HIV, HCV, HBV, and syphilis among transgender women from Brazil: Assessing different methods to adjust infection rates of a hard-to-reach, sparse population.

Different sampling strategies, analytic alternatives, and estimators have been proposed to better assess the characteristics of different hard-to-reach populations and their respective infection rates (as well as their sociodemographic characteristics, associated harms, and needs) in the context of studies based on respondent-driven sampling (RDS). Despite several methodological advances and hundreds of empirical studies implemented worldwide, some inchoate findings and methodological challenges remain. The in-depth assessment of the local structure of networks and the performance of the available estimators are particularly relevant when the target populations are sparse and highly stigmatized. In such populations, bottlenecks as well as other sources of biases (for instance, due to homophily and/or too sparse or fragmented groups of individuals) may be frequent, affecting the estimates.In the present study, data were derived from a cross-sectional, multicity RDS study, carried out in 12 Brazilian cities with transgender women (TGW). Overall, infection rates for HIV and syphilis were very high, with some variation between different cities. Notwithstanding, findings are of great concern, considering the fact that female TGW are not only very hard-to-reach but also face deeply-entrenched prejudice and have been out of the reach of most therapeutic and preventive programs and projects.We cross-compared findings adjusted using 2 estimators (the classic estimator usually known as estimator II, originally proposed by Volz and Heckathorn) and a brand new strategy to adjust data generated by RDS, partially based on Bayesian statistics, called for the sake of this paper, the RDS-B estimator. Adjusted prevalence was cross-compared with estimates generated by non-weighted analyses, using what has been called by us a naïve estimator or rough estimates

Adherence to antiretroviral therapy among HIV-infected drug users: a meta-analysis

Submitted by Cléa Mara Barradas ([email protected]) on 2011-05-02T18:28:44Z No. of bitstreams: 1 Adherence to Antiretroviral_2010.pdf: 384714 bytes, checksum: cd062b61d620faccaefbf9db80ba5796 (MD5)Made available in DSpace on 2011-05-02T18:28:44Z (GMT). No. of bitstreams: 1 Adherence to Antiretroviral_2010.pdf: 384714 bytes, checksum: cd062b61d620faccaefbf9db80ba5796 (MD5) Previous issue date: 2010Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Departamento Ciência Social. Rio de Janeiro, RJ, BrasilUniversidade Federal do Rio de Janeiro. Instituto de Estudos de Saúde Coletiva. Rio de Janeiro, RJ, BrasilUniversity of California. School of Medicine, San Diego. Division of International Health and Cross Cultural Medicine. Department of Family and Preventive Medicine. San Diego, CA, USA.Fundação Oswaldo Cruz. Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Laboratório de Informação em Saúde. Rio de Janeiro, RJ, BrasilAbstract We conducted a meta-analysis of studies assessing adherence to highly active antiretroviral therapy (HAART) and a qualitative systematic review of factors associated with better HAART outcomes among HIV? drug users (DU). Thirty-eight studies were considered, which analyzed 14,960 patients (11,394 HIV? DU, 76.2%). Overall adherence (pooled percent of DU classified as adherent in each study) was 0.60 (95% CI: 0.52– 0.68), similar to levels identified by studies conducted with HIV? patients who are not drug users. Time frame used to measure adherence was an independent predictor of interstudy heterogeneity. The systematic review identified better HAART outcomes among former DU, those with less severe psychiatric conditions, those receiving opioid substitution therapy and/or psychosocial support. Patients initiating HAART with lower viral load and higher CD4 counts, and those without co-infections also had better treatment outcomes. Our findings suggest that HIV? DU tend to be inappropriately assumed to be less adherent and unlikely to achieve desirable treatment outcomes, when compared to their non-DU cohort

Social geography of AIDS in Brazil: identifying patterns of regional inequalities

The trend towards decline and stabilization of the AIDS epidemic in Brazil should be analyzed carefully, since aggregate data can mask regional or local inequalities in such a large and diverse country. The current study reevaluates the epidemic’s spatial dissemination and the AIDS-related mortality pattern in Brazil. The study considered all AIDS cases diagnosed in individuals over 18 years of age and living in Brazil, as well as AIDS deaths recorded in 1998-2008. Three-year moving average rates were estimated, and a spatial analysis was conducted using a local empirical Bayesian method. The epidemic was only found to be expanding in the North and Northeast regions, while declining in the rest of the country, especially in the Southeast. According to the findings, the apparent stabilization of AIDS mortality tends to mask regional disparities. Social determinants of health and regional disparities should be taken into account in program development and policymaking

