A randomized trial of audio computer and in-person interview to assess HIV risk among drug and alcohol users in Rio De Janeiro, Brazil

Made available in DSpace on 2010-08-23T16:58:40Z (GMT). No. of bitstreams: 3 license.txt: 1841 bytes, checksum: f2f331ce1a7c2174c37f581246062f98 (MD5) Bastos_A randomized trial of audio_2006.pdf: 116296 bytes, checksum: 4ea18f6ce912eb987018416918bba17b (MD5) Bastos_A randomized trial of audio_2006.pdf.txt: 34456 bytes, checksum: cf201ed43d6d92a7abd87044e2434f1d (MD5) Previous issue date: 2006Made available in DSpace on 2010-11-04T14:19:48Z (GMT). No. of bitstreams: 3 Bastos_A randomized trial of audio_2006.pdf.txt: 34456 bytes, checksum: cf201ed43d6d92a7abd87044e2434f1d (MD5) Bastos_A randomized trial of audio_2006.pdf: 116296 bytes, checksum: 4ea18f6ce912eb987018416918bba17b (MD5) license.txt: 1841 bytes, checksum: f2f331ce1a7c2174c37f581246062f98 (MD5) Previous issue date: 2006This research was supported by grant 914/BRA/3014 from the Brazilian Ministry of Health—HIV/STD National Coordination and the Health Department of Rio de Janeiro State Government, with additional funds from the HIV Prevention Research Division, University of Pennsylvania. We would like to acknowledge the following persons and institutions for their contributions to this research: Lucia Beck, Claudete Bueno, Rosana Silva, Carlos Silva, Rita Barcelos, Nadima Bernacchi, and Tereza Knett (ACORI); Rosa Ferreira and Eliane Campagnuci (Sao Francisco de Assisi Hospital); Eduardo Barbosa (Sao Sebastiao Institute; in memoriam); Mariana Hacker (Oswaldo Cruz Foundation); the CENTRA-RIO/SES team; and the people who took part in the research.Health Department of the State Government of Rio de Janeiro. Rio de Janeiro, RJ, Brazil.Oswaldo Cruz Foundation. Rio de Janeiro, RJ, Brazil.Oswaldo Cruz Foundation. Rio de Janeiro, RJ, Brazil.University of Pennsylvania. Philadelphia, PA, USA.University of Pennsylvania. Philadelphia, PA, USA.This study compares drug patterns and prevalence of risk behaviors in a randomized trial using two methods of administration, Audio Computer-Assisted Self-Interview (ACASI) and Interviewer-Administered Questionnaire (IAQ), among drug users seeking treatment in a drug treatment center. We randomized 735 participants: 367 to ACASI and 368 to IAQ. No significant difference in sociodemographic variables were found between subjects in the two arms of the study. Those interviewed by ACASI were more likely to report use on 7 of 10 substances assessed. Rates of reporting of sexual risk behaviors (male-to-male and commercial sex) were higher among participants in the ACASI arm. ACASI seems to be a key resource in improving the reporting of sensitive data in Brazil, as it has been in prior international studies

Acceptability of audio computer-assisted self-interview (ACASI) among substance abusers seeking treatment in Rio de Janeiro, Brazil

