RESUMEN
BACKGROUND: Routine screening for viral infections at blood donation is important to avoid transfusion-transmitted infections. It also offers an opportunity to detect an asymptomatic infection. OBJECTIVE: To study changes in serology positivity for viral infections (B and C hepatitis, HTLV-1/2, and HIV) at blood donation in a blood bank from Southern Brazil, comparing two periods of 5 years: the period from 2013 to 2017 with the period from 2018 to 2022. In addition, data on the donor fidelity rate during the studied period were sought. METHODS: Retrospective study using data from 2013 to 2022 from a single blood center electronic database from Curitiba, Southern Brazil. RESULTS: A significant drop in positive serology for all studied viruses was observed: highest in HIV (OR=0.39; 95% CI=0.27-0.57) and lowest in total anti HBc (0.56; 95 CI=0.50-0.63). Anti HBc serology became more commonly seen in women in the period of 2018-2022 when compared to men. No changes in the distribution of positive serology according to donors' ages were observed. Loyalty rates had a median of 70%, with the lowest being 60% in 2013, while the highest was 73% in 2018 and 2022. CONCLUSION: A significant reduction in discarded blood bags due to viral serology was observed when the period of 2013-2017 was compared to 2018-2022 on this blood bank; the highest reduction was observed in HIV serology and the lowest in HBc serology, which became more common in women in the second period. High rates of donor fidelity were observed during the period studied.
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Bancos de Sangre , Donantes de Sangre , Humanos , Donantes de Sangre/estadística & datos numéricos , Brasil/epidemiología , Masculino , Femenino , Estudios Retrospectivos , Adulto , Bancos de Sangre/estadística & datos numéricos , Persona de Mediana Edad , Adulto Joven , Infecciones por VIH/sangre , Infecciones por VIH/diagnóstico , Tamizaje Masivo/métodos , Adolescente , Hepatitis B/sangre , Hepatitis B/diagnóstico , Hepatitis B/epidemiología , Virosis/diagnóstico , Virosis/sangre , Hepatitis C/sangre , Hepatitis C/diagnóstico , Hepatitis C/epidemiología , Pruebas Serológicas/estadística & datos numéricos , Pruebas Serológicas/métodosRESUMEN
OBJECTIVE: To investigate the prior testing for HIV, syphilis, hepatitis B (HBV), and hepatitis C (HCV) among transgender women and travestis (TGW) in five Brazilian cities and identify factors associated with each of these previous tests. METHODS: This is a cross-sectional study with the recruitment of TGW through respondent-driven sampling (TransOdara Study). The investigated outcome variable was prior testing for HIV, syphilis, HBV, and HCV in the last 12 months. The association between sociodemographic and behavioral factors with the outcome was analyzed using a binomial logistic regression with mixed effects. Adjusted odds ratios (aOR) and 95% confidence intervals (CI95%) were estimated. RESULTS: The proportions of individuals with prior testing in the past year were as follows: 56.3% for HIV, 58.0% for syphilis, 42.1% for HBV, and 44.7% for HCV. Negative associations with prior testing were observed for individuals aged 35 years or older, whereas positive associations were found for those with high school education, those who experienced verbal or psychological violence in the last 12 months, and those who had commercial or casual partners in the last 6 months. CONCLUSION: There was low frequency of testing in the 12 months preceding the study for HIV, syphilis, HBV, and HCV compared to the guidelines established by the Ministry of Health. Expanding access to and engagement with healthcare and prevention services for TGW is an essential strategy in reducing the transmission chain of HIV and other sexually transmitted infections (STIs).
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Infecciones por VIH , Hepatitis B , Hepatitis C , Sífilis , Personas Transgénero , Humanos , Estudios Transversales , Brasil/epidemiología , Personas Transgénero/estadística & datos numéricos , Femenino , Sífilis/diagnóstico , Sífilis/epidemiología , Adulto , Hepatitis B/diagnóstico , Hepatitis B/epidemiología , Hepatitis C/diagnóstico , Hepatitis C/epidemiología , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Masculino , Adulto Joven , Adolescente , Persona de Mediana Edad , Factores Socioeconómicos , Factores Sociodemográficos , Factores de RiesgoRESUMEN
Stigma affects adversely the HIV prevention continuum and care cascade. Our population-based, mixed-methods study aimed to assess women's perceived HIV stigma and discriminatory attitudes, and their relation with HIV testing in a high-prevalence area in Belize. This population-representing household survey in the mixed urban-rural setting of Stann Creek District, Belize, collected data from 236 women age 15 to 49 years. We analyzed HIV testing rates, HIV prevention and transmission knowledge, perceived stigma manifestations, and participant attitudes. Concurrently, a nested qualitative component of study cognitive interviews with a purposive sample of 23 women explored HIV stigma in their community. A vast majority of women (96%) perceived HIV stigma manifestations in their communities as pervasive and a deterrent to people from testing. Discriminatory attitudes (16% believe children with HIV should not attend school) and HIV misconceptions (53% fear acquiring HIV through saliva) tended to be more common in nonurban areas and among women with less formal education. Stigma persisted even with high HIV testing rates among women. Qualitative findings triangulated survey results and, taken together, suggest that prejudices held against people with HIV led to avoidance of HIV preventive measures such as testing and status disclosure, fueled by a strong distrust of the medical care system regarding confidentiality of HIV test results. Misconceptions about HIV and stigmatizing attitudes remain pervasive among women in Stann Creek, Belize. Health literacy, stigma interventions, and expansion of routine confidential testing to include men are needed to address the HIV and stigma syndemic in Belize.