Aderência à terapia anti-retroviral: um estudo qualitativo com médicos no Rio de Janeiro, Brasil

Made available in DSpace on 2010-08-23T16:58:48Z (GMT). No. of bitstreams: 3 license.txt: 1841 bytes, checksum: d961e0538ea3789aa393734e643649c9 (MD5) Bastos_Adherence to antiretroviral therapy_2005.pdf: 76915 bytes, checksum: 854a671456d98ec8ea779faa6f7c9f31 (MD5) Bastos_Adherence to antiretroviral therapy_2005.pdf.txt: 39406 bytes, checksum: dd0f8e58b574f1162a5c516c5a722e03 (MD5) Previous issue date: 2005Made available in DSpace on 2010-11-04T14:19:58Z (GMT). No. of bitstreams: 3 Bastos_Adherence to antiretroviral therapy_2005.pdf.txt: 39406 bytes, checksum: dd0f8e58b574f1162a5c516c5a722e03 (MD5) Bastos_Adherence to antiretroviral therapy_2005.pdf: 76915 bytes, checksum: 854a671456d98ec8ea779faa6f7c9f31 (MD5) license.txt: 1841 bytes, checksum: d961e0538ea3789aa393734e643649c9 (MD5) Previous issue date: 2005Fundação Oswaldo Cruz. Centro de Informação Científica e Tecnológica. Rio de Janeiro, RJ, Brasil.University of California. School of Public Health. Berkeley, USA.Iowa State University. Prevention Science Institute. Iowa, USA.Universidade do Estado do Rio de Janeiro. Instituto de Psicologia. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Centro de Informação Científica e Tecnológica. Rio de Janeiro, RJ, Brasil.O Brasil fornece gratuitamente terapia anti-retroviral (ARV) para cerca de 150 mil pessoas vivendo com HIV/ AIDS. A terapia ARV requer aderência ótima, visando alcançar carga viral indetectável e evitar resistência viral. Os médicos desempenham papel central quanto à aderência à ARV, mas há escassa informação sobre a comunicação entre médicos/pessoas vivendo com HIV/ AIDS. Entrevistas em profundidade foram realizadas com 40 médicos assistentes de seis hospitais de referência do Rio de Janeiro, Brasil. Tópicos da entrevista incluíram: experiências relativas ao tratamento de pessoas vivendo com HIV/AIDS, relacionamento/diálogo com pacientes, barreiras/facilitadores para aderência aos serviços disponíveis e eficácia destes. As barreiras para aderência à ARV se referiam, principalmente, ao relacionamento médico-paciente. Outras barreiras estavam relacionadas a estilos de vida “caóticos” de alguns pacientes, conhecimento inadequado/crenças negativas sobre HIV/AIDS e a eficácia da ARV. É necessário melhorar as redes de serviços de saúde, com encaminhamento mais ágil e maior integração entre diferentes profissionais de saúde. Essas mudanças estruturais podem melhorar a aderência e a qualidade de vida das pessoas vivendo com HIV/AIDS.Brazil provides free antiretroviral (ARV) therapy to some 150,000 individuals living with HIV/AIDS). ARV regimens require optimal adherence to achieve undetectable viral loads and to avoid viral resistance. Physicians play a key role to foster ARV adherence, but until now little is known about the communication between physicians/ people living with HIV/AIDS in this setting. Indepth interviews were conducted with 40 physicians treating people living with HIV/AIDS at six public reference centers in Rio de Janeiro, Brazil. Interview topics included: experiences in the treatment of people living with HIV/AIDS, relationship and dialogue with patients, barriers/ facilitators to adherence, and effectiveness of available services. Barriers to ARV adherence were mainly related to the low quality of patient-provider relationship. Other barriers were related to “chaotic” patients’ lifestyles, and inadequate knowledge and/or negative beliefs about HIV/AIDS and ARV effectiveness. It is necessary to improve networking between services, establish agile referral systems, and improve health professionals’integration. These structural changes could contribute to improved adherence, resulting in improved quality of life for people living with HIV/AIDS