Made available in DSpace on 2010-08-23T16:58:28Z (GMT). No. of bitstreams: 3 license.txt: 1841 bytes, checksum: 637f136383eb7219d8e2343b66f7b26f (MD5) Bastos_Acceptability of audio_2006.pdf: 538210 bytes, checksum: 82c896f65c25ada0c30fa099e755ece1 (MD5) Bastos_Acceptability of audio_2006.pdf.txt: 25854 bytes, checksum: 408c627128d5a62fa67a2acd6e3f9834 (MD5) Previous issue date: 2006Made available in DSpace on 2010-11-04T14:19:56Z (GMT). No. of bitstreams: 3 Bastos_Acceptability of audio_2006.pdf.txt: 25854 bytes, checksum: 408c627128d5a62fa67a2acd6e3f9834 (MD5) Bastos_Acceptability of audio_2006.pdf: 538210 bytes, checksum: 82c896f65c25ada0c30fa099e755ece1 (MD5) license.txt: 1841 bytes, checksum: 637f136383eb7219d8e2343b66f7b26f (MD5) Previous issue date: 2006This research was supported by grant 914/BRA/3014 from the Brazilian Ministry of Health HIV/STD National Coordination and the Health Department of Rio de Janeiro State Government, with additional funds from the Center for Studies of Addiction at the University of Pennsylvania. We would like to acknowledge the following persons and institutions for their contributions to this research: ACORI staff Lucia Beck, Claudete Bueno, Rosana Silva, Carlos Silva, Rita Barcelos, Nadima Bernacchi, Tereza Knett; Silo Francisco de Assis Hospital Rosa Ferreira and Eliane Campagnuci; Silo Sebastiio Institute Eduardo Barbosa (in memoriam); Oswaldo Cruz Foundation Mariana Hacker; the Centra-Rio/SES team; and the people who took part in the research.State Government of Rio de Janeiro. State Department of Health. Health Department. Rio de Janeiro, RJ, Brazil.Fundação Oswaldo Cruz. Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Laboratório de Informação em Saúde. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Rio de Janeiro, RJ, BrazilUniversity of Pennsylvania. Philadelphia, PA, USA.University of Pennsylvania. Philadelphia, PA, USA.This study aimed to determine the acceptability of the ACASI approach to risk assessment and the impact of personal preference regarding mode of interview on reporting risk behaviors among drug users entering treatment in Rio de Janeiro, Brazil. We assessed 268 substance users who completed the ACASI arm in a randomized trial comparing the ACASI with the Interviewer-Administered Questionnaire (IAQ). The vast majority of interviewees (90.7%) reported no problem using the computer, and 37.3% felt that their privacy was best protected by the ACASI (vs. 16.4% who preferred the IAQ). Nearly half (45.5%) reported that the computer interview would produce more "honest" answers, whereas 30.6% selected the IAQ. In the adjusted regression analysis, problems using the computer were associated only with lower educational level (p < 0.05). We found no evidence that preference had an impact on reporting risk behaviors or drug use. Our study showed both good feasibility and acceptability of the ACASI for interviewing drug users in Brazil. The findings extend our understanding of the role of the ACASI method by suggesting the utility of this approach in assessing HIV risk among low- to middle-income drug users in a cultural setting quite different from previous studies

Long-Acting Injectable Cabotegravir for HIV Preexposure Prophylaxis Among Sexual and Gender Minorities: Protocol for an Implementation Study

BackgroundLong-acting injectable cabotegravir (CAB-LA) for preexposure prophylaxis (PrEP) has proven efficacious in randomized controlled trials. Further research is critical to evaluate its effectiveness in real-world settings and identify effective implementation approaches, especially among young sexual and gender minorities (SGMs). ObjectiveImPrEP CAB Brasil is an implementation study aiming to generate critical evidence on the feasibility, acceptability, and effectiveness of incorporating CAB-LA into the existing public health oral PrEP services in 6 Brazilian cities. It will also evaluate a mobile health (mHealth) education and decision support tool, digital injection appointment reminders, and the facilitators of and barriers to integrating CAB-LA into the existing services. MethodsThis type-2 hybrid implementation-effectiveness study includes formative work, qualitative assessments, and clinical steps 1 to 4. For formative work, we will use participatory design methods to develop an initial CAB-LA implementation package and process mapping at each site to facilitate optimal client flow. SGMs aged 18 to 30 years arriving at a study clinic interested in PrEP (naive) will be invited for step 1. Individuals who tested HIV negative will receive mHealth intervention and standard of care (SOC) counseling or SOC for PrEP choice (oral or CAB-LA). Participants interested in CAB-LA will be invited for step 2, and those with undetectable HIV viral load will receive same-day CAB-LA injection and will be randomized to receive digital appointment reminders or SOC. Clinical appointments and CAB-LA injection are scheduled after 1 month and every 2 months thereafter (25-month follow-up). Participants will be invited to a 1-year follow-up to step 3 if they decide to change to oral PrEP or discontinue CAB-LA and to step 4 if diagnosed with HIV during the study. Outcomes of interest include PrEP acceptability, choice, effectiveness, implementation, and feasibility. HIV incidence in the CAB-LA cohort (n=1200) will be compared with that in a similar oral PrEP cohort from the public health system. The effectiveness of the mHealth and digital interventions will be assessed using interrupted time series analysis and logistic mixed models, respectively. ResultsDuring the third and fourth quarters of 2022, we obtained regulatory approvals; programmed data entry and management systems; trained sites; and performed community consultancy and formative work. Study enrollment is programmed for the second quarter of 2023. ConclusionsImPrEP CAB Brasil is the first study to evaluate CAB-LA PrEP implementation in Latin America, one of the regions where PrEP scale-up is most needed. This study will be fundamental to designing programmatic strategies for implementing and scaling up feasible, equitable, cost-effective, sustainable, and comprehensive alternatives for PrEP programs. It will also contribute to maximizing the impact of a public health approach to reducing HIV incidence among SGMs in Brazil and other countries in the Global South. Trial RegistrationClinicaltrials.gov NCT05515770; https://clinicaltrials.gov/ct2/show/NCT05515770 International Registered Report Identifier (IRRID)PRR1-10.2196/4496