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Infecciones por VIH , Conocimientos, Actitudes y Práctica en Salud , Estigma Social , Humanos , Femenino , Adulto , Infecciones por VIH/psicología , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Adolescente , Belice/epidemiología , Persona de Mediana Edad , Adulto Joven , Prueba de VIH , Población Rural , Población UrbanaRESUMEN
BACKGROUND: In Peru, one-third of transgender women (TW) are estimated to be living with HIV. While TW are recognized as a priority population, their sexual partners are an at-risk hidden population with unmet needs for HIV services. We conducted a study examining the practices and preferences for HIV services among partners of transgender women (PTW), as compared to TW, to better understand the needs of PTW and inform HIV service delivery for them in Peru. METHODS: Between July-October 2022 we conducted a cross-sectional mixed methods study among PTW and TW in Lima, Peru. Using an explanatory sequential design, we administered online surveys to PTW (n = 165) and TW (n = 69), then interviewed a subset of participants (n = 20: 16 PTW, 4 TW). We quantitatively and qualitatively described PTW practices/perspectives on HIV testing and treatment and compared them to TW practices/preferences; we also compared practices/preferences among PTW based on their relationship with TW. RESULTS: Overall, PTW and TW shared similar experiences and preferences for HIV testing/treatment, but fewer PTW reported accessing non-traditional HIV testing options and PTW expressed less strong preferences for HIV services. PTW practices/preferences varied by type of relationship with TWs. Surveys and interviews highlighted a need to prioritize efficiency for HIV testing, eliminate gender/sexuality-based discrimination in healthcare settings, increase privacy when delivering HIV services, and increase awareness of pre-exposure prophylaxis. CONCLUSION: PTW identified many aspects related to the location, convenience, and privacy of HIV services as important. Next steps could include a discrete choice experiment to further clarify priorities for HIV services for PTW in Peru.
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Infecciones por VIH , Prueba de VIH , Parejas Sexuales , Personas Transgénero , Humanos , Personas Transgénero/psicología , Femenino , Perú/epidemiología , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Infecciones por VIH/psicología , Adulto , Masculino , Estudios Transversales , Parejas Sexuales/psicología , Persona de Mediana Edad , Adulto Joven , Adolescente , Encuestas y Cuestionarios , Prioridad del Paciente/estadística & datos numéricosRESUMEN
Transgender women (TGW) and men who have sex with other men (MSM) often encounter disparities in accessing HIV testing, leading to delayed diagnoses and worse prognoses. We analysed barriers and facilitators for accessing HIV rapid testing by TGW and MSM in Brazil, 2004-2023. Citations were included whether the study population consisted of individuals aged ≥18y old, and studies addressed HIV testing and have been conducted in Brazil. The study protocol was based on Joanna Briggs' recommendations for scoping reviews. We included 11 studies on TGW and 17 on MSM. The belief that one is not at risk of contracting HIV infection, fear expressed in different ways (e.g. lack of confidentiality) and younger age were the main barriers. Feeling at risk for HIV infection, curiosity, and favourable characteristics of the setting where the testing takes place were cited as the main facilitators. Barriers and facilitators specifically for HIV self-testing included, respectively, concerns about conducting the test alone vs. autonomy/flexibility. Brazil is unlikely to achieve the UN' 95-95-95 goal without minimising testing disparities. Combating prejudice against TGW and MSM in testing settings, along with educational campaigns and transparent protocols to ensure confidentiality, can help increase HIV testing among these populations.
