Estimating HIV-1 incidence using the serologic testing algorithm for recent HIV infections at HIV counseling and testing centers in the city of São Paulo, Brazil

The network of HIV counseling and testing centers in São Paulo, Brazil is a major source of data used to build epidemiological profiles of the client population. We examined HIV-1 incidence from November 2000 to April 2001, comparing epidemiological and socio-behavioral data of recently-infected individuals with those with long-standing infection. A less sensitive ELISA was employed to identify recent infection. The overall incidence of HIV-1 infection was 0.53/100/year (95% CI: 0.31-0.85/100/year): 0.77/100/year for males (95% CI: 0.42-1.27/100/year) and 0.22/100/ year (95% CI: 0.05-0.59/100/year) for females. Overall HIV-1 prevalence was 3.2% (95% CI: 2.8-3.7%), being 4.0% among males (95% CI: 3.3-4.7%) and 2.1% among females (95% CI: 1.6-2.8%). Recent infections accounted for 15% of the total (95% CI: 10.2-20.8%). Recent infection correlated with being younger and male (p = 0.019). Therefore, recent infection was more common among younger males and older females.Secretaria Municipal de Saúde de São PauloUniversidade de São Paulo Faculdade de Saúde Pública Departamento de EpidemiologiaSanta Casa de São Paulo Faculdade de Ciências Médicas Departamento de Medicina SocialUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Laboratório de RetrovirologiaUNIFESP, EPM, Laboratório de RetrovirologiaSciEL

Violência sexual contra homens no Brasil: subnotificação, prevalência e fatores associados

OBJECTIVES: Identifying and mapping the literature regarding sexual violence against Brazilian boys and men, as well as describing its underreporting, prevalence, and associated factors. METHODS: We conducted a scoping review by searching PubMed, Biblioteca Digital Brasileira de Teses e Dissertações, Biblioteca Virtual em Saúde, Scopus, and Web of Science databases. The inclusion criteria were: (a) surveys including data on sexual violence; (b) inclusion of boys or men as victims of sexual violence; (c) presenting statistical data on prevalence, underreporting, and factors associated with sexual violence among Brazilian boys and men. RESULTS: We found a total of 1,481 papers. Ultimately, 53 were included and had their data extracted. Most studies are quantitative in nature (n = 48). The total number of participants across studies was 1,416,480 and the prevalence of sexual violence ranged from 0.1% to 71%. It is important to note that underreporting statistical data was cited in several studies. The group with the highest prevalences was men who have sex with men and those with sexual dysfunctions. Increased tendency to drug use, social isolation, unprotected anal sex, suicidal ideation, sexual dysfunction, and post-traumatic stress disorder were statistically significant predictors for having experienced sexual violence. CONCLUSIONS: Despite the prevalence of sexual violence being high against Brazilian boys and men, this area of is surprisingly understudied and there are few studies with this exclusive scope. Social cultural issues, such as sexism, contribute to the underreporting of sexual violence. Additionally, we identified issues related to mental, sexual and reproductive health to be associated with sexual violence. Based on our findings, we recommend the implementation and development of a structural infrastructure aimed at supporting boys and men who are victims of sexual violence, and preventing negative outcomes for this affected group.OBJETIVOS: Identificar e mapear a literatura referente à violência sexual contra meninos e homens brasileiros, bem como descrever sua subnotificação, sua prevalência e os fatores associados. MÉTODOS: Realizou-se uma de revisão de escopo com buscas nas bases de dados: PubMed, Biblioteca Digital Brasileira de Teses e Dissertações, Biblioteca Virtual em Saúde, Scopus e Web of Science. Os critérios de inclusão foram: (a) pesquisas que incluíssem dados sobre violência sexual; (b) inclusão de meninos ou homens como vítimas de violência sexual; (c) apresentassem dados sobre prevalência, subnotificação e fatores associados à violência sexual entre meninos e homens brasileiros. RESULTADOS: Foram encontrados 1.481 trabalhos. No total, 53 foram incluídos e tiveram seus dados extraídos. A maioria dos estudos é de natureza quantitativa (n = 48). O total de participantes em todos os estudos foi de 1.416.480 e a prevalência de violência sexual variou de 0.1% a 71%. A subnotificação foi um aspecto citado em vários estudos. Entre os grupos com maiores prevalências estão os homens que fazem sexo com homens e com disfunções sexuais. Maior tendência ao uso de drogas, isolamento social, sexo anal desprotegido, ideação suicida, disfunções sexuais e transtorno de estresse pós-traumático foram alguns dos fatores associados. CONCLUSÕES: A violência sexual contra meninos e homens brasileiros é pouco estudada e existem poucos estudos com esse recorte exclusivo, apesar da prevalência de a violência sexual ser alta. Questões culturais, como o machismo, contribuem para a subnotificação da violência sexual. Em relação aos fatores associados, identificamos questões relacionadas à saúde mental, sexual e reprodutiva. Recomenda-se que seja estruturado acolhimento para meninos e homens vítimas de violência sexual, prevenindo ou minimizando desfechos negativos

