HIV continuum of care among trans women and travestis living in São Paulo, Brazil

OBJECTIVE: To examine the HIV care cascade among trans women and travestis in São Paulo – Brazil, the most populous city in South America. METHODS: Using data from a cross-sectional study carried out between November 2016 and May 2017 in the city of São Paulo (Divas Research). Respondent driven sampling (RDS) was used to recruit 386 transgender women and travestis who participated in a HIV risk survey and were tested for HIV. The cascade was defined as HIV prevalence, HIV diagnosed, Antiretroviral (ART) Prescription, and currently on ART. A multiple analysis model was conducted to identify the association between sociodemographics and the cascade gaps. RESULTS: Of the trans women living with HIV, 80.9% were already diagnosed, 76.6% of them had been prescribed, of which 90.3% were currently on treatment. Those who were registered in care had a higher rate of ART (aPR 2.06; 95%CI 1.09-3.88). Trans women between 31-40 years old (aPR 1.65; 95%CI 1.09-2.50) and those older than 40 (aPR 1.59; 95%CI 1.04-2.43) had higher prevalence of ART. CONCLUSIONS: Our data suggest an increase in the testing and treatment policy implementation among trans women in the city of São Paulo, although gaps have been found in the linkage to care. However, young trans women and those not registered in health care service may benefit from efforts to engage this part of the population in care to improve HIV treatment and care outcomes

Tendências da epidemia de Aids no Brasil após a terapia anti-retroviral

OBJECTIVE: Universal access to antiretroviral therapy starting from 1996 has changed HIV/AIDS epidemic profile in Brazil. The objective of this study was to review the epidemiology of HIV/AIDS epidemic in Brazil. METHODS: Indicators of temporal trends were developed for Brazilian regions from 1990 to 2003 using the Ministry of Health's databases. Exponential regression models adjusted to the 1990-1996 trends were used to estimate expected values for the entire period. RESULTS: The proportion of AIDS hospitalizations has not changed over the study period but there was a decrease in hospitalizations among those using ARV therapy. There was a 2.7 growth in those receiving Highly Active Anti-Retroviral Therapy (HAART) from 1997 to 2003. HIV/AIDS incidence and mortality rates rose up to 1995 in all regions. From 1996, there has been a gradual reduction in mortality rates while incidence rates have increased. In all regions, except in the Northern region, expected incidence rates have been greater than the observed ones in the last years but these differences were statistically significant only in the Southeastern and Midwestern regions. CONCLUSIONS: The observed trend can be explained by universal access to ARV therapy in Brazil, which had a significant impact on HIV/AIDS mortality. But other factors, such as years of epidemic, prevention actions, knowledge on HIV/AIDS, years of schooling, need to be considered as well.OBJETIVO: A terapia anti-retroviral disponível no Brasil a partir de 1996, modificou o curso da epidemia de Aids, alterando sua evolução e tendências. Nesse sentido, o estudo teve por objetivo avaliar a epidemia da Aids no Brasil, nos seus aspectos epidemiológicos. MÉTODOS: Estudo realizado a partir de bases de dados do Ministério da Saúde que caracterizavam a evolução temporal da Aids nas macrorregiões brasileiras, de 1990 a 2003. Foram utilizados modelos de regressão exponencial, ajustados à série temporal de 1990 a 1996 e estimados valores esperados para toda a série. RESULTADOS: O percentual de internações não se modificou no tempo, mas ocorreu diminuição de hospitalizações entre os usuários de terapia anti-retrovial. Houve um incremento de 2,7 vezes no número de indivíduos em uso da terapia, de 1997 a 2003. Incidência e mortalidade apresentaram crescimentos uniformes até 1995, em todas as regiões. A partir de 1996, verificou-se uma redução progressiva da mortalidade, embora a incidência continue crescendo. Em todas as regiões, exceto a Norte, as incidências esperadas foram maiores do que as observadas nos últimos anos, embora as diferenças somente tenham atingido níveis de significância estatística nas regiões Sudeste e Centro-Oeste. CONCLUSÕES: As mudanças observadas no perfil de morbi-mortalidade da epidemia de Aids no Brasil poderiam ser explicadas pelo amplo acesso a terapia anti-retroviral. Tal fato representou um impacto importante sobre a mortalidade por HIV/Aids, porém, outros fatores devem ser considerados, como idade da epidemia, medidas de prevenção, conhecimento sobre HIV/Aids e anos de escolaridade