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Infecciones por VIH , Homosexualidad Masculina , Personas Transgénero , Humanos , Masculino , Brasil , Infecciones por VIH/diagnóstico , Femenino , Prueba de VIH , Accesibilidad a los Servicios de Salud , Minorías Sexuales y de Género , AdultoRESUMEN
INTRODUCTION: Globally, transgender ('trans') women experience extreme social and economic marginalisation due to intersectional stigma, defined as the confluence of stigma that results from the intersection of social identities and positions among those who are oppressed multiple times. Among trans women, gender-based stigma intersects with social positions such as engagement in sex work and substance use, as well as race-based stigma to generate a social context of vulnerability and increased risk of HIV acquisition. In Brazil, trans women are the 'most at-risk' group for HIV, with 55 times higher estimated odds of HIV infection than the general population; further, uptake of HIV testing and pre-exposure prophylaxis (PrEP) among trans women is significantly lower than other at-risk groups. Through extensive formative work, we developed Manas por Manas, a multilevel intervention using HIV prevention strategies with demonstrated feasibility and acceptability by trans women in Brazil, to address intersectional stigma and increase engagement in the HIV prevention continuum. METHODS AND ANALYSIS: We are conducting a two-arm randomised wait-list controlled trial of the intervention's efficacy in São Paulo, Brazil, to improve uptake of HIV testing and PrEP among transgender women (N=400). The primary outcomes are changes in HIV testing (self-testing and clinic based), changes in PrEP uptake and changes in PrEP persistence at baseline and follow-up assessment for 12 months at 3-month intervals. ETHICS AND DISSEMINATION: This study was approved by University of California, San Francisco Institutional Review Board (15-17910) and Comissão Nacional de Ética em Pesquisa (Research Ethics National Commission, CAAE: 25215219.8.0000.5479) in Brazil. Participants provided informed consent before enrolment. We are committed to collaboration with National Institutes of Health officials, other researchers, and health and social services communities for rapid dissemination of data and sharing of materials. The results will be published in peer-reviewed academic journals and scientific presentations. TRIAL REGISTRATION NUMBER: NCT03081559.
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Infecciones por VIH , Profilaxis Pre-Exposición , Estigma Social , Personas Transgénero , Humanos , Personas Transgénero/psicología , Brasil/epidemiología , Femenino , Infecciones por VIH/prevención & control , Infecciones por VIH/diagnóstico , Masculino , Adulto , Prueba de VIH , Ensayos Clínicos Controlados Aleatorios como Asunto , Adulto Joven , Adolescente , Aceptación de la Atención de Salud/psicologíaRESUMEN
The HIV/AIDS epidemic remains a persistent and real issue, especially in key populations such as men who have sex with men (MSM), travestis and transgender persons. Projects for expanding rapid HIV testing are strategic initiatives aimed at the earliest possible identification of individuals' serological status and thus early treatment, screening of sex partners, and upscaling of preventive actions to interrupt the transmission chain. This study thus maps, describes, and systematizes the projects for expanding rapid HIV testing implemented from 2004 to 2021 in Brazil, highlighting the on-going contribution of civil society organizations and discussing the interoperability and cooperation resulting from public governance processes. We selected 67 documents for analysis, including 30 scientific publications retrieved from electronic databases and 37 documents produced by government institutions and nongovernmental organizations (NGOs). Find Out (Fique Sabendo), I Want to Get Tested (Quero Fazer), The Time is Now (A Hora É Agora), Live Better Knowing (Viva Melhor Sabendo), and Live Better Knowing Young (Viva Melhor Sabendo Jovem) were the projects mapped. Results show that the projects have used strategies adapted to the key population, such as mobile testing units, peer education, and innovative community engagement approaches. Such actions were enabled by effective cooperation and interoperability between participating stakeholders, especially NGOs.
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Infecciones por VIH , Prueba de VIH , Humanos , Brasil/epidemiología , Infecciones por VIH/diagnóstico , Infecciones por VIH/prevención & control , Infecciones por VIH/epidemiología , Masculino , Prueba de VIH/métodos , Tamizaje Masivo/métodos , Homosexualidad Masculina , Femenino , Personas TransgéneroRESUMEN
BACKGROUND: Adolescents living with HIV are disproportionally affected by depression, which worsens antiretroviral therapy adherence, increases viral load, and doubles the risk of mortality. Because most adolescents living with HIV live in low- and middle-income countries, few receive depression treatment due to a lack of mental health services and specialists in low-resource settings. Chatbot technology, used increasingly in health service delivery, is a promising approach for delivering low-intensity depression care to adolescents living with HIV in resource-constrained settings. OBJECTIVE: The goal of this study is to develop and pilot-test for the feasibility and acceptability of a prototype, optimized conversational agent (chatbot) to provide mental health education, self-help skills, and care linkage for adolescents living with HIV. METHODS: Chatbot development comprises 3 phases conducted over 2 years. In the first phase (year 1), formative research will be conducted to understand the views, opinions, and preferences of up to 48 youths aged 10-19 years (6 focus groups of up to 8 adolescents living with HIV per group), their caregivers (5 in-depth interviews), and HIV program personnel (5 in-depth interviews) regarding depression among adolescents living with HIV. We will also investigate the perceived acceptability of a mental health chatbot, including barriers and facilitators to accessing and using a chatbot for depression care by adolescents living with HIV. In the second phase (year 1), we will iteratively program a chatbot using the SmartBot360 software with successive versions (0.1, 0.2, and 0.3), meeting regularly with a Youth Advisory Board comprised of adolescents living with HIV who will guide and inform the chatbot development and content to arrive at a prototype version (version 1.0) for pilot-testing. In the third phase (year 2), we will pilot-test the prototype chatbot among 50 adolescents living with HIV naïve to its development. Participants will interact with the chatbot for up to 2 weeks, and data will be collected on the acceptability of the chatbot-delivered depression education and self-help strategies, depression knowledge changes, and intention to seek care linkage. RESULTS: The study was awarded in April 2022, received institutional review board approval in November 2022, received funding in December 2022, and commenced recruitment in March 2023. By the completion of study phases 1 and 2, we expect our chatbot to incorporate key needs and preferences gathered from focus groups and interviews to develop the chatbot. By the completion of study phase 3, we will have assessed the feasibility and acceptability of the prototype chatbot. Study phase 3 began in April 2024. Final results are expected by January 2025 and published thereafter. CONCLUSIONS: The study will produce a prototype mental health chatbot developed with and for adolescents living with HIV that will be ready for efficacy testing in a subsequent, larger study. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/55559.