Association of internalised homonegativity with partner notifcation after diagnosis of syphilis or gonorrhoea among men having sex with men in 49 countries across four continents

Background: Partner notifcation (PN) after a sexually transmitted infection (STI) diagnosis is being promoted as a means to interrupt transmission chains. We investigated whether Internalised Homonegativity (IH) is associated with PN among men having sex with men (MSM). Methods: PN, defned as notifying at least one partner after diagnosis of syphilis and gonorrhoea, was queried in two internet-based self-completion surveys conducted between Oct 2017 and May 2018 in 68 countries in Europe, Latin America, Canada, and the Philippines. IH is defned by a man’s level of agreement or disagreement with negative social beliefs about male homosexuality. Covariates included in a multivariate regression model with a random intercept at country level were age, HIV diagnosis, partnership status, sexual self-efcacy, HIV serostatus communication during last sex with a non-steady partner, place where this partner was met, and PN-related socio-historical background of the country of residence. We grouped countries in three areas: North- and Central-Western European countries plus Canada, former socialist countries, and Latin-American/Mediterranean countries plus the Philippines. In each of the three areas individuals were assigned to 4 subgroups based on IH quartiles and PN rates were determined for each subgroup. Results: PN rates were calculated for 49 countries (excluding countries with less than 10 diagnoses). Mean proportions of MSM notifying their partners were 68.1% and 72.9% after syphilis and gonorrhoea diagnoses, respectively. PN rates were lower in Latin American countries and the Philippines compared to European countries. Within Europe, a North–South divide with lower PN rates in Mediterranean countries was observed. In each of the three regions we mostly observed a stepwise increase of PN rates with decreasing IH. Regression analysis showed lower IH scores associated with higher PN rates. Higher perceived self-efcacy, living in a partnership, and HIV status communication were positively associated with PN. Men who had met their last partner in a gay social venue were more likely to have notifed their partners of a syphilis diagnosis compared to men who had met this partner online. Men with diagnosed HIV were less likely to report PN. Conclusions: We could demonstrate that IH was associated with PN among MSM across all countries included in our analysis. Reducing cultural homophobia and ensuring inclusive policies may contribute to STI prevention and control

O potencial de propagação da Covid-19 e a tomada de decisão governamental: uma análise retrospectiva em Florianópolis, Brasil