HIV prevalence among men who have sex with men in Brazil

This paper reports human immuno-deficiency virus (HIV) prevalence in the 2nd National Biological and Behavioral Surveillance Survey (BBSS) among men who have sex with men (MSM) in 12 cities in Brazil using respondent-driven sampling (RDS). Following formative research, RDS was applied in 12 cities in the 5 macroregions of Brazil between June and December 2016 to recruit MSM for BBSS. The target sample size was 350 per city. Five to 6 seeds were initially selected to initiate recruitment and coupons and interviews were managed online. On-site rapid testing was used for HIV screening, and confirmed by a 2nd test. Participants were weighted using Gile estimator. Data from all 12 cities were merged and analyzed with Stata 14.0 complex survey data analysis tools in which each city was treated as its own strata. Missing data for those who did not test were imputed HIV+ if they reported testing positive before and were taking antiretroviral therapy. A total of 4176 men were recruited in the 12 cities. The average time to completion was 10.2 weeks. The longest chain length varied from 8 to 21 waves. The sample size was achieved in all but 2 cities. A total of 3958 of the 4176 respondents agreed to test for HIV (90.2%). For results without imputation, 17.5% (95%CI: 14.7–20.7) of our sample was HIV positive. With imputation, 18.4% (95%CI: 15.4–21.7) were seropositive. HIV prevalence increased beyond expectations from the results of the 2009 survey (12.1%; 95%CI: 10.0–14.5) to 18.4%; CI95%: 15.4 to 21.7 in 2016. This increase accompanies Brazil's focus on the treatment to prevention strategy, and a decrease in support for community-based organizations and community prevention programs

Comparing HIV risk-related behaviors between 2 RDS national samples of MSM in Brazil, 2009 and 2016

Introduction: Periodic monitoring of sociobehavior characteristics at a national level is an essential component of understanding the dynamics the human immunodeficiency virus (HIV) epidemic worldwide, including Brazil. Methods: This paper compares descriptive sociobehavior characteristics in 2 national cross-sectional HIV biological behavioral surveillance surveys (BBSS) conducted in 2009 and 2016 among men who have sex with men (MSM) in Brazil. Respondent driven sampling (RDS) was used for recruitment in both years. Overall proportions were weighted according to Gile’s estimator using RDS Analyst Software and 95% confidence intervals were calculated for comparisons between the 2 periods. Further comparisons were stratified by age groups (<25 and 25+ years old). Results: Overall, 3749 and 4176 MSM were recruited in 2009 and 2016, respectively. In 2016, participants were younger than 25 years old (58.3%), with 12 or more years of education (70.4%), with higher socioeconomic status (40.7%), and had a higher proportion of whites (31.8%), as compared to 2009. Also, participants in 2016 reported less alcohol use and binge drinking, but used illicit drugs more frequently. There was an increase among MSM who self-reported their HIV risk as low and had low HIV knowledge while the proportion of those who were never tested for HIV dropped from 49.8% in 2009 to 33.8% in 2016. Although more than three-quarters received free condoms in both years, STD counseling remained low (32% and 38% for 2009 and 2016, respectively). Sexual risk behavior remained at high levels, especially unprotected anal receptive sex and sex with multiple partners. Younger MSM (<25 years old) showed riskier sexual practices than those 25+ years old, when comparing 2016 to 2009. Conclusions: Our results indicate a worrisome risk behavior trend among Brazilian MSM, especially among younger ones. These results can contribute for a better understanding of the HIV epidemics in Brazil, with timely shift in strategies so improved effectiveness in public health prevention efforts can be achieved

Desenvolvimento e validação de metodologia para determinação de ivermectina em formas farmacêuticas

A ivermectina é um fármaco da classe dos antiparasitários que possui efeito comprovado sobre vários tipos de infestações por vermes, parasitas e nematoides. A dosagem do teor de ivermectina não possui um método oficial indicado pela Farmacopeia Brasileira, assim, estudos que avaliem a qualidade do produto, principalmente a concentração de princípio ativo nas preparações e sua conformidade com o especificado são fundamentais. O presente trabalho teve por objetivo desenvolver e avaliar um método rápido para controle de qualidade, capaz de quantificar ivermectina nas formas farmacêuticas, utilizando o método de espectrofotometria no UV/VIS, recomendado pela Farmacopeia Brasileira para quantificação de substâncias. O estudo apresentou resultados satisfatórios em todos os testes que foi submetido nas concentrações utilizadas, confirmando sua confiabilidade para uso em laboratórios de controle de qualidade. O método escolhido também apresentou maior facilidade de manuseio, menor custo e geração de resíduos em comparação com técnicas cromatográficas

Acceptability of self-sampling for etiological diagnosis of mucosal sexually transmitted infections (STIs) among transgender women in a longitudinal cohort study in São Paulo, Brazil.