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Infecciones por VIH , Humanos , Adolescente , Infecciones por VIH/psicología , Infecciones por VIH/diagnóstico , Proyectos Piloto , Masculino , Femenino , Perú/epidemiología , Adulto Joven , Niño , Tamizaje Masivo/métodos , Depresión/terapia , Autocuidado , Salud Mental , Grupos FocalesRESUMEN
In Mozambique, targeted provider-initiated HIV testing and counselling (PITC) is recommended where universal PITC is not feasible, but its effectiveness depends on healthcare providers' training. This study aimed to evaluate the effect of a Ministry of Health training module in targeted PITC on the HIV positivity yield, and identify factors associated with a positive HIV test. We conducted a single-group pre-post study between November 2018 and November 2019 in the triage and emergency departments of four healthcare facilities in Manhiça District, a resource-constrained semi-rural area. It consisted of two two-month phases split by a one-week targeted PITC training module ("observation phases"). The HIV positivity yield of targeted PITC was estimated as the proportion of HIV-positive individuals among those recommended for HIV testing by the provider. Additionally, we extracted aggregated health information system data over the four months preceding and following the observation phases to compare yield in real-world conditions ("routine phases"). Logistic regression analysis from observation phase data was conducted to identify factors associated with a positive HIV test. Among the 7,102 participants in the pre- and post-training observation phases (58.5% and 41.5% respectively), 68% were women, and 96% were recruited at triage. In the routine phases with 33,261 individuals (45.8% pre, 54.2% post), 64% were women, and 84% were seen at triage. While HIV positivity yield between pre- and post-training observation phases was similar (10.9% (269/2470) and 11.1% (207/1865), respectively), we observed an increase in yield in the post-training routine phase for women in triage, rising from 4.8% (74/1553) to 7.3% (61/831) (Yield ratio = 1.54; 95%CI: 1.11-2.14). Age (25-49 years) (OR = 2.43; 95%CI: 1.37-4.33), working in industry/mining (OR = 4.94; 95%CI: 2.17-11.23), unawareness of partner's HIV status (OR = 2.50; 95%CI: 1.91-3.27), and visiting a healer (OR = 1.74; 95%CI: 1.03-2.93) were factors associated with a positive HIV test. Including these factors in the targeted PITC algorithm could have increased new HIV diagnoses by 2.6%. In conclusion, providing refresher training and adapting the current targeted PITC algorithm through further research can help reach undiagnosed PLHIV, treat all, and ultimately eliminate HIV, especially in resource-limited rural areas.