STROBE initiative: guidelines on reporting observational studies

Submitted by Cléa Mara Barradas ([email protected]) on 2011-04-29T14:27:50Z No. of bitstreams: 1 Iniciativa STROBE_2010.pdf: 154124 bytes, checksum: 8496ac19f58e5af9d03981c1f04ac15f (MD5)Made available in DSpace on 2011-04-29T14:27:50Z (GMT). No. of bitstreams: 1 Iniciativa STROBE_2010.pdf: 154124 bytes, checksum: 8496ac19f58e5af9d03981c1f04ac15f (MD5) Previous issue date: 2010Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sérgio Arouca. Departamento de Ciências Sociais. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sérgio Arouca. Departamento de Epidemiologia e Métodos Quantitativos em Saúde. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Laboratório de Informação em Saúde. Rio de Janeiro, RJ, Brasil.Universidade Federal do Rio de Janeiro. Instituto de Estudos em Saúde Coletiva. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sérgio Arouca. Departamento de Epidemiologia e Métodos Quantitativos em Saúde. Rio de Janeiro, RJ, Brasil.Freqüentemente, a descrição de pesquisas de natureza observacional é inadequada, dificultando a avaliação de seus pontos fracos e fortes e, em conseqüência, a generalização de seus resultados. A iniciativa denominada Strengthening the Reporting of Observational Studies in Epidemiology (STROBE), formulou uma lista de verificação que contém 22 itens, denominada STROBE Statement (“Declaração STROBE”), com recomendações sobre o que deveria ser incluído em uma descrição mais precisa e completa de estudos observacionais. Entre junho e dezembro de 2008, um grupo de pesquisadores brasileiros dedicou-se à tradução e adaptação da “Declaração STROBE” para o português. O objetivo do estudo foi apresentar a tradução para o português, bem como introduzir a discussão sobre o contexto de utilização, as potencialidades e limitações da Iniciativa STROBE.Reporting of observational studies is often inadequate, hampering the assessment of their strengths and weaknesses and, consequently, the generalization of study results. The initiative named Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) developed a checklist of 22 items, the STROBE Statement, with recommendations about what should be included in a more accurate and complete description of observational studies. Between June and December 2008, a group of Brazilian researchers was dedicated to the translation and adaptation of the STROBE Statement into Portuguese. The present study aimed to show the translation into Portuguese, introduce the discussion on the context of use, the potential and limitations of the STROBE initiative

Doubts remain, risks persist: HIV prevention knowledge and HIV testing among drug users in Rio de Janeiro, Brazil