Awareness of Prevention Strategies and Willingness to Use Preexposure Prophylaxis in Brazilian Men Who Have Sex With Men Using Apps for Sexual Encounters: Online Cross-Sectional Study

Submitted by Fábio Marques ([email protected]) on 2018-09-06T14:18:22Z No. of bitstreams: 1 Awareness of Prevention Strategies and Willingness_Thiago_Torres_INI_Lapclin-AIDS_2018.pdf: 826237 bytes, checksum: e824cc149a67d6dcf486e4d70139339d (MD5)Approved for entry into archive by Regina Costa ([email protected]) on 2018-09-27T15:12:37Z (GMT) No. of bitstreams: 1 Awareness of Prevention Strategies and Willingness_Thiago_Torres_INI_Lapclin-AIDS_2018.pdf: 826237 bytes, checksum: e824cc149a67d6dcf486e4d70139339d (MD5)Made available in DSpace on 2018-09-27T15:12:37Z (GMT). No. of bitstreams: 1 Awareness of Prevention Strategies and Willingness_Thiago_Torres_INI_Lapclin-AIDS_2018.pdf: 826237 bytes, checksum: e824cc149a67d6dcf486e4d70139339d (MD5) Previous issue date: 2018Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, BrasilEscola Nacional de Ciências Estatísticas, Rio de Janeiro, BrasilFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, BrasilGeosocial networking (GSN) smartphone apps are becoming the main venue for sexual encounters among Brazilian men who have sex with men (MSM). To address the increased HIV incidence in this population, preexposure prophylaxis (PrEP) was recently implemented in the Brazilian public health system in the context of combined HIV prevention

Hybrid capture as a tool for cervical lesions screening in HIV-infected women: insights from a Brazilian cohort

Introduction: Cervical cancer remains an important burden for HIV-infected women in the era of combination antiretroviral therapy. Recommendations for cervical screening in these women diverge and may include high-risk HPV (HRHPV) testing. We aimed to evaluate the clinical usefulness of a single HRHPV testing for cervical screening of HIV-infected women. Methods: 723 HIV-infected women from a Brazilian prospective cohort were included between 1996 and 2012. Inclusion criteria were: normal cervical cytology at baseline and having a HRHPV-test at baseline. We calculated incidence rates of any squamous intraepithelial lesion (SIL) and high grade SIL+ (HSIL+) and negative predictive values (NPV) within 12 and 36 months. Hazard Ratios were obtained using Cox proportional hazards regression models. Results: Incidence rate for both outcomes was low (9.9 cases per 100 PY [95% CI 8.8–11.0] for any SIL and 1.3 cases per 100 PY [95% IC 0.9–1.8] for HSIL+). Women with a HRHPV positive status at baseline had 1.7-fold (95% CI 1.3–2.2) and 3.2-fold (95% CI 1.5–7.1) increased risk of presenting any SIL and HSIL+, respectively, during follow-up. Negative-HRHPV test presented high NPV for both periods and outcomes (any SIL: 92.4% [95% CI 89.7–94.6] for 12 months and 80.9% [95% CI 77.2–84.3] for 36 months; and HSIL+: 99.8% [95% CI 98.9–100.0] for 12 months and 99.0 [95% CI 97.6–99.7] for 36 months). Conclusions: Incidence of any and high grade cytological abnormality was significantly higher among HIV-infected women with positive-HRHPV test. A single negative-HRHPV test helped reassure follow-up free of cytological abnormalities through three years of follow-up in HIV-infected women with negative cytology. Keywords: HPV, HIV, Women, Cohort, Incidenc

Clinical outcomes of first-line antiretroviral therapy in Latin America: analysis from the LATINA retrospective cohort study