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Humanos , Masculino , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Consejo , Triaje/métodos , Técnicas y Procedimientos Diagnósticos/estadística & datos numéricos , Servicio de Urgencia en Hospital , Mozambique/epidemiologíaRESUMEN
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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Gonorrea , Infecciones por VIH , Mpox , Minorías Sexuales y de Género , Enfermedades de Transmisión Sexual , Adulto , Humanos , Masculino , Brasil/epidemiología , Estudios Transversales , Demografía , Brotes de Enfermedades , Gonorrea/diagnóstico , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Infecciones por VIH/complicaciones , Homosexualidad Masculina , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/epidemiologíaRESUMEN
BACKGROUND: Despite being at elevated risk for HIV, men who have sex with transgender women (MSTW) are an overlooked population in the global HIV response. Venue-based HIV interventions have previously had success reaching other HIV priority populations, including transgender women (TW). Similar approaches could be applied for MSTW. OBJECTIVE: To evaluate the prospective acceptability of venue-based HIV testing and prevention interventions for MSTW and TW in Lima, Peru. METHODS: In this exploratory qualitative study, we conducted in-depth interviews (IDI) and focus group discussions (FGD) with three types of participants: MSTW (7 IDIs, 1 FGD), TW (1 FGD), and owners of social venues frequented by MSTW/TW in Lima (2 IDIs). We elicited participants' attitudes and perceptions related to the following four hypothetical interventions delivered at social venues in Lima: rapid HIV testing; HIV self-test distribution; condom/lubricant distribution; and enrolment in a mobile app supporting HIV prevention. We performed a mixed deductive-inductive thematic analysis using the framework method, then applied the Theoretical Framework of Acceptability to classify the overall acceptability of each intervention. RESULTS: Condom/lubricant distribution and app-based HIV prevention information were highly acceptable among all participant types. The two HIV testing interventions had relatively lower acceptability; however, participants suggested this could be overcome if such interventions focused on ensuring discretion, providing access to healthcare professionals, and offering appropriate incentives. CONCLUSIONS: Overall, MSTW and TW shared similar favourable attitudes towards venue-based HIV interventions. Venue-based outreach warrants further exploration as a strategy for engaging MSTW and TW in HIV prevention activities.
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Infecciones por VIH , Personas Transgénero , Masculino , Humanos , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/prevención & control , Infecciones por VIH/epidemiología , Perú/epidemiología , Estudios Prospectivos , Prueba de VIH , LubricantesRESUMEN
The purpose of this analysis is to describe HIV tests and associated outcomes for Asian people reached by the Centers for Disease Control and Prevention (CDC) HIV testing program. We analyzed CDC-funded HIV tests among Asian individuals in the United States, Puerto Rico, and the U.S. Virgin Islands (2014-2020). Of the 415,560 tests, the positivity of new diagnoses was higher among males (0.49%, aPR = 7.64) than females (0.06%), and in the West (0.42%, aPR = 1.15) than in the South (0.25%). In non-health care settings, positivity was highest among men who have sex with men (MSM; 0.87%) and transgender people (0.46%). Linkage to HIV medical care among Asian people was 87.5%, and 70.7% were interviewed for partner services. Our findings suggest that improvements are crucial, particularly for Asian MSM, in linkage to care and interview for partner services.
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Centers for Disease Control and Prevention, U.S. , Infecciones por VIH , Prueba de VIH , Tamizaje Masivo , Humanos , Masculino , Infecciones por VIH/diagnóstico , Infecciones por VIH/prevención & control , Infecciones por VIH/etnología , Femenino , Estados Unidos , Prueba de VIH/estadística & datos numéricos , Adulto , Tamizaje Masivo/estadística & datos numéricos , Tamizaje Masivo/métodos , Persona de Mediana Edad , Adulto Joven , Homosexualidad Masculina/estadística & datos numéricos , Homosexualidad Masculina/etnología , Puerto Rico , Pueblo Asiatico/estadística & datos numéricos , Trazado de Contacto , Parejas Sexuales , Adolescente , Islas Virgenes de los Estados Unidos , Personas Transgénero/estadística & datos numéricos , Asiático/estadística & datos numéricos , Entrevistas como Asunto , Minorías Sexuales y de Género/estadística & datos numéricosRESUMEN
El enfrentamiento de las personas que viven con VIH es amplio y requiere dedicación en múltiples dimensiones, más allá de la terapia antirretroviral. Estas recomendaciones abordan el manejo desde el diagnóstico, primera visita, seguimiento, manejo de comorbilidades infecciosas y no infecciosas, tamizaje de neoplasias, profilaxis antimicrobiana y vacunas, entre otras.
Management of people living with HIV is broad and multiple dimensions must be considered, beyond antiretroviral therapy. These recommendations include management from diagnosis, first visit, patient follow-up, infectious and non-infectious comorbidities, malignancies screening, antimicrobial and immunizations prophylaxis, among others.
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Humanos , Infecciones por VIH/diagnóstico , Infecciones por VIH/terapia , Atención Ambulatoria/normas , ChileRESUMEN
OBJECTIVES: to analyze the role of nursing in the establishment of an HIV/AIDS Testing and Counseling Center in a Brazilian municipality. METHODS: a historical study utilizing primary sources, including documents and oral accounts, involving a total of ten participants. The study encompasses the years 1997 and 1998. The research took place at the Testing and Counseling Center in São João de Meriti. Data was collected from March to May 2022. RESULTS: nursing made significant contributions through the development of training initiatives led by nurses, who were also responsible for individual and group counseling, as well as HIV testing requests. FINAL CONSIDERATIONS: nursing played a crucial role in the center and in the management of Sexually Transmitted Infections, being involved in all stages of treatment in accordance with current public health policy.