O estudo foi realizado no Rio de Janeiro por um equipe interdisciplinar de pesquisadores da Universidade de Iowa (Ames, IA), Fundação Oswaldo Cruz (FIOCRUZ; (Rio de Janeiro), e da Hispanic Conselho de Saúde (Hartford, CT). Todos os métodos e instrumentos utilizados no estudo foram aprovados pelos conselhos de revisão institucional destes três instituições, bem como pela CONEP, nacional do Brasil comitê de ética, conforme exigido pela legislação brasileira para estudos colaborativos internacionais.Submitted by Tatiana Oliveira ([email protected]) on 2012-05-02T19:49:58Z No. of bitstreams: 1 Doubts_remain_risks_persist_HIV.pdf: 327675 bytes, checksum: 4253dab649a6c0eeba44054ebadb2f4f (MD5)Made available in DSpace on 2012-05-02T19:49:58Z (GMT). No. of bitstreams: 1 Doubts_remain_risks_persist_HIV.pdf: 327675 bytes, checksum: 4253dab649a6c0eeba44054ebadb2f4f (MD5) Previous issue date: 2011Instituto Nacional sobre Abuso de DrogasUniversity of Connecticut. Center for Health, Intervention and Prevention. Department of Anthropology. Storrs, CT, USA / Yale University. Center for Interdisciplinary Research on AIDS. New Haven, CT, USA.Yale University. Center for Interdisciplinary Research on AIDS. New Haven, CT, USA.Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Departamento de Ciências Sociais. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Laboratório de Informação em Saúde. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Rio de Janeiro, RJ, Brasil.Northeastern University. Institute on Urban Health Research. Boston, MA, USA.O Brasil tem sido reconhecido como o primeiro país em desenvolvimento a implementar um programa de tratamento universal da AIDS. O Brasil implementou também iniciativas abrangentes de prevenção. Os esforços têm sido bem sucedidos, tendo sido registrados, aproximadamente, metade do número de casos de HIV/AIDS que, em 1992, previu-se que viriam a ser registrados em 2000. No entanto, o HIV/AIDS continua se disseminando, inclusive entre os usuários de drogas que não estão em tratamento. Questões têm sido formuladas acerca de possíveis lacunas no âmbito dos esforços de prevenção em curso. Baseado em pesquisa qualitativa realizada em 2006–2008, com usuários de drogas, das ruas do Rio de Janeiro (grupos focais, N = 24; escolha de pilhas de cartas com ilustrações N = 108; entrevistas abertas, N = 34), este artigo avalia lacunas persistentes no conhecimento acerca do HIV e nos padrões de risco mais frequentes, e propõe estratégias para o fortalecimento da prevenção.Brazil has been recognized for being the first developing country to provide universal AIDS treatment. Brazil also implemented a comprehensive prevention initiative. These efforts have been successful, with about half the number of HIV/AIDS cases forecast in 1992 developing by 2000. However, HIV/AIDS continues to spread, including among not-in-treatment drug users. Questions have been raised about gaps in existing prevention efforts. Based on qualitative research in 2006–2008 with street drug users in Rio de Janeiro (focus groups, N = 24; a pile sort, N = 108; open-ended interviews,N=34), this paper examines enduring gaps in HIV knowledge and prevailing risk patterns and proposes strategies for strengthening prevention

Putting Respondent-Driven Sampling on the Map: Insights from Rio de Janeiro, Brazil

Brazilian Multicity Study Group on Drug MisuseSubmitted by Tatiana Silva ([email protected]) on 2012-08-12T04:06:36Z No. of bitstreams: 1 Putting_Respondent_Driven_Sampling_on_the_Map.pdf: 729068 bytes, checksum: 0e419ac4de3a516364173d3bdd2971f6 (MD5)Made available in DSpace on 2012-08-12T04:06:36Z (GMT). No. of bitstreams: 1 Putting_Respondent_Driven_Sampling_on_the_Map.pdf: 729068 bytes, checksum: 0e419ac4de3a516364173d3bdd2971f6 (MD5) Previous issue date: 2011-08-15Fundação Oswaldo Cruz. Instituto de Comunicação e Informação Cientifica e Tecnológica em Saúde. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto de Comunicação e Informação Cientifica e Tecnológica em Saúde. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto de Comunicação e Informação Cientifica e Tecnológica em Saúde. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto de Comunicação e Informação Cientifica e Tecnológica em Saúde. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto de Comunicação e Informação Cientifica e Tecnológica em Saúde. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto de Comunicação e Informação Cientifica e Tecnológica em Saúde. Rio de Janeiro, RJ, Brasil.Hard-to-reach populations with high background infection rates for HIV are particularly relevant in countries with restricted HIVepidemics, such as Brazil, where the very dynamics of the epidemic depends on the bridges between those populations and the general population. Respondent-driven sampling (RDS) has been one of the key strategies to assess such populations and inform policy makin

Treatment for HIV/AIDS in Brazil: strengths, challenges, and opportunities for operations research

