniel Guillen
- Department of Pediatrics, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru,Hospital Cayetano Heredia, Lima, Peru
| | - Miguel Campos
- Department of Mathematics, School of Science and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Linda Ewing-Cobbs
- Department of Pediatrics and Children’s Learning Institute, School of Medicine, University of Texas Health Science Center at Houston, Houston, Texas, United States
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Calderon-Anyosa R, Galvez-Petzoldt C, Garcia PJ, Carcamo CP. Housing Characteristics and Leishmaniasis: A Systematic Review. Am J Trop Med Hyg 2019; 99:1547-1554. [PMID: 30382013 DOI: 10.4269/ajtmh.18-0037] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Leishmaniasis is a major neglected tropical disease associated with high rates of disability and death. This disease is associated with poverty, which can be reflected in housing quality, especially in rural areas. This systematic review found that mud walls with cracks and holes, damp, and dark houses were risk factors for transmission of leishmaniasis. These characteristics create favorable conditions for sand fly breeding and resting as sand flies prefer humidity, warmth, and protection from sunlight during the day. Housing interventions might be a promising research area with a special focus on education as individual and collective protection for the effective control of leishmaniasis.
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Affiliation(s)
- Renzo Calderon-Anyosa
- Kuskaya Program, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Camila Galvez-Petzoldt
- Kuskaya Program, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Patricia J Garcia
- Kuskaya Program, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Cesar P Carcamo
- Kuskaya Program, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
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8
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Limaye NP, Rivas-Nieto AC, Carcamo CP, Blas MM. Nuestras Historias- Designing a novel digital story intervention through participatory methods to improve maternal and child health in the Peruvian Amazon. PLoS One 2018; 13:e0205673. [PMID: 30396200 PMCID: PMC6218201 DOI: 10.1371/journal.pone.0205673] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 09/29/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In rural areas of the Loreto region within the Peruvian Amazon, maternal mortality rate is above the national average and the majority of women deliver at home without care from a trained health care provider. METHODS To develop community-tailored videos that could be used for future interventions, we conducted Photovoice and digital storytelling workshops with community health workers (CHW) and mothers from 13 rural communities in the Parinari district. Through Photovoice we recognized local barriers to healthy pregnancies. Participants (n = 28) were trained in basic photography skills and ethics. They captured photos representing perceived pregnancy-related road-blocks and supports, and these photos identified central themes. Participants recorded personal stories and "storyboarded" to develop digital stories around these themes, and a Digital Story Curriculum called Nuestras Historias (Our Stories), was created. An acceptability survey of the digital stories was then conducted including 47 men (M) and 60 women (F). RESULTS According to the PhotoVoice workshops, pregnancy-related problems included: lack of partner support, domestic violence, early pregnancies, difficulty attending prenatal appointments, and complications during pregnancy and delivery. Over 30 stories on these themes were recorded. Seven were selected based on clarity, thematic relevance, and narrative quality and were edited by a professional filmmaker. The acceptability survey showed that local participants found the digital stories novel (M = 89.4%, F = 83.3%), relatable (M = 89.4%, F = 93.2%), educational (M = 91.5%, F = 93.3%) and shareable (M = 100%, F = 100%). Over 90% of respondents rated the digital stories as "Excellent" or "Good", found the videos "Useful" and considered them "Relevant" to their communities. CONCLUSIONS The digital stories address community-specific problems through narrative persuasion using local voices and photography. This combination had a high acceptability among the target population and can serve as a model for developing educational strategies in a community-tailored manner. This package of seven videos will be further evaluated through a cluster randomized trial.
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Affiliation(s)
- Neha P. Limaye
- Department of Internal Medicine-Pediatrics, Harvard Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Boston Medical Center, Boston, Massachusetts, United States of America
| | - Andrea C. Rivas-Nieto
- Department of Epidemiology, STD and HIV Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Cesar P. Carcamo
- Department of Epidemiology, STD and HIV Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Magaly M. Blas
- Department of Epidemiology, STD and HIV Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
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Abstract
Genital warts (GW) are mucosal or skin lesions caused by sexual transmission of human papillomavirus (HPV). This study estimates the frequency of GW cases in physicians' clinics and physicians' usual practices of GW referral and diagnosis in Peru. Participants in this study were a convenience sample of 100 physicians in five specialties: primary care (17), gynecology (37), urology (10), dermatology (31), and infectious diseases (5). Physicians completed a survey and daily log of all patients aged 18-60 years seen over ten days in their offices located in Peru. The survey recorded GW referral patterns and the daily log recorded patient demographic information and GW diagnosis. Among 12,058 patients, the annual GW prevalence (95% confidence interval [CI]) was 2.28% (2.02-2.56) and cumulative incidence (95% CI) was 1.60% (1.38-1.84). Physicians reported that most GW patients were direct consult (73.5% of male and 67.9% of females) and physicians treated most GW patients themselves (73.4% of males and 76.7% of females). As reported, the most common reasons for referring were 'serious cases requiring more specialized treatment' (73.2% of male and 72.2% of female) and 'lack of resources to treat' (26.8% of male and 27.8% of female). We conclude that GW cases are commonly seen by physicians in Peru.