Nearly 2 million people are infected with human immunodeficiency virus (HIV) in Latin America. However, information regarding population-scale outcomes from a regional perspective is scarce. We aimed to describe the baseline characteristics and therapeutic outcomes of newly-treated individuals with HIV infection in Latin America. A Retrospective cohort study was undertaken. The primary explanatory variable was combination antiretroviral therapy based on either a protease inhibitor (PI) or a non-nucleoside reverse transcriptase inhibitor (NNRTI). The main outcome was defined as the composite of all-cause mortality and the occurrence of an AIDS-defining clinical event or a serious non-AIDS-defining event during the first year of therapy. The secondary outcomes included the time to a change in treatment strategy. All analyses were performed according to the intention to treat principle. A total of 937 treatment-naive patients from four participating countries were included (228 patients with PI therapy and 709 with NNRTI-based treatment). At the time of treatment initiation, the patients had a mean age of 37 (SD: 10) years and a median CD4 + T-cell count of 133 cells/mm(3) (interquartile range: 47.5-216.0). Patients receiving PI-based regimens had a significantly lower CD4 + count, a higher AIDS prevalence at baseline and a shorter time from HIV diagnosis until the initiation of treatment. There was no difference in the hazard ratio for the primary outcome between groups. The only covariates associated with the latter were CD4 + cell count at baseline, study site and age. The estimated hazard ratio for the time to a change in treatment (NNRTI vs PI) was 0.61 (95% CI 0.47-0.80, p &lt; 0.01). This study concluded that patients living with HIV in Latin America present with similar clinical outcomes regardless of the choice of initial therapy. Patients treated with PIs are more likely to require a treatment change during the first year of follow up

Factors associated with increased prevalence of human papillomavirus infection in a cohort of HIV-Infected Brazilian women

Objectives: Human papillomavirus (HPV) infection is a major risk factor for cervical disease. Using baseline data from the HIV-infected cohort of Evandro Chagas Clinical Research Institute at Fiocruz, Rio de Janeiro, Brazil, factors associated with an increased prevalence of HPV were assessed. Methods: Samples from 634 HIV-infected women were tested for the presence of HPV infection using hybrid capture 11 and polymerase chain reaction. Prevalence ratios (PR) were estimated using Poisson regression analysis with robust variance. Results: The overall prevalence of HPV infection was 48%, of which 94% were infected with a high-risk HPV. In multivariate analysis, factors independently associated with infection with high-risk HPV type were: younger age (<30 years of age; PR 1.5, 95% confidence interval (CI) 1.1-2.1), current or prior drug use (PR 1.3, 95% CI 1.0-1.6), self-reported history of HPV infection (PR 1.2, 95% CI 0.96-1.6), condom use in the last sexual intercourse (PR 1.3, 95% CI 1.1-1.7), and nadir CD4+ T-cell count <100 cells/mm(3) (PR 1.6, 95% CI 1.2-2.1). Conclusions: The estimated prevalence of high-risk HPV-infection among HIV-infected women from Rio de Janeiro, Brazil, was high. Close monitoring of HPV-related effects is warranted in all HIV-infected women, in particular those of younger age and advanced immunosuppression. (C) 2008 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.Digene Inc., Brazilian branchDigene Inc., Brazilian branchBrazilian National AIDS ProgramBrazilian National AIDS Progra

Prevalência e fatores associados ao aborto induzido no ingresso em uma coorte de mulheres vivendo com HIV/aids, Rio de Janeiro, Brasil, 1996-2016