Made available in DSpace on 2010-08-23T16:58:33Z (GMT). No. of bitstreams: 3 license.txt: 1841 bytes, checksum: 56a1101de03324fec7faa1f4cc5ea3f0 (MD5) Bastos_Treatment for HIV_AIDS in Brazil_2001.pdf: 141786 bytes, checksum: 8cba5a45354d88735c8a5f5f918e254e (MD5) Bastos_Treatment for HIV_AIDS in Brazil_2001.pdf.txt: 44962 bytes, checksum: c585c6263af75c28a2e2793f99963606 (MD5) Previous issue date: 2001Made available in DSpace on 2010-11-04T14:20:08Z (GMT). No. of bitstreams: 3 Bastos_Treatment for HIV_AIDS in Brazil_2001.pdf.txt: 44962 bytes, checksum: c585c6263af75c28a2e2793f99963606 (MD5) Bastos_Treatment for HIV_AIDS in Brazil_2001.pdf: 141786 bytes, checksum: 8cba5a45354d88735c8a5f5f918e254e (MD5) license.txt: 1841 bytes, checksum: 56a1101de03324fec7faa1f4cc5ea3f0 (MD5) Previous issue date: 2001Oswaldo Cruz Foundation. Rio de Janeiro, RJ, Brazil.Johns Hopkins School of Public Health, Baltimore, Maryland, United StatesOswaldo Cruz Foundation. Rio de Janeiro, RJ, Brazil.Oswaldo Cruz Foundation. Rio de Janeiro, RJ, Brazil.Johns Hopkins School of Public Health, Baltimore, Maryland, United StatesBrazil is the only middle-income country to provide free, universal access to antiretroviral (ARV) therapy for the treatment of HIV/AIDS. Currently, the Brazilian National STD/AIDS Program provides ARV therapy to over 95,000 people living with HIV/AIDS (PLWHA). But a successful HIV/AIDS treatment program must provide more than drugs. It must offer a comprehensive set of services along the continuum of care and support, including promoting early entrance into care, facilitating adherence to ARV therapy especially among vulnerable populations, integrating psychosocial support services into care, ensuring that access to ARV therapy does not lead to unintended behaviors, and providing ongoing training to medical personnel and psychosocial support staff. Additionally, the ARV therapy and related support services must be affordable. Brazil has been engaged in a permanent effort to foster national production of ARV and to negotiate substantial discounts with international drug companies. This paper outlines Brazil's significant achievements in creating and sustaining access to ARVs and other anti-AIDS drugs as well as developing innovative care and support services with which to respond to the multifaceted needs of PLWHA in Brazil. The paper also reviews the improvements in AIDS-related mortality and morbidity and subsequent cost savings attributed to the provision of universal access to ARV therapy in Brazil

Patient–provider communication and reproductive health among HIV-positive women in Rio de Janeiro, Brazil

Submitted by Cléa Mara Barradas ([email protected]) on 2011-05-03T14:17:08Z No. of bitstreams: 1 Patient-provider_2010.pdf: 143698 bytes, checksum: 40c0ce6c25f1ed5337b695e310c67b60 (MD5)Made available in DSpace on 2011-05-03T14:17:08Z (GMT). No. of bitstreams: 1 Patient-provider_2010.pdf: 143698 bytes, checksum: 40c0ce6c25f1ed5337b695e310c67b60 (MD5) Previous issue date: 2010Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil.Columbia University. Department of Obstetrics & Gynecology. New York, NY, USALacuna Consulting. Houston, TX, USAFundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Rio de Janeiro, RJ, BrasilObjective: To qualitatively assess the influence of patient–provider communication on contraceptive choice among HIV-positive women in the context of universal antiretroviral therapy (ART) access. Methods: Focus group discussions (FGD; n = 3), in-depth (IDI; n = 15) and freelist interviews (FLI; n = 36) were conducted with HIV-positive women aged 18–40 years recruited from public health units in Rio de Janeiro/Brazil. Results: Of 70 participants, 49 used ART and the median time since HIV diagnosis was 6 years (range: 1– 18). The majority of participants (71.4%) reported some degree of dissatisfaction with their health providers (usually lack of open dialogue) and a few reported experiences of stigma/prejudice during appointments. Intra, interpersonal and social factors modulated behaviors and reproductive health decisions, and those issues were rarely addressed by providers during HIV clinical care. Conclusion: Despite dramatic increases in survival and life quality after universal ART implementation in Brazil, reproductive health issues are neglected by multiple cadres of HIV health providers. Communication on reproductive health issues remains fragmented and potentially contradictory, compromising care in these settings. Practice implications: Adequate provider training to address reproductive health-related issues in a comprehensive, culturally sensitive manner and improved integration of HIV and reproductive health care are urgently needed in this setting