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Affiliation(s)
- Patricia J García
- 1 School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Cesar P Carcamo
- 1 School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Maria Valderrama
- 1 School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Sayda La Rosa
- 1 School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Cerise James
- 2 Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Raul Gutiérrez
- 2 Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Brianna R Lindsay
- 2 Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
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10
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Gonsalves L, Hindin MJ, Bayer A, Carcamo CP, Gichangi P, Habib N, Mwaisaka J, Say L. Protocol of an open, three-arm, individually randomized trial assessing the effect of delivering sexual and reproductive health information to young people (aged 13-24) in Kenya and Peru via mobile phones: adolescent/youth reproductive mobile access and delivery initiative for love and life outcomes (ARMADILLO) study stage 2. Reprod Health 2018; 15:126. [PMID: 29996854 PMCID: PMC6042417 DOI: 10.1186/s12978-018-0568-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 05/31/2018] [Accepted: 07/02/2018] [Indexed: 11/27/2022] Open
Abstract
Background Young people face special challenges to accessing needed sexual and reproductive health (SRH) information and support. With high penetration and access, mobile phones provide a new channel for reaching young people, but there is little evidence around the impact of digital interventions on improving health outcomes. The Adolescent/Youth Reproductive Mobile Access and Delivery Initiative for Love and Life Outcomes (ARMADILLO) study will assess the effect of an intervention providing SRH information to young people via text message on their mobile phones in Kenya and Peru. This protocol details an open, individually-randomized, three-arm trial lasting seven weeks to assess the effect of the ARMADILLO intervention on dispelling myths and misconceptions related to contraception. A secondary objective is to determine whether youth given access to SRH information via text message can accurately retain that information. Methods Following a household enumeration, one eligible youth per household will be randomly selected for participation and randomized by computer into one of the three arms. Intervention arm participants will receive access to ARMADILLO content, control participants will receive no information, and ‘Arm 3’ participant interactions will vary by site: in Kenya, they will be alerted to various SRH domains and encouraged to learn on their own; in Peru, they will receive key content from each domain with the option to learn more if they wish. Participants will complete multiple-choice questionnaires administered by data collectors at baseline (prior to randomization), at intervention-period end (after week seven), and eight weeks after timing out of the intervention period. Discussion Part of the Sustainable Development Goal commitment towards ensuring healthy lives and promoting well-being for all at all ages includes a commitment to ‘ensuring universal access to sexual health and reproductive health-care services, including for family planning, information and education’. If proven to be effective, interventions like ARMADILLO can bridge an important gap towards achieving universal access to SRH information and education for an otherwise difficult-to-reach group. Trial registration This trial was retrospectively registered with the ISRCTN Registry and assigned registration number ISRCTN85156148 on 29 May, 2018.
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Affiliation(s)
- Lianne Gonsalves
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Avenue Appia 20, 1201, Geneva, Switzerland.
| | - Michelle J Hindin
- Population Council, Department of Reproductive Health, 1 Dag Hammarskjold Plaza, New York, NY, 10017, USA
| | - Angela Bayer
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porres, Lima, Peru
| | - Cesar P Carcamo
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porres, Lima, Peru
| | - Peter Gichangi
- International Centre for Reproductive Health Kenya, P.O. Box 91109-80103, Mombasa, Kenya.,Department of Human Anatomy, University of Nairobi, P. O. Box 30197, Nairobi, 00100, Kenya.,Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Ndema Habib
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Avenue Appia 20, 1201, Geneva, Switzerland
| | - Jefferson Mwaisaka
- International Centre for Reproductive Health Kenya, P.O. Box 91109-80103, Mombasa, Kenya
| | - Lale Say
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Avenue Appia 20, 1201, Geneva, Switzerland
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11
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Limaye NP, Blas MM, Alva IE, Carcamo CP, García PJ. The Amazon Hope: A qualitative and quantitative assessment of a mobile clinic ship in the Peruvian Amazon. PLoS One 2018; 13:e0196988. [PMID: 29927934 PMCID: PMC6013175 DOI: 10.1371/journal.pone.0196988] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 04/24/2018] [Indexed: 11/23/2022] Open
Abstract
The Loreto region of the Peruvian Amazon faces many obstacles to health care delivery. The majority of the population is river-bound and lives below the poverty line, with some of the worst health indicators in Peru. To overcome these barriers and fill a gap in health services, an NGO-based provider known as the Vine Trust has been providing care since 2001 via a mobile ship clinic called the Amazon Hope. This study presents an assessment of the Amazon Hope, first reporting health indicators of the program´s catchment area, services provided, and program utilization. It then describes perceptions of the program by community members and health workers, the program’s strengths and weaknesses in contributing to health service delivery, and provides recommendations addressing limitations. The qualitative analysis included 20 key informant interviews with community members and health service providers. In the quantitative analysis, 4,949 residents of the catchment area were surveyed about medical histories, experiences with the program, and suggestions for improvement. The survey showed poor indicators for reproductive health. The AH clinic was the main provider of health care among those surveyed. Community members reported satisfaction with the program’s quality of care, and health workers felt the program provided a unique and necessary service. However, community members requested prior notification and additional services, while health workers described misunderstandings in community-tailored care, and difficulties with continuity of care and coordination. Data show that the program has been successful in providing quality health care to a population but has room to improve in its health service delivery. Suggested improvements are provided based on participant suggestions and relevant literature. The study sheds light on the important role of mobile clinics in Peru, and the methodology can serve as a model for assessing the role of mobile clinics in other remote settings.