This study conducted among transgender women in São Paulo, Brazil assessed the acceptability and suitability of screening sexually transmitted infections (STIs), such as Chlamydia trachomatis and Neisseria gonorrhoeae, by sampling multiple anatomical sites (i.e. urethral, anorectal, oropharyngeal, and neovaginal), and utilizing self- or provider-collection methods. First, a convenience sample of 23 cohort participants were recruited during a scheduled study visit between October and November 2018. Data collection was through a short investigator-led quantitative survey in Portuguese, and included presentation of investigator-designed, gender-neutral instructional diagrams to guide self-sampling. Three supplemental focus group discussions (FGDs) with a total of 30 participants guided by semi-structured script were conducted in Portuguese between September and October 2019. All participants reported being assigned male sex at birth and self-identified with a feminine gender identity at time of study. All survey respondents (100%; n = 23) indicated willingness to provide samples for STI screening during a future study visit. Preference was for self-collection of urine samples (83%; n = 19), urethral swabs (82%; n = 18), and anorectal swabs (77%; n = 17). A lower preference for self-collection of oropharyngeal swabs (48%; n = 11) was observed. Most respondents (78%; n = 18) indicated that they would not prefer specimens to be collected by a health professional, mainly due to 'more privacy' (72%; n = 13). All respondents indicated that they would feel comfortable to provide a self-collected sample based on instructional diagrams shown. In FGDs, although the collection by a health professional was described as a technically safer option for some participants, there was a preference for self-collection to avoid discomfort and embarrassment in exposing the body. Overall, this sub-study suggested acceptability among transgender women of introducing self-sampling for etiological diagnosis of STIs from potential infection sites. Uptake and usability will be explored further in a cross-sectional STI prevalence study of transgender women in Brazil

Assessing the best time interval between doses in a two-dose vaccination regimen to reduce the number of deaths in an ongoing epidemic of SARS-CoV-2

Funding: This work was supported by the Coordination of Superior Level Staff Improvement (CAPES), Brazil (Finance Code 001 to LSF and FMDM), National Council for Scientific and Technological Development (CNPq), Brazil (grant number: 315854/2020-0 to MEB, 141698/2018-7 to RLPS, 312559/2020-8 to MASMV and 311832/2017-2 to RAK), São Paulo Research Foundation (FAPESP), Brazil (grant #2019/26310-2 and #2017/26770-8 to CF, #2018/26512-1 to OC, #2018/24037-4 to SP, #2018/23984-0 to VS and contract #2016/01343-7 to RAK) and Swiss National Science Foundation (grant PCEFP3_181243 to VS). The Sound Foundation (Massachusetts, USA) provided financial support for the open-source publication of this work via a grant to The University of Oxford (UK) to support the work of members of the COVID-19 International Modeling (CoMo) Consortium. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Peer reviewedPublisher PD

Factores asociados al uso inconsistente del preservativo con las parejas comerciales entre los hombres que tienen sexo con hombres en Brasil