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Infecciones por VIH , Enfermedades de Transmisión Sexual , Humanos , Infecciones por VIH/diagnóstico , Consejo , Prueba de VIH , BrasilRESUMEN
OBJECTIVES: Screening tools in which participants self-report sexual behaviors can identify people at risk of HIV acquisition for enrollment in preexposure prophylaxis (PrEP). We compared enrollment outcomes (ie, receiving PrEP vs being excluded by a counselor or declining PrEP) in Mexico's PrEP demonstration project and evaluated the validity of a 4-criteria PrEP eligibility tool in which participants self-reported risk behavior-having condomless anal sex, transactional sex, a partner living with HIV, or a sexually transmitted infection-as compared with PrEP eligibility assessed by a counselor. METHODS: We recruited men who have sex with men and transwomen who were offered PrEP services in Mexico. We characterized participants according to enrollment outcome and identified underlying factors through logistic regression analyses. We calculated the sensitivity and specificity of the self-reported risk criteria, using the counselor's risk assessment as the point of reference. RESULTS: Of 2460 participants, 2323 (94%) had risk criteria of HIV acquisition according to the 4-criteria tool; 1701 (73%) received PrEP, 247 (11%) were excluded by a counselor, and 351 (15%) declined PrEP despite being considered eligible by the counselor. Participants who were excluded or who declined PrEP were less likely to report HIV risk behaviors than those who received PrEP, and participants who declined PrEP were more likely to be transwomen (vs men who have sex with men) and aged ≤25 years (vs >25 y). The 4-criteria risk tool had high sensitivity (98.6%) and low specificity (29.8%). CONCLUSION: The screening tool identified most participants at risk of HIV acquisition, but counselors' assessment helped refine the decision for enrollment in PrEP by excluding those with low risk. Public health strategies are needed to enhance enrollment in PrEP among some groups.
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Infecciones por VIH , Profilaxis Pre-Exposición , Humanos , Infecciones por VIH/prevención & control , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Masculino , Profilaxis Pre-Exposición/estadística & datos numéricos , México/epidemiología , Adulto , Femenino , Homosexualidad Masculina/estadística & datos numéricos , Adulto Joven , Tamizaje Masivo/estadística & datos numéricos , Tamizaje Masivo/métodos , Medición de Riesgo/métodos , Adolescente , Conducta Sexual/estadística & datos numéricos , Personas Transgénero/estadística & datos numéricos , Persona de Mediana Edad , Autoinforme , Asunción de Riesgos , Minorías Sexuales y de Género/estadística & datos numéricosRESUMEN
Many barriers to human immunodeficiency virus (HIV) testing among Black people exist. This study analysed the association between race/skin colour and lifetime HIV testing among adolescent men who have sex with men (AMSM) and transgender women (ATGW) in three Brazilian cities. This cross-sectional study was nested within the PrEP1519 cohort, a multicentre study of AMSM and ATGW aged 15-19 years in Belo Horizonte, Salvador, and São Paulo, Brazil. The outcome variable was the lifetime HIV testing (no or yes). The main exposure variable was self-reported race/skin colour as White and a unique Black group (composed of Pardo-mixed colour and Black, according to the Brazilian classification). Descriptive statistics and bivariate and multiple logistic regression analyses were conducted to estimate the adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) to determine the association between the main exposure and outcome, adjusted for covariates. White adolescents were tested more frequently than the unique Black group (64.0% vs. 53.7%, respectively; Ρ = 0.001). Multiple logistic regression analysis showed that the unique Black group of AMSM and ATGW had 26% (adjusted OR [aOR], 0.74; 95% CI, 0.55-0.98) and 38% (aOR, 0.62; 95% CI, 0.45-0.87) lower odds of being tested for HIV in a lifetime than Whites in model 1 and 2, respectively. Our findings highlight the role of racism in lifetime HIV testing among AMSM and ATGW. Therefore, an urgent need for advances exists in public policies to combat racism in Brazil.