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Affiliation(s)
- Neha P. Limaye
- North Pacific Global Health Fellows, Fogarty and Kuskaya Fellowship, University of Washington, Seattle, Washington, United States of America
- * E-mail:
| | - Magaly M. Blas
- Epidemiology, STD, HIV Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Isaac E. Alva
- Epidemiology, STD, HIV Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Cesar P. Carcamo
- Epidemiology, STD, HIV Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Patricia J. García
- Epidemiology, STD, HIV Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
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12
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Kohler PK, Campos PE, Garcia PJ, Carcamo CP, Buendia C, Hughes JP, Mejia C, Garnett GP, Holmes KK. Sexually transmitted infection screening uptake and knowledge of sexually transmitted infection symptoms among female sex workers participating in a community randomised trial in Peru. Int J STD AIDS 2016; 27:402-10. [PMID: 25941053 PMCID: PMC4742423 DOI: 10.1177/0956462415584488] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 04/07/2015] [Indexed: 11/15/2022]
Abstract
This study aims to evaluate condom use, sexually transmitted infection (STI) screening, and knowledge of STI symptoms among female sex workers in Peru associated with sex work venues and a community randomised trial of STI control. One component of the Peru PREVEN intervention conducted mobile-team outreach to female sex workers to reduce STIs and increase condom use and access to government clinics for STI screening and evaluation. Prevalence ratios were calculated using multivariate Poisson regression models with robust standard errors, clustering by city. As-treated analyses were conducted to assess outcomes associated with reported exposure to the intervention. Care-seeking was more frequent in intervention communities, but differences were not statistically significant. Female sex workers reporting exposure to the intervention had a significantly higher likelihood of condom use, STI screening at public health clinics, and symptom recognition compared to those not exposed. Compared with street- or bar-based female sex workers, brothel-based female sex workers reported significantly higher rates of condom use with last client, recent screening exams for STIs, and HIV testing. Brothel-based female sex workers also more often reported knowledge of STIs and recognition of STI symptoms in women and in men. Interventions to promote STI detection and prevention among female sex workers in Peru should consider structural or regulatory factors related to sex work venues.
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Affiliation(s)
- Pamela K Kohler
- Departments of Global Health, Psychosocial & Community Health, University of Washington, Seattle, WA, USA
| | | | - Patricia J Garcia
- Epidemiology, STD/AIDS Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Cesar P Carcamo
- Epidemiology, STD/AIDS Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Clara Buendia
- Epidemiology, STD/AIDS Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Carolina Mejia
- Department of Health Services, University of Washington, Seattle, USA
| | - Geoff P Garnett
- HIV/AIDS and TB, Bill and Melinda Gates Foundation, Seattle, WA, USA
| | - King K Holmes
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, WA, USA
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Garcia PJ, Egoavil MS, Blas MM, Alvarado-Vásquez E, Curioso WH, Zimic M, Castagnetto JM, Lescano AG, Lopez DM, Carcamo CP. Primer programa universitario de diplomado virtual y maestría en informática biomédica en el Perú. Rev Peru Med Exp Salud Publica 2015. [DOI: 10.17843/rpmesp.2015.322.1632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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14
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Planas ME, García PJ, Bustelo M, Carcamo CP, Martinez S, Nopo H, Rodriguez J, Merino MF, Morrison A. Effects of ethnic attributes on the quality of family planning services in Lima, Peru: a randomized crossover trial. PLoS One 2015; 10:e0115274. [PMID: 25671664 PMCID: PMC4324646 DOI: 10.1371/journal.pone.0115274] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 11/19/2014] [Indexed: 11/18/2022] Open
Abstract
Most studies reporting ethnic disparities in the quality of healthcare come from developed countries and rely on observational methods. We conducted the first experimental study to evaluate whether health providers in Peru provide differential quality of care for family planning services, based on the indigenous or mestizo (mixed ethnoracial ancestry) profile of the patient. In a crossover randomized controlled trial conducted in 2012, a sample of 351 out of the 408 public health establishments in Metropolitan Lima, Peru were randomly assigned to receive unannounced simulated patients enacting indigenous and mestizo profiles (sequence-1) or mestizo and then indigenous profiles (sequence-2), with a five week wash-out period. Both ethnic profiles used the same scripted scenario for seeking contraceptive advice but had distinctive cultural attributes such as clothing, styling of hair, make-up, accessories, posture and patterns of movement and speech. Our primary outcome measure of quality of care is the proportion of technical tasks performed by providers, as established by Peruvian family planning clinical guidelines. Providers and data analysts were kept blinded to the allocation. We found a non-significant mean difference of -0.7% (p = 0.23) between ethnic profiles in the percentage of technical tasks performed by providers. However we report large deficiencies in the compliance with quality standards of care for both profiles. Differential provider behaviour based on the patient's ethnic profiles compared in the study did not contribute to deficiencies in family planning outcomes observed. The study highlights the need to explore other determinants for poor compliance with quality standards, including demand and supply side factors, and calls for interventions to improve the quality of care for family planning services in Metropolitan Lima.
