El plan integrado de la ONU en apoyo a la respuesta al SIDA en el Amazonas y Bahia, Brasil : una experiencia interprogramática e intersectorial de cooperación técnica

Este artigo apresenta o Plano Integrado das Nações Unidas em Apoio à resposta à Aids no Amazonas e na Bahia, uma iniciativa de mobilização conjunta do Sistema das Nações Unidas no Brasil em implementação desde o final de 2007. Estabelecido a partir da prioridade nacional de se responder às inequidades regionais, o “Amazonaids” e o “Laços Sociaids” buscam fortalecer sinergias locais por meio de um apoio coordenado das Agências do Sistema ONU à resposta à epidemia nos dois estados. O artigo apresenta o contexto de elaboração do Plano Integrado, sua construção, regiões e temas prioritários no Amazonas e na Bahia. Descreve, ainda, aforma de organização para implementação das atividades e as lições aprendidas até o momento. O artigo conclui destacando o processo de apropriação e liderança locais na implementação das atividades e tambémno processo de fortalecimento de ações conjuntas e integradas das Nações Unidas no Brasil, como preconizado no processo de reforma da ONU.This article presents the UN IntegratedPlan in Support to the AIDS responsein Amazonas and Bahia, a joint UNmobilization initiative, being implementedin Brazil since late 2007. Establishedfrom the national priority to respond toregional inequities, the “Amazonaids” and“Laços Sociaids” seek to strengthen localsynergies through coordinated supportof the UN system agencies to respond tothe epidemic in the two states. The articlepresents the context for the elaborationof the Integrated Plan, its development,regions and priority areas in Amazonas andBahia. It also describes the organization forimplementing the activities and lessonslearned so far. The paper concludesby highlighting the process of local ownership and leadership in implementingthe activities and also in the process ofstrengthening joint and integrated actionsof the United Nations in Brazil, as foreseenin the process of UN reform.En este artículo presenta el Plan Integradode la ONU en Apoyo a la respuesta alSIDA en Amazonas y Bahía, una iniciativaconjunta de movilización del sistema de lasNaciones Unidasimplementado en Brasildesde finales de 2007. Fue establecidoa partir de la prioridad nacional deresponder a las desigualdades regionales.Los proyectos “Amazonaids” y “LazosSociaids” buscan reforzar las sinergiaslocales mediante el apoyo coordinado delos organismos del sistema de las Naciones Unidas para responder a la epidemia en losdos estados. El artículo presenta el contextode la elaboración del Plan Integrado, suconstrucción, las regiones y las prioridadestemáticas en Amazonas y en Bahia.También describe la forma de organizaciónpara la ejecución de las actividades y laslecciones aprendidas hasta ahora. Tambiéndescribe la forma de organización para laejecución de las actividades y las leccionesaprendidas hasta ahora.El documento concluye destacando elproceso de apropiación y liderazgo local enla ejecución de las actividades y también enel proceso de fortalecimiento de accionesconjuntas e integradas de las NacionesUnidas en Brasil, como se recomienda enel proceso de reforma de la ONU

Rapid Point-of-Care Diagnostic Test for Syphilis in High-Risk Populations, Manaus, Brazil

We assessed the acceptability and operational suitability of a rapid point-of-care syphilis test and identified barriers to testing among high-risk groups and healthcare professionals in a sexually transmitted infections clinic in Manaus, Brazil. Use of this test could considerably alleviate the impact of syphilis in hard-to-reach populations in the Amazon region of Brazil

HIV and syphilis in the context of community vulnerability among indigenous people in the Brazilian Amazon.

BACKGROUND: Contextual factors shape the risk of acquiring human immunodeficiency virus (HIV) and syphilis. We estimated the prevalence of both infections among indigenous people in nine indigenous health districts of the Brazilian Amazon and examined the context of community vulnerability to acquiring these infections. METHODS: We trained 509 health care workers to screen sexually active populations in the community for syphilis and HIV using rapid testing (RT). We then assessed the prevalence of HIV and syphilis using RT. A multivariable analysis was used to identify factors associated with syphilis infection (sociodemographic, condom use, intrusion, population mobility, and violence). RESULTS: Of the 45,967 indigenous people tested, the mean age was 22.5 years (standard deviation: 9.2), and 56.5% were female. Overall, for HIV, the prevalence was 0.13% (57/43,221), and for syphilis, the prevalence was 1.82% (745/40,934). The prevalence in men, women, and pregnant women for HIV was 0.16%, 0.11%, and 0.07%, respectively, and for syphilis, it was 2.23%, 1.51%, and 1.52%, respectively. The district Vale do Javari had the highest prevalence of both infections (HIV: 3.38%, syphilis: 1.39%). This district also had the highest population mobility and intrusion and the lowest availability of prenatal services. Syphilis infection was independently associated with age (odds ratio [OR] 1.04, 95% confidence interval [CI]: 1.03-1.05), male sex (OR 1.32, 95% CI: 1.14-1.52), and mobility (moderate: OR: 7.46, 95% CI: 2.69-20.67; high: OR 7.09, 95% CI: 3.79-13.26). CONCLUSIONS: The large-scale integration of RT in remote areas increased case detection among pregnant women, especially for syphilis, in districts with higher vulnerability. Mobility is an important risk factor, especially in districts with higher vulnerability. Contextually appropriate approaches that address this factor could contribute to the long-term success of HIV and syphilis control programs

Quality of life in Amazonian women during cervical cancer treatment: the moderating role of spirituality