RESUMEN: Existen numerosas barreras para la realización de las pruebas del virus de la inmunodeficiencia humana (VIH) entre la población negra. Este estudio analizó la asociación entre la raza/color de piel y haber realizado pruebas de VIH a lo largo de la vida entre hombres adolescentes que tienen sexo con hombres (AHSH) y mujeres transgénero (AMTG) en tres ciudades brasileñas. Este estudio transversal es parte de la cohorte PrEP1519, un estudio multicéntrico de AHSH y AMTG de 15 a 19 años en Belo Horizonte, Salvador y São Paulo, Brasil. La variable de resultado fue haber realizado la prueba del VIH a lo largo de la vida (no o sí). La variable de exposición principal fue la raza/color de piel autoinformada, categorizada como blanca y un grupo negro único (compuesto por color pardo/mixto y negro, según la clasificación brasileña). Se realizaron estadísticas descriptivas y análisis de regresión logística bivariada y multivariada para estimar los odds ratios (OR) ajustados y los intervalos de confianza del 95% (IC del 95%) con el fin de determinar la asociación entre la exposición principal y el resultado, ajustado por covariables. Los adolescentes blancos se hicieron la prueba del VIH con más frecuencia que el grupo negro único (64,0% frente a 53,7%, respectivamente; Ρ = 0,001). El análisis de regresión logística múltiple reveló que el grupo negro único de AHSH y AMTG tenía 26% (OR ajustado [aOR], 0,74; IC 95%, 0,550,98) y 38% (aOR, 0,62; IC 95%, 0,450,87) menores probabilidades de realizarse la prueba del VIH a lo largo de su vida que los blancos en los modelos 1 y 2, respectivamente. Nuestros hallazgos resaltan la influencia del racismo en la realización de pruebas de VIH a lo largo de la vida entre AHSH y AMTG. Por lo tanto, es urgente avanzar en la implementación de políticas públicas para combatir el racismo en Brasil.
Asunto(s)
Infecciones por VIH , Prueba de VIH , Disparidades en Atención de Salud , Homosexualidad Masculina , Racismo , Personas Transgénero , Adolescente , Femenino , Humanos , Masculino , Adulto Joven , Población Negra/estadística & datos numéricos , Brasil/epidemiología , Ciudades , Estudios Transversales , Disparidades en Atención de Salud/etnología , Disparidades en Atención de Salud/estadística & datos numéricos , Infecciones por VIH/diagnóstico , Infecciones por VIH/etnología , Infecciones por VIH/epidemiología , Prueba de VIH/estadística & datos numéricos , Homosexualidad Masculina/estadística & datos numéricos , Homosexualidad Masculina/etnología , Homosexualidad Masculina/psicología , Factores Socioeconómicos , Personas Transgénero/estadística & datos numéricos , Personas Transgénero/psicología , Población Blanca/estadística & datos numéricos , Población Blanca/psicología , Grupos Raciales/etnología , Grupos Raciales/estadística & datos numéricosRESUMEN
INTRODUCTION: Globally, the incidence of HIV and syphilis can be reduced by the use of validated point of care tests (POCTs). As part of the WHO PRoSPeRo Network, we aimed to evaluate the performance, acceptability, and operational characteristics of two dual HIV/syphilis POCTs (Bioline HIV/Syphilis Duo (Abbott) and DPP® HIV-Syphilis assay (Chembio) for the screening of HIV and syphilis amongst men who have sex with men (MSM). METHOD AND ANALYSES: A cross sectional study of 2,577 MSM in Italy, Malta, Peru, and the United Kingdom (UK) presenting to seven clinic sites, were enrolled. Finger prick blood was collected to perform POCTs and results compared with standard laboratory investigations on venepuncture blood. Acceptability and operational characteristics were assessed using questionnaires. Diagnostic meta-analysis was used to combine data from the evaluation sites. RESULTS: Based on laboratory tests, 23.46% (n = 598/2549) of participants were confirmed HIV positive, and 35.88% of participants (n = 901/2511) were positive on treponemal reference testing. Of all participants showing evidence of antibodies to Treponema pallidum, 50.56% (n = 455/900) were Rapid Plasma Reagin (RPR) test reactive. Of HIV positive individuals, 60.62% (n = 354/584) had evidence of antibodies to T. pallidum, and of these 60.45% (n = 214/354) exhibited reactive RPR tests indicating probable (co)infection. For Bioline POCT, pooled sensitivities and specificities for HIV were 98.95% and 99.89% respectively, and for syphilis were 73.79% and 99.57%. For Chembio pooled sensitivities and specificities for HIV were 98.66% and 99.55%, and for syphilis were 78.60% and 99.48%. Both tests can detect greater than 90% of probable active syphilis cases, as defined by reactive RPR and treponemal test results. These dual POCTs were preferred by 74.77% (n = 1,926) of participants, due to their convenience, and the operational characteristics made them acceptable to health care providers (HCPs). CONCLUSIONS: Both the Bioline and the Chembio dual POCT for syphilis and HIV had acceptable performance, acceptability and operational characteristics amongst MSM in the PRoSPeRo network. These dual POCTs could serve as a strategic, more cost effective, patient and healthcare provider (HCP) friendly alternative to conventional testing; in clinical and other field settings, especially those in resource-limited settings.