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Affiliation(s)
- Maria-Elena Planas
- Interculturality and Gender Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
- * E-mail:
| | - Patricia J. García
- Epidemiology, STD and HIV Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Monserrat Bustelo
- Gender and Diversity Division, Inter- American Development Bank, Washington, DC, United States of America
| | - Cesar P. Carcamo
- Epidemiology, STD and HIV Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Sebastian Martinez
- Office of Strategic Planning and Development Effectiveness, Inter- American Development Bank, Washington, DC, United States of America
| | - Hugo Nopo
- Education Division, Inter- American Development Bank, Washington, DC, United States of America
| | - Julio Rodriguez
- Gender and Diversity Division, Inter- American Development Bank, Washington, DC, United States of America
| | - Maria-Fernanda Merino
- Executive Vice-President Division, Inter- American Development Bank, Washington, DC, United States of America
| | - Andrew Morrison
- Gender and Diversity Division, Inter- American Development Bank, Washington, DC, United States of America
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15
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Guillen MA, Mejia FA, Villena J, Turin CG, Carcamo CP, Ticse R. Insulin resistance by homeostasis model assessment in HIV-infected patients on highly active antiretroviral therapy: cross-sectional study. Diabetol Metab Syndr 2015; 7:49. [PMID: 26034512 PMCID: PMC4450995 DOI: 10.1186/s13098-015-0046-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 05/22/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The highly active antiretroviral therapy (HAART) has altered the course of HIV infection, transforming it from a fatal illness to a chronic condition, reducing morbidity and mortality. However, this therapy has led to an increased incidence of metabolic problems such as insulin resistance, dyslipidemia, lipodystrophy and impaired glucose metabolism. The objectives of this study are to determine the prevalence of insulin resistance (IR) in a cohort of human immunodeficiency virus (HIV)-infected patients on highly active antiretroviral therapy (HAART) and to investigate the potentially associated factors. METHODS We conducted a cross-sectional study including 219 adult patients with HIV on HAART. IR was determined through the homeostasis model assessment (HOMA-IR) mathematical model, using fasting plasma glucose (FPG) and insulin. Bivariate and multivariate analyses were performed to assess the association between demographic information, clinical characteristics and laboratory results, and IR. RESULTS 75 (34.2 %) [95 % confidence interval (CI) 28.9-40.9] HIV-patients on HAART showed IR. 61 (81 %) of these patients were on HAART for more than one year, which was mainly composed by non-protease inhibitors drugs (88 %). Metabolic syndrome (MS) was found in 59 (26.9 %) subjects. In the multivariate analysis, the factors associated with IR were age ≥ 46 years (Prevalence ratio = 2.767, 95 % CI 1.325 to 5.780) and greater body mass index (BMI) (Prevalence ratio = 1.148, 95 % CI 1.054 to 1.250). CONCLUSIONS The prevalence of IR was 34.2 %. Factors associated with IR were age and BMI. We did not find any significant association between IR and protease inhibitors (PI), which may be explained by the small number of patients using PI as part of their HAART regimen included in our study.
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Affiliation(s)
- Miguel A. Guillen
- />Department of Medicine, Universidad Peruana Cayetano Heredia, Avenue Honorio Delgado 430, San Martin de Porres, Lima, Peru
| | - Fernando A. Mejia
- />Department of Infectious Diseases, Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Jaime Villena
- />Department of Endocrinology, Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Christie G. Turin
- />Department of Medicine, Universidad Peruana Cayetano Heredia, Avenue Honorio Delgado 430, San Martin de Porres, Lima, Peru
| | - Cesar P. Carcamo
- />Department of Public Health, Administration and Social Sciences, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ray Ticse
- />Department of Medicine, Universidad Peruana Cayetano Heredia, Avenue Honorio Delgado 430, San Martin de Porres, Lima, Peru
- />Department of Endocrinology, Hospital Nacional Cayetano Heredia, Lima, Peru
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Lewnard JA, Berrang-Ford L, Lwasa S, Namanya DB, Patterson KA, Donnelly B, Kulkarni MA, Harper SL, Ogden NH, Carcamo CP. Relative undernourishment and food insecurity associations with Plasmodium falciparum among Batwa pygmies in Uganda: evidence from a cross-sectional survey. Am J Trop Med Hyg 2014; 91:39-49. [PMID: 24821844 PMCID: PMC4080566 DOI: 10.4269/ajtmh.13-0422] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Although malnutrition and malaria co-occur among individuals and populations globally, effects of nutritional status on risk for parasitemia and clinical illness remain poorly understood. We investigated associations between Plasmodium falciparum infection, nutrition, and food security in a cross-sectional survey of 365 Batwa pygmies in Kanungu District, Uganda in January of 2013. We identified 4.1% parasite prevalence among individuals over 5 years old. Severe food insecurity was associated with increased risk for positive rapid immunochromatographic test outcome (adjusted relative risk [ARR] = 13.09; 95% confidence interval [95% CI] = 2.23–76.79). High age/sex-adjusted mid-upper arm circumference was associated with decreased risk for positive test among individuals who were not severely food-insecure (ARR = 0.37; 95% CI = 0.19–0.69). Within Batwa pygmy communities, where malnutrition and food insecurity are common, individuals who are particularly undernourished or severely food-insecure may have elevated risk for P. falciparum parasitemia. This finding may motivate integrated control of malaria and malnutrition in low-transmission settings.