This study aimed to examine the contribution of psychological variables to quality of life (QoL) of Amazonian women and to analyze the moderating role of spirituality in the relationship between psychological morbidity and Qol and between illness perception and QoL. This cross-sectional study included 119 women undergoing treatment for cervical cancer (CC). The Pearson correlation test was used to evaluate the relationship between sociodemographic, clinical, and psychological variables. To test how psychological morbidity, illness perception, and spirituality contribute to QoL, a path analysis was performed and to test the moreating role of spirituality, a moderation analysis was conducted. The results revealed that the presence of symptoms, high psychological morbidity, negative body image, and threatening illness perception were predictors of lower QoL. Spirituality moderated the relationship between psychological morbidity and QoL, and between illness perception and QoL. The moderating role of spirituality emphasizes its role as a coping strategy and should be included in cancer treatment. Interventions should target psychological morbidity, threatening illness perception, and address women’s concerns with body image and sexual concerns. CC treatment should include interprofessional healthcare teams addressing the biological and psychosocial factors of Amazonian women. As a result of this study a mobile application to monitor women’s health, adapted to cultural and social characteristics, was created.This study was conducted at the Psychology Research Centre (PSI/01662), School of Psychology, University of Minho, supported by the Foundation for Science and Technology (FCT) through the Portuguese State Budget (Ref: UIDB/PSI/01662/2020)

Point-of-care screening for syphilis and HIV in the borderlands: challenges in implementation in the Brazilian Amazon.

BACKGROUND: Point-of-care (POC) screening for HIV and syphilis using rapid testing was implemented in indigenous communities in the triple-border area of the Brazilian Amazon. We describe the context of the early introduction of POC screening, explore hindering and enabling factors for POC implementation, and recommend strategies for feasible, viable, and sustainable syphilis and HIV screening interventions. METHODS: This was a qualitative study based on grounded theory methodology. Data were collected using in-depth interviews, semi-structured questionnaires, and field observations and were analysed using the framework approach. Qualitative information was complemented by quantitative data for descriptive purposes. RESULTS: An overall high score for vulnerability to acquiring HIV and syphilis was observed among the indigenous communities. Health professionals reported satisfactory rapid testing acceptance, although concerns were raised about the pain of the fingerprick. Counselling-related challenges included ensuring the accuracy of translations, collaborating with translators and communicating positive test results. Over 3 months, 86.7% of the syphilis-positive individuals began treatment, and all of them notified their partners. Accessibility, measured as travel time via the local transportation network, was a barrier to health care access. A lack of gasoline for boats and other transportation was also a hindering factor at all levels of implementation. CONCLUSIONS: The recommendations address the preparation phase at the coordination level as well as at the training level. Tools such as strengths, weaknesses, opportunities, and threats (SWOT) analyses; checklists; context-adapted protocols; and fact sheets are very simple methods to facilitate implementation. The findings of this study are important because they may inform the implementation of new health technologies in low-resource national disease control programmes in remote communities

Factors associated with self-reported discrimination against men who have sex with men in Brazil

OBJECTIVE: To estimate self-reported discrimination due to sexual orientation among men who have sex with men (MSM) in Brazil and to analyze associated factors. METHODS: A cross-sectional study of 3,859 MSM recruited in 2008–2009 with respondent driven sampling. Data collection conducted in health centers in 10 Brazilian cities. A face-to-face questionnaire was used and rapid HIV and syphilis tests conducted. Aggregated data were weighted and adjusted odds ratio estimated to measure the association between selected factors and self-reported discrimination due to sexual orientation. RESULTS: The sample was predominantly young, eight plus years of schooling, pardo (brown), single, low-income, and identified themselves as gay or homosexual. The prevalence of self-reported discrimination due to sexual orientation was 27.7% (95%CI 26.2–29.1). Discrimination was independently associated with: age < 30 years, more years of schooling,community involvement and support, history of sexual and physical violence, suicidal thoughts, and unprotected receptive anal intercourse. CONCLUSIONS: The prevalence of self-reported discrimination among MSM in Brazil is high. These results challenge the assumptions that MSM-specific prevention and support programs are not required or that health professionals do not need special training to address MSM needs

POP-Brazil study protocol : a nationwide cross-sectional evaluation of the prevalence and genotype distribution on human papillomavirus (HPV) in Brazil

Introduction Human papillomavirus (HPV) is associated with the development of genital warts and different types of cancer, including virtually all cervical cancers and a considerable number of penile, anal and oropharyngeal cancers. Data regarding the prevalence of HPV infection in Brazil are limited and fragmented. We aim to determine HPV prevalence in sexually active women and men aged 16–25 years and to investigate regional differences in virus prevalence and types. Methods and analysis This is a nationwide, multicentric, cross-sectional, prospective study that will include participants aged 16–25 years from all Brazilian capital cities. Recruitment will occur in primary health units by trained health professionals who will be responsible for collecting biological samples and interviewing the volunteers. After signing informed consent, all participants will answer a questionnaire that will collect sociodemographic and behavioural data All samples will be processed in a certified central laboratory, and strict quality control will be performed by many different procedures, including double data entry, training and certification of primary care health professionals responsible for data collection, simulation of interviews, and auditing and monitoring of visits. The sample size will be standardised based on the population distribution of each capital using SAS and R statistical software. Ethics and dissemination The project was approved by the research ethics committee of the main institution and the corresponding ethics committees of the recruitment sites. This will be the first Brazilian nationwide study to determine overall HPV prevalence and to examine regional differences and social, demographic and behavioural factors related to HPV infection. Critical analysis of the study results will contribute to epidemiological knowledge and will set a baseline for future evaluation of the impact of the National HPV Vaccination Program

Point-of-Care Tests to Strengthen Health Systems and Save Newborn Lives: The Case of Syphilis

Rosanna Peeling and colleagues describe their experience of introducing point-of-care testing to screen for syphilis in pregnant women living in low- and middle-income countries