Submitted by Fábio Marques ([email protected]) on 2020-02-27T14:48:29Z No. of bitstreams: 2 Prevalence_Rosa_Domingues_INI_2020.pdf: 691401 bytes, checksum: 2850e9664cc10115d8f459a9242797ae (MD5) Prevalencia_Rosa_Domingues_INI_2020.pdf: 693031 bytes, checksum: b5a492b7b0f02f8b758253d6d958d4f1 (MD5)Approved for entry into archive by Regina Costa ([email protected]) on 2020-02-27T14:58:25Z (GMT) No. of bitstreams: 2 Prevalence_Rosa_Domingues_INI_2020.pdf: 691401 bytes, checksum: 2850e9664cc10115d8f459a9242797ae (MD5) Prevalencia_Rosa_Domingues_INI_2020.pdf: 693031 bytes, checksum: b5a492b7b0f02f8b758253d6d958d4f1 (MD5)Made available in DSpace on 2020-02-27T14:58:25Z (GMT). No. of bitstreams: 2 Prevalence_Rosa_Domingues_INI_2020.pdf: 691401 bytes, checksum: 2850e9664cc10115d8f459a9242797ae (MD5) Prevalencia_Rosa_Domingues_INI_2020.pdf: 693031 bytes, checksum: b5a492b7b0f02f8b758253d6d958d4f1 (MD5) Previous issue date: 2020Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sérgio Arouca. Rio de Janeiro RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.O objetivo deste estudo é verificar a prevalência e os fatores associados ao aborto induzido no ingresso em uma coorte de mulheres vivendo com HIV/aids, no Município do Rio de Janeiro, Brasil, no período 1996-2016. O critério de elegibilidade para o ingresso na coorte era ser do sexo feminino ao nascimento, ter mais de 18 anos de idade e ter infecção comprovada pelo HIV. Na visita inicial, dados sobre aspectos sexuais, reprodutivos, comportamentais e da infecção pelo HIV foram obtidos durante entrevista face a face com o médico assistente. Foi calculada a prevalência de aborto induzido na vida e verificados os fatores associados ao aborto induzido por meio de regressão logística múltipla, para o total de mulheres e entre aquelas com gestação prévia. Do total de mulheres, 30,4% referiram algum aborto induzido na vida, sendo este valor de 33,5% em mulheres com gestação prévia. A frequência de aborto induzido relatado apresentou queda significativa no período analisado (41,7% de 1996-2000 vs. 22,5% de 2011-2016, p < 0,001). Os fatores associados ao aborto induzido, tanto para o total de mulheres quanto para aquelas com gestação prévia, foram o aumento da idade, escolaridade mais elevada, número de parceiros sexuais na vida ≥ 5, gestação na adolescência, uso de qualquer droga ilícita na vida e período de ingresso na coorte após 2005. Mudanças no perfil socioeconômico, sexual, reprodutivo e da infecção pelo HIV são explicações possíveis para a redução da prática do aborto no período. Estudos que utilizem métodos de aferição direta do aborto devem ser conduzidos em outras populações, para confirmar a tendência de queda do aborto induzido no país e seus determinantes.The aim of this study was to verify the prevalence of induced abortion and associated factors at the time of inclusion in a cohort of women living with HIV/AIDS in the city of Rio de Janeiro, Brazil, from 1996 to 2016. Eligibility criteria for inclusion in the cohort were female sex at birth, age 18 years and older, and confirmed HIV infection. At the baseline visit, data on sexual, reproductive, and behavioral aspects and HIV infection were obtained through a face-to-face interview with the attending physician. Lifetime prevalence of induced abortion was calculated, and factors associated with induced abortion were verified by multiple logistic regression for all the women and for those with previous pregnancy. In the entire cohort of women, 30.4% reported a history of induced abortion, compared to 33.5% in women with previous pregnancy. Frequency of reported induced abortion showed a significant reduction during the period (41.7% in 1996-2000 versus 22.5% in 2011-2016, p < 0.001). Factors associated with induced abortion, both for the entire cohort and for the women with previous pregnancy, were age, schooling, ≥ 5 lifetime sexual partners, teenage pregnancy, lifetime use of any illicit drug, and inclusion in the cohort after the year 2005. Changes in the socioeconomic, sexual, reproductive, and HIV infection profile are possible explanations for the reduction in abortions during the period. Studies that use direct methods to measure abortion should be conducted in other populations to confirm the downward trend in induced abortion and its determinants in Brazil.El objetivo de este estudio es verificar la prevalencia y los factores asociados al aborto inducido en el ingreso en una cohorte de mujeres, que viven con VIH/sida, en el municipio de Rio de Janeiro, durante el período 1996-2016. El criterio de elegibilidad para el ingreso en la cohorte era ser del sexo femenino al nacer, tener más de 18 años de edad y sufrir una infección comprobada por VIH. En la visita inicial, datos sobre aspectos sexuales, reproductivos, comportamentales y de infección por el VIH se obtuvieron durante la entrevista cara a cara con el médico asistente. Se calculó la prevalencia del aborto inducido en la vida y se verificaron los factores asociados al aborto inducido mediante regresión logística múltiple, para el total de mujeres y entre aquellas con gestación previa. Del total de mujeres, un 30,4% refería algún aborto inducido en la vida, siendo ese valor de un 33,5% en mujeres con gestación previa. La frecuencia de aborto inducido relatado presentó una caída significativa durante el período analizado (un 41,7% en el período 1996-2000 vs. 22,5% en el período 2011-2016, p < 0,001). Los factores asociados al aborto inducido, tanto para el total de mujeres, como para aquellas con gestación previa, fueron el aumento de la edad de la mujer, escolaridad más elevada, número de parejas sexuales en la vida ≥ 5, gestación en la adolescencia, consumo de cualquier droga ilícita en la vida y período de ingreso en la cohorte tras 2005. Cambios en el perfil socioeconómico, sexual, reproductivo y de infección por VIH son explicaciones posibles para la reducción de la realización de abortos durante el período. Se deben llevar a cabo estudios que utilicen métodos de medición directa del aborto en otras poblaciones para confirmar la tendencia de caída del aborto inducido en el país y sus determinantes