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Affiliation(s)
- Joseph A. Lewnard
- *Address correspondence to Joseph A. Lewnard, Department of Geography, McGill University, 805 Sherbrooke W, Burnside 705, Montreal, Quebec, Canada H3A 0B9. E-mail:
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García PJ, Carcamo CP, Garnett GP, Campos PE, Holmes KK. Improved STD syndrome management by a network of clinicians and pharmacy workers in Peru: The PREVEN Network. PLoS One 2012; 7:e47750. [PMID: 23082208 PMCID: PMC3474757 DOI: 10.1371/journal.pone.0047750] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 09/20/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Sexually Transmitted diseases (STD) syndrome management has been one cornerstone of STD treatment. Persons with STD symptoms in many countries, especially those with limited resources, often initially seek care in pharmacies. The objective of the study was to develop and evaluate an integrated network of physicians, midwives and pharmacy workers trained in STD syndromic management (The PREVEN Network) as part of a national urban community-randomized trial of sexually transmitted infection prevention in Peru. METHODS AND FINDINGS After a comprehensive census of physicians, midwives, and pharmacies in ten intervention and ten control cities, we introduced seminars and workshops for pharmacy workers, and continuing education for physicians and midwives in intervention cities and invited graduates to join the PREVEN Network. "Prevention Salespersons" visited pharmacies, boticas and clinicians regularly for educational support and collection of information on numbers of cases of STD syndromes seen at pharmacies and by clinicians in intervention cities. Simulated patients evaluated outcomes of training of pharmacy workers with respect to adequate STD syndrome management, recommendations for condom use and for treatment of partners. In intervention cities we trained, certified, and incorporated into the PREVEN Network the workers at 623 (80.6%) of 773 pharmacies and 701 (69.6%) of 1007 physicians and midwives in private practice. Extremely high clinician and pharmacy worker turnover, 13.4% and 44% respectively in the first year, dictated continued training of new pharmacy workers and clinicians. By the end of the intervention the Network included 792 pharmacies and 597 clinicians. Pharmacies reported more cases of STDs than did clinicians. Evaluations by simulated patients showed significant and substantial improvements in the management of STD syndromes at pharmacies in intervention cities but not in control cities. CONCLUSIONS Training pharmacy workers linked to a referral network of clinicians proved feasible and acceptable. High turn-over was challenging but over come.
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Affiliation(s)
- Patricia J García
- Epidemiology, STI/AIDS Unit, School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru.
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Alva IE, Orellana ER, Blas MM, Bernabe-Ortiz A, Cotrina A, Chiappe M, Kochel TJ, Carcamo CP, García PJ, Zunt JR, Buffardi AL, Montano SM. HTLV-1 and -2 infections among 10 indigenous groups in the Peruvian Amazon. Am J Trop Med Hyg 2012; 87:954-6. [PMID: 22964719 DOI: 10.4269/ajtmh.2012.12-0289] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Infections with HTLV-1 and -2 were detected in 12 (1.9%) and 6 (0.9%) indigenous individuals living in 27 Amazonian villages in Peru. All infections occurred in Shipibo-Konibo people. HTLV was more common among participants living in villages distant from larger port cities and women with non-monogamous sexual partners.
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Affiliation(s)
- Isaac E Alva
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru.