O objetivo foi analisar os fatores associados ao uso inconsistente de preservativo com parceiros comerciais entre homens que fazem sexo com homens (HSH) no Brasil. Foi feito um estudo transversal, com HSH adultos, recrutados por meio da técnica respondent-driven sampling (RDS), em 12 capitais brasileiras, em 2016. Os HSH responderam a um questionário sociocomportamental, que incluía questões sobre o comportamento sexual. O uso inconsistente de preservativo com parceiros comerciais foi mensurado por meio das relações sexuais anais insertivas e receptivas, ocorridas nos últimos seis meses e na última relação sexual. A associação entre as variáveis independentes e o uso inconsistente de preservativo foi mensurada utilizando o modelo de regressão de Poisson com variância robusta, com estimação de razões de prevalência ajustadas (RPa). Foram analisados dados de 461 HSH. A prevalência de uso inconsistente de preservativo com parceiros comerciais foi de 26% (IC95%: 19,0-34,3, n = 123). Pertencer às classes econômicas mais baixas (D/E), ter médio ou baixo conhecimento sobre HIV, ter praticado sexo anal insertivo e receptivo e nunca ter realizado teste para HIV na vida são fatores que estiveram associados ao uso inconsistente de preservativo com parceiros comerciais. As variáveis associadas ao uso inconsistente indicaram que o sexo comercial está sendo praticado em um contexto de maior vulnerabilidade à infecção pelo HIV. Nesse sentido, são necessárias intervenções biomédicas e comportamentais, com foco no acesso e na utilização de estratégias de prevenção, aliadas a políticas públicas para a redução de desigualdades socioeconômicas entre HSH que praticam sexo comercial.We aimed to analyze the factors associated with inconsistent condom use among men who have sex with men (MSM) and their commercial sexual partners in Brazil. This is a cross-sectional study with adult MSM who were recruited via respondent-driven sampling (RDS) in 12 Brazilian capitals in 2016. MSM answered a sociobehavioral questionnaire which included questions on their sexual behavior. The inconsistent use of condoms with their clientele was measured via insertive and receptive anal sex in the six months prior to our research and in their last sexual intercourse. The association between independent variables and the inconsistent use of condoms was measured via a Poisson regression model with robust variance and estimation of adjusted prevalence ratios (aPR). Data from 461 MSM were analyzed. We found a 26% prevalence of inconsistent condom use with their clientele (95%CI: 19.0-34.3, n = 123). Belonging to the lowest economic classes (D/E), having medium or low knowledge about HIV, having practiced insertive and receptive anal sex, and having never tested for HIV throughout their lives were associated with inconsistent use of condoms with their clientele. The variables associated with inconsistent use indicated that commercial sex is practiced in a context of greater vulnerability to HIV infection, referring to the need for biomedical and behavioral interventions which focus on access to and use of prevention strategies together with public policies to reduce socioeconomic inequalities among MSM who practice commercial sexual.El objetivo fue analizar los factores asociados al uso inconsistente del preservativo con las parejas comerciales entre los hombres que tienen sexo con hombres (HSH) en Brasil. Estudio transversal, con HSH adultos, reclutados a través de la técnica respondent-driven sampling (RDS), en 12 capitales brasileñas, en 2016. Los HSH respondieron a un cuestionario sociocomportamental que incluía preguntas sobre el comportamiento sexual. El uso inconsistente del preservativo con parejas comerciales se midió por las relaciones anales insertivas y receptivas que se produjeron en los últimos seis meses y por la última relación sexual. La asociación entre las variables independientes y el uso inconsistente del preservativo se midió mediante el modelo de regresión de Poisson con varianza robusta, con estimación de las razones de prevalencia ajustadas (RPa). Se analizaron los datos de 461 HSH. La prevalencia del uso inconsistente del preservativo con las parejas comerciales fue del 26% (IC95%: 19,0-34,3, n = 123). Pertenecer a las clases económicas más bajas (D/E), tener un conocimiento medio o bajo sobre el VIH, haber practicado sexo anal tanto insertivo como receptivo y no haberse sometido nunca a la prueba del VIH en su vida se asociaron con el uso inconsistente del preservativo con las parejas comerciales. Las variables asociadas al uso inconsistente indicaron que el sexo comercial se está practicando en un contexto de mayor vulnerabilidad a la infección por el VIH, refiriendo la necesidad de intervenciones biomédicas y conductuales, con un enfoque en el acceso y uso de estrategias de prevención, junto con políticas públicas para reducir las desigualdades socioeconómicas entre los HSH que practican el sexo comercial

Anorectal gonorrhoea and chlamydia among transgender women in Brazil: prevalence and assessment of performance and cost of anorectal infection detection and management approaches

OBJECTIVES: We aimed to determine the prevalence of anorectal Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) among transgender women in Brazil, and to assess the performance and costs of various approaches for the diagnosis and management of anorectal NG/CT. METHODS: TransOdara was a multicentric, cross-sectional STI prevalence study among 1317 transgender women conducted in five capital cities representing all Brazilian regions. Participants aged >18 years were recruited using respondent-driven sampling (RDS), completed an interviewer-led questionnaire, offered an optional physical examination and given choice between self-collected or provider-collected samples for NG/CT testing. Performance and cost indicators of predetermined management algorithms based on the WHO recommendations for anorectal symptoms were calculated. RESULTS: Screening uptake was high (94.3%) and the estimated prevalence of anorectal NG, CT and NG and/or CT was 9.1%, 8.9% and 15.2%, respectively. Most detected anorectal NG/CT infections were asymptomatic (NG: 87.6%, CT: 88.9%), with a limited number of participants reporting any anorectal symptoms (9.1%). Of those who permitted anal examination, few had clinical signs of infection (13.6%). Sensitivity of the tested algorithms ranged from 1.4% to 5.1% (highest for treatment based on the reported anorectal discharge or ulcer and receptive anal intercourse (RAI) in the past 6 months) and specificity from 98.0% to 99.3% (highest for treatment based on the reported anorectal discharge with clinical confirmation or report of RAI). The estimated cost-per-true case of anorectal NG/CT infection treated varied from lowest providing treatment for anorectal discharge syndrome based on the reported RAI ($2.70-4.28), with algorithms including clinical examinations decreasing cost-effectiveness. CONCLUSIONS: High prevalence of mostly asymptomatic anorectal NG and CT was observed among Brazilian transgender women. Multi-site NG/CT screening should be offered to transgender women. Where diagnostic testing capacity is limited, syndromic management for those presenting with anorectal symptoms is recommended