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Infecciones por VIH , Minorías Sexuales y de Género , Sífilis , Masculino , Humanos , Sífilis/diagnóstico , Sífilis/epidemiología , Homosexualidad Masculina , Perú/epidemiología , Malta , Estudios Transversales , Treponema pallidum , Pruebas en el Punto de Atención , Serodiagnóstico de la Sífilis/métodos , Sensibilidad y Especificidad , Anticuerpos Antibacterianos , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiologíaRESUMEN
BACKGROUND: Transfusion-transmitted malaria (TTM) is a public health problem in endemic and nonendemic areas. The Brazilian Ministry of Health (MH) requested the development of a nucleic acid amplification test (NAT) for the detection of Plasmodium spp. in public blood centers to increase blood safety. STUDY DESIGN AND METHODS: The new Brazilian NAT kit named NAT PLUS HIV/HBV/HCV/Malaria Bio-Manguinhos was first implemented in HEMORIO, a public blood center in the city of Rio de Janeiro. Since October 1, 2022, this blood center has been testing all its blood donations for malaria in a pool of six plasma samples to detect Plasmodium spp. by real-time polymerase chain reaction (PCR). RESULTS: Since the implementation of the NAT PLUS platform until February 2023, HEMORIO has successfully received and tested 200,277 donations. The platform detected two asymptomatic donors in the city of Rio de Janeiro, which is a nonendemic region for malaria. Our analyses suggested a malaria from the Amazon region caused by Plasmodium vivax, in the first case, while an autochthonous transmission case by Plasmodium malariae was identified in the rural area of Rio de Janeiro state. DISCUSSION: The NAT PLUS platform detects Plasmodium spp. in plasma samples with sensitivity capable of detecting subpatent infections. This is the first time worldwide that a group developed and implemented molecular diagnosis for Plasmodium spp. to be used by public blood centers to avoid TTM.
Asunto(s)
Infecciones por VIH , Hepatitis C , Malaria , Humanos , Virus de la Hepatitis B , Donantes de Sangre , Brasil/epidemiología , Malaria/diagnóstico , Malaria/epidemiología , Plasmodium malariae , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiologíaRESUMEN
The main goal of this study was to spatially analyze the HIV epidemic scenario in young men in Brazil, 2007-2021. We used secondary data obtained from the Brazilian Information System for Notifiable Diseases. Individuals aged 15-29 years with permanent residence in Brazil who were diagnosed with HIV during the study period were included in the analysis. Municipality HIV age-adjusted detection rates were analyzed through spatial distribution, autocorrelation, and spatiotemporal risk analyses. During the study period, 108,392 HIV cases were reported in young Brazilian men. The HIV epidemic increased territorially in the northern, northeastern, midwestern, and southeastern regions but decreased in the southern region. Although the number of clusters comprising municipalities with high HIV detection rates (hotspots) decreased, new ones appeared, expanded, or stopped changing size. Hotspots and spatio-temporal risk zones (spatial areas with increased HIV detection in a specific period) comprised economically developed municipalities with high demographic density surrounded by less developed municipalities. The period of the spatiotemporal risk zones was between 2008 and 2021. Our study showed that HIV detection rates continue to increase among young Brazilian men, and health authorities should reinforce efforts mainly in capitals and surrounded municipalities in the north, northeast, southeast, and midwest regions.
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Infecciones por VIH , Análisis Espacial , Humanos , Masculino , Brasil/epidemiología , Infecciones por VIH/epidemiología , Infecciones por VIH/diagnóstico , Adolescente , Adulto Joven , Adulto , Análisis Espacio-Temporal , Factores de RiesgoRESUMEN
OBJECTIVES: This study aims to evaluate the disruption in HIV screening and diagnoses due to the coronavirus disease 2019 (COVID-19) pandemic and to investigate the pandemic's subsequent influence on the HIV epidemic. DESIGN: A retrospective examination of testing and confirmed diagnoses time series was undertaken from 2011 to 2022. The analysis encompassed testing, positive tests, positivity rates, and diagnosis outcomes, including new HIV diagnoses, asymptomatic HIV diagnoses, and symptomatic HIV diagnoses. METHODS: We used Autoregressive Integrated Moving Average (ARIMA) models to estimate the COVID-19 epidemic's impact on screening and diagnosis outcomes. We gauged the pandemic's effect between January 2020 and December 2022 by comparing modeled predicted results with actual outcomes. RESULTS: The advent of COVID-19 prompted a reduction of 50.7% in HIV testing, followed by a monthly escalation in testing afterward, estimated at 30.2 and 65.1% for 2021 and 2022, respectively. Although new diagnoses reported between 2020 and 2022 gradually increased to prepandemic levels, we estimate a gap of 13â207 new diagnoses, with symptomatic detections increasing more than proportionally in 2021 and 2022. CONCLUSION: Our results suggest that the COVID-19 pandemic resulted in missed HIV diagnoses and a rise in late HIV diagnoses. Implementing tailored post-COVID-19 strategies to accelerate timely HIV testing and prevention is needed to avert additional burdens and remain on track toward achieving the 2030 HIV management goals.