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Bernabe-Ortiz A, Carcamo CP, Sanchez JF, Rios J. Weight variation over time and its association with tuberculosis treatment outcome: a longitudinal analysis. PLoS One 2011; 6:e18474. [PMID: 21494617 PMCID: PMC3072983 DOI: 10.1371/journal.pone.0018474] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 03/01/2011] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE Weight variation during therapy has been described as a useful marker to predict TB treatment outcome. No previous study has used longitudinal analysis to corroborate this finding. The goal of this study was to evaluate change and trends of patients' bodyweight over time depending on TB treatment outcome. METHODS AND FINDINGS A retrospective cohort study with all TB cases diagnosed from 2000 to 2006 was carried out. Information from 5 public tuberculosis treatment facilities at Pampas de San Juan de Miraflores, Lima, Peru was analyzed. Poor outcome was defined as failure or death during TB therapy, and compared to good outcome defined as cured. Longitudinal analysis with a pre-specified marginal model was fitted using Generalized Estimating Equations to compare weight trends for patients with good and poor outcome adjusting for potential confounders. A total of 460 patients (55.4% males, mean age: 31.6 years) were included in the analysis: 42 (9.1%) had a poor outcome (17 failed and 25 died). Weight at baseline was not different comparing outcome groups (p = 0.17). After adjusting for age, gender, type of TB, scheme of treatment, HIV status and sputum variation during follow-up, after the first month of treatment, patients with good outcome gained, on average, almost 1 kg compared to their baseline weight (p<0.001), whereas those with poor outcome lost 1 kg (p = 0.003). Similarly, after 4 months, a patient with good outcome increased 3 kg on average (p<0.001), while those with poor outcome only gained 0.2 kg (p = 0.02). CONCLUSIONS Weight variation during tuberculosis therapy follow-up can predict treatment outcome. Patients losing weight during TB treatment, especially in the first month, should be more closely followed as they are at risk of failure or death.
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Affiliation(s)
- Antonio Bernabe-Ortiz
- Epidemiology Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru.
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Canchihuaman FA, Carcamo CP, Garcia PJ, Aral SO, Whittington WLH, Hawes SE, Hughes JP, Holmes KK. Non-monogamy and risk of infection with Chlamydia trachomatis and Trichomonas vaginalis among young adults and their cohabiting partners in Peru. Sex Transm Infect 2011; 86 Suppl 3:iii37-44. [PMID: 21098055 DOI: 10.1136/sti.2010.045310] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To determine how patterns of non-monogamy influence prevalences of sexually transmitted infections (STIs) in individuals and their cohabitating sex partners. METHODS A 2002 survey in 24 Peruvian cities enrolled men and women aged 18-29 years from random household samples. The cohabiting sex partner of each enrolee was also enrolled until approximately 100 couples per city were recruited. Men provided urine and women vaginal swabs or urine for molecular testing for Chlamydia trachomatis and Trichomonas vaginalis; both genders provided blood for serological testing. RESULTS Among 2099 females and 2052 males providing specimens and behavioural data, 18.2% of males and 2.5% of females reported non-monogamy during the past year. C trachomatis was detected in 121 females (5.8%) and 80 males (4.1%) and T vaginalis in 87 females (4.2%) and 26 males (1.3%). Multivariate analyses showed that C trachomatis infection in females was significantly associated with her male partner's non-monogamy (OR 2.02, CI 1.32 to 3.08) but not significantly with her own non-monogamy; T vaginalis was associated with her own non-monogamy (OR 3.11, CI 1.25 to 7.73) and with her partner's non-monogamy (OR 2.07, CI 1.26 to 3.42). For males, both C trachomatis (OR 2.17, CI 1.29 to 3.69) and T vaginalis (OR 2.49, CI 1.06 to 5.87) were significantly associated only with his own non-monogamy. CONCLUSIONS Among cohabiting couples, male non-monogamy was common and was associated with C trachomatis and T vaginalis infection in himself and in his female partner, whereas female non-monogamy was reported infrequently and was significantly associated only with her own T vaginalis infection. Patterns of non-monogamy may guide public health interventions.
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Blas MM, Curioso WH, Garcia PJ, Zimic M, Carcamo CP, Castagnetto JM, Lescano AG, Lopez DM. Training the biomedical informatics workforce in Latin America: results of a needs assessment. BMJ Open 2011; 1:e000233. [PMID: 22080537 PMCID: PMC3208899 DOI: 10.1136/bmjopen-2011-000233] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective To report the results of a needs assessment of research and training in Medical Informatics (MI) and Bioinformatics (BI) in Latin America. Methods and results This assessment was conducted by QUIPU: The Andean Global Health Informatics Research and Training Center. After sending email invitations to MI-BI related professionals from Latin America, 142 surveys were received from 11 Latin American countries. The following were the top four ranked MI-related courses that a training programme should include: introduction to biomedical informatics; data representation and databases; mobile health; and courses that address issues of security, confidentiality and privacy. Several new courses and topics for research were suggested by survey participants. The information collected is guiding the development of curricula and a research agenda for the MI and BI QUIPU multidisciplinary programme for the Andean Region and Latin America.
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Affiliation(s)
| | | | | | - Mirko Zimic
- Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | - Andres G Lescano
- Universidad Peruana Cayetano Heredia, Lima, Peru
- US Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru
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Gomez GB, Campos PE, Buendia C, Carcamo CP, Garcia PJ, Segura P, Whittington WL, Hughes JP, Ward H, Garnett GP, Holmes KK. Studying complex interactions among determinants of healthcare-seeking behaviours: self-medication for sexually transmitted infection symptoms in female sex workers. Sex Transm Infect 2010; 86:285-91. [PMID: 20660592 DOI: 10.1136/sti.2009.036806] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To describe the frequency and determinants of self-medication for symptoms of sexually transmitted infections (STI) in a female sex worker (FSW) population. To present a methodology exploring the best predictors as well as the interactions between determinants of self-medication. METHODS A cross-sectional survey of 4153 FSW carried out in Peru. The prevalence of self-medication was estimated from the subsample of participants who had experienced symptoms of STI in the past 12 months (n=1601), and used successive logistic regression models to explore the determinants. RESULTS Self-medication prevalence for a reported symptomatic episode during the past 12 months was 32.1% (95% CI 29.8 to 34.6). It was negatively correlated with work in brothels (adjusted odds ratio (OR) 0.51, 95% CI 0.28 to 0.93; p=0.028) and awareness of STI services available for FSW (adjusted OR 0.49, 95% CI 0.29 to 0.81; p=0.006). Other determinants were organised at different levels of proximity to the outcome creating pathways leading to self-medication. CONCLUSIONS The importance of the staggered analysis presented in this study resides in its potential to improve the understanding of associations between determinants and, consequently, the targeting of interventions. The awareness of STI services available for FSW increases access to health care, which in turn decreases self-medication. In addition, the sharing of information that takes place between brothel-based FSW was also related to a diminishing prevalence of self-medication. These two main predictors provide an opportunity for prevention programmes, in particular those designed to be led by peers.
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Affiliation(s)
- Gabriela B Gomez
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
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Blas MM, Alva IE, Carcamo CP, Cabello R, Goodreau SM, Kimball AM, Kurth AE. Effect of an online video-based intervention to increase HIV testing in men who have sex with men in Peru. PLoS One 2010; 5:e10448. [PMID: 20454667 PMCID: PMC2862715 DOI: 10.1371/journal.pone.0010448] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Accepted: 11/27/2009] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although many men who have sex with men (MSM) in Peru are unaware of their HIV status, they are frequent users of the Internet, and can be approached by that medium for promotion of HIV testing. METHODS We conducted an online randomized controlled trial to compare the effect of HIV-testing motivational videos versus standard public health text, both offered through a gay website. The videos were customized for two audiences based on self-identification: either gay or non-gay men. The outcomes evaluated were 'intention to get tested' and 'HIV testing at the clinic.' FINDINGS In the non-gay identified group, 97 men were randomly assigned to the video-based intervention and 90 to the text-based intervention. Non-gay identified participants randomized to the video-based intervention were more likely to report their intention of getting tested for HIV within the next 30 days (62.5% vs. 15.4%, Relative Risk (RR): 2.77, 95% Confidence Interval (CI): 1.42-5.39). After a mean of 125.5 days of observation (range 42-209 days), 11 participants randomized to the video and none of the participants randomized to text attended our clinic requesting HIV testing (p = 0.001). In the gay-identified group, 142 men were randomized to the video-based intervention and 130 to the text-based intervention. Gay-identified participants randomized to the video were more likely to report intentions of getting an HIV test within 30 days, although not significantly (50% vs. 21.6%, RR: 1.54, 95% CI: 0.74-3.20). At the end of follow up, 8 participants who watched the video and 10 who read the text visited our clinic for HIV testing (Hazard Ratio: 1.07, 95% CI: 0.40-2.85). CONCLUSION This study provides some evidence of the efficacy of a video-based online intervention in improving HIV testing among non-gay-identified MSM in Peru. This intervention may be adopted by institutions with websites oriented to motivate HIV testing among similar MSM populations. TRIAL REGISTRATION Clinicaltrials.gov NCT00751192.
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Affiliation(s)
- Magaly M Blas
- Unit of Epidemiology, HIV and STD, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru.
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Bernabé-Ortiz A, White PJ, Carcamo CP, Hughes JP, Gonzales MA, Garcia PJ, Garnett GP, Holmes KK. Clandestine induced abortion: prevalence, incidence and risk factors among women in a Latin American country. CMAJ 2009; 180:298-304. [PMID: 19188628 DOI: 10.1503/cmaj.071399] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Clandestine induced abortions are a public health problem in many developing countries where access to abortion services is legally restricted. We estimated the prevalence and incidence of, and risk factors for, clandestine induced abortions in a Latin American country. METHODS We conducted a large population-based survey of women aged 18-29 years in 20 cities in Peru. We asked questions about their history of spontaneous and induced abortions, using techniques to encourage disclosure. RESULTS Of 8242 eligible women, 7992 (97.0%) agreed to participate. The prevalence of reported induced abortions was 11.6% (95% confidence interval [CI] 10.9%-12.4%) among the 7962 women who participated in the survey. It was 13.6% (95% CI 12.8%-14.5%) among the 6559 women who reported having been sexually active. The annual incidence of induced abortion was 3.1% (95% CI 2.9%-3.3%) among the women who had ever been sexually active. In the multivariable analysis, risk factors for induced abortion were higher age at the time of the survey (odds ratio [OR] 1.11, 95% CI 1.07-1.15), lower age at first sexual intercourse (OR 0.87, 95% CI 0.84-0.91), geographic region (highlands: OR 1.56, 95% CI 1.23-1.97; jungle: OR 1.81, 95% CI 1.41-2.31 [v. coastal region]), having children (OR 0.82, 95% CI 0.68-0.98), having more than 1 sexual partner in lifetime (2 partners: OR 1.61, 95% CI 1.23-2.09; > or = 3 partners: OR 2.79, 95% CI 2.12-3.67), and having 1 or more sexual partners in the year before the survey (1 partner: OR 1.36, 95% CI 1.01-1.72; > or = 2 partners: OR 1.54, 95% CI 1.14-2.02). Overall, 49.0% (95% CI 47.6%-50.3%) of the women who reported being currently sexually active were not using contraception. INTERPRETATION The incidence of clandestine, potentially unsafe induced abortion in Peru is as high as or higher than the rates in many countries where induced abortion is legal and safe. The provision of contraception and safer-sex education to those who require it needs to be greatly improved and could potentially reduce the rate of induced abortion.
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Affiliation(s)
- Antonio Bernabé-Ortiz
- Universidad Peruana Cayetano Heredia, Avenida Honorio Delgado 430, Ingenieria, Lima 31, Peru.
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Bernabe-Ortiz A, Curioso WH, Gonzales MA, Evangelista W, Castagnetto JM, Carcamo CP, Hughes JP, Garcia PJ, Garnett GP, Holmes KK. Handheld computers for self-administered sensitive data collection: a comparative study in Peru. BMC Med Inform Decis Mak 2008; 8:11. [PMID: 18366687 PMCID: PMC2323371 DOI: 10.1186/1472-6947-8-11] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [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: 07/21/2007] [Accepted: 03/19/2008] [Indexed: 11/15/2022] Open
Abstract
Background Low-cost handheld computers (PDA) potentially represent an efficient tool for collecting sensitive data in surveys. The goal of this study is to evaluate the quality of sexual behavior data collected with handheld computers in comparison with paper-based questionnaires. Methods A PDA-based program for data collection was developed using Open-Source tools. In two cross-sectional studies, we compared data concerning sexual behavior collected with paper forms to data collected with PDA-based forms in Ancon (Lima). Results The first study enrolled 200 participants (18–29 years). General agreement between data collected with paper format and handheld computers was 86%. Categorical variables agreement was between 70.5% and 98.5% (Kappa: 0.43–0.86) while numeric variables agreement was between 57.1% and 79.8% (Spearman: 0.76–0.95). Agreement and correlation were higher in those who had completed at least high school than those with less education. The second study enrolled 198 participants. Rates of responses to sensitive questions were similar between both kinds of questionnaires. However, the number of inconsistencies (p = 0.0001) and missing values (p = 0.001) were significantly higher in paper questionnaires. Conclusion This study showed the value of the use of handheld computers for collecting sensitive data, since a high level of agreement between paper and PDA responses was reached. In addition, a lower number of inconsistencies and missing values were found with the PDA-based system. This study has demonstrated that it is feasible to develop a low-cost application for handheld computers, and that PDAs are feasible alternatives for collecting field data in a developing country.
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Affiliation(s)
- Antonio Bernabe-Ortiz
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru.
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Campos PE, Buffardi AL, Chiappe M, Buendía C, Garcia PJ, Carcamo CP, Garnett G, White P, Holmes KK. Utility of the Determine Syphilis TP rapid test in commercial sex venues in Peru. Sex Transm Infect 2006; 82 Suppl 5:v22-5. [PMID: 17116642 PMCID: PMC2563917 DOI: 10.1136/sti.2006.023325] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study sought to evaluate the utility of the Determine Syphilis TP test performed in Peruvian commercial sex venues for the detection of active syphilis; and determine the feasibility of integrating rapid syphilis testing for female sex workers (FSW) into existing health outreach services. METHODS We tested 3586 female sex workers for syphilis by Determine in the field using whole blood fingerstick, and by rapid plasma reagin (RPR) and Treponema pallidum haemagglutination assay (TPHA) in a central laboratory in Lima using sera. RESULTS 97.4% of the FSW offered rapid syphilis testing participated; and among those who tested positive, 87% visited the local health centre for treatment. More than twice as many specimens were RPR reactive using serum in Lima (5.7%) than tested positive by whole blood Determine in the field (2.8%), and although most were confirmed by TPHA, only a small proportion (0.7%) were RPR reactive at >or=1:8 dilutions, and likely indicating active syphilis. Sensitivity, specificity and positive predictive value of the Determine Syphilis TP test in whole blood when compared to serum RPR reactivity at any dilution confirmed by TPHA as the gold standard were 39.3%, 99.2% and 71.4%, respectively. Sensitivity improved to 64.0% when using serum RPR >or=1:8 confirmed by TPHA. Invalid tests were rare (0.3%). CONCLUSIONS Rapid syphilis testing in sex work venues proved feasible, but Determine using whole blood obtained by fingerstick was substantially less sensitive than reported in previous laboratory-based studies using serum. Although easy to perform in outreach venues, the utility of this rapid syphilis test was relatively low in settings where a large proportion of the targeted population has been previously tested and treated.
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Affiliation(s)
- P E Campos
- Unidad de Epidemiología, Enfermedades de Transmisión Sexual y SIDA, Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
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