Objective: to analyze the association between the spreading potential of SARS-CoV-2 and the decision-making of the municipal government of Florianópolis (Brazil) regarding social distance. Methods: We analyzed new cases of COVID-19 with nowcasting treatment identified in Florianópolis residents between February 1 and July 14, 2020. Decrees related to COVID-19 published in the Official Gazette of the Municipality between February 1 and July 14, 2020 were also analyzed. Based on the actions proposed in the decrees, it was analyzed whether they relaxed social isolation, increased or maintained existing restrictions, thus creating the Social Distancing Index. Time-dependent reproduction numbers (Rt) for the period of 14 days prior to each decree were calculated. A matrix was constructed associating the classification of each decree and the Rt values, analyzing the consonance or dissonance between the potential dissemination of SARS-CoV-2 and the actions of the decrees. Results: 5,374 cases of COVID-19 and 26 decrees were analyzed. Nine decrees increased measures of social distance, nine maintained them and eight made them more flexible. Of the 26 actions, 9 were consonant and 17 dissonant with the tendency indicated by the Rt. Dissonances were observed in all the decrees that maintained the distance measures or made them more flexible. In the last two months analyzed there was the fastest expansion in the number of new cases and the greatest amount of dissonant decrees. Conclusion: There was an important divergence between municipal measures of social distance with epidemiological indicators at the time of each political decision.   Key-words: Coronavirus Infections. Epidemiology. Decision Making. Government.Objetivo: analisar a relação entre o potencial de propagação do SARS-CoV-2 e as tomadas de decisão do governo municipal de Florianópolis (Brasil) quanto ao distanciamento social. Métodos: Foram analisados casos novos de COVID-19 com tratamento de nowcasting identificados em residentes de Florianópolis entre 01 de fevereiro e 14 de julho de 2020. Também foram analisados os decretos relacionados à COVID-19 publicadas no Diário Oficial do Município entre 01 de fevereiro e 14 de julho de 2020. Com base nas ações dispostas nos decretos, analisou-se se elas promoviam o relaxamento, o aumento ou a manutenção das restrições vigestes, criando-se o Índice de Distanciamento Social. Para o período de cinco dias anteriores a cada decreto calcularam-se os números de reprodução dependente do tempo (Rt). Construiu-se matriz entre a classificação de cada decreto e os valores de Rt, verificando-se a consonância ou a dissonância entre o potencial de disseminação do SARS-CoV-2 e as ações dos decretos. Resultados: Foram analisados 5.374 casos de COVID-19 e 26 decretos. Nove decretos aumentaram as medidas de distanciamento social, nove mantiveram e oito as flexibilizaram. Das 26 ações, 9 eram consonantes e 17 dissonantes com a tendência indicada pelos Rt. Dissonâncias foram observadas com todos os decretos que mantiveram as medidas de distanciamento e que as flexibilizavam. No segundo bimestre da análise houve a mais rápida expansão do número de casos novos e a maior quantidade de dissonâncias dos decretos. Conclusão: Observou-se importante divergência entre as medidas de distanciamento social com indicadores epidemiológicos no momento da decisão política

Fortalecer as atividades de informação e vigilância epidemiológica é essencial e urgente para reduzir a força de transmissão do SARS-CoV-2

Situação: O preprint foi submetido para publicação em um periódico

Risk of SARS-CoV-2 infection among front-line healthcare workers in Northeast Brazil : a respondent-driven sampling approach

Objectives We assessed the prevalence of SARS-CoV-2 infection, personal protective equipment (PPE) shortages and occurrence of biological accidents among front-line healthcare workers (HCW). Design, setting and participants Using respondent-driven sampling, the study recruited distinct categories of HCW attending suspected or confirmed patients with COVID-19 from May 2020 to February 2021, in the Recife metropolitan area, Northeast Brazil. Outcome measures The criterion to assess SARS-CoV-2 infection among HCW was a positive self-reported PCR test. Results We analysed 1525 HCW: 527 physicians, 471 registered nurses, 263 nursing assistants and 264 physical therapists. Women predominated in all categories (81.1%; 95% CI: 77.8% to 84.1%). Nurses were older with more comorbidities (hypertension and overweight/obesity) than the other staff. The overall prevalence of SARS-CoV-2 infection was 61.8% (95% CI: 55.7% to 67.5%) after adjustment for the cluster random effect, weighted by network, and the reference population size. Risk factors for a positive RT-PCR test were being a nursing assistant (OR adjusted: 2.56; 95% CI: 1.42 to 4.61), not always using all recommended PPE while assisting patients with COVID-19 (OR adj: 2.15; 95% CI: 1.02 to 4.53) and reporting a splash of biological fluid/respiratory secretion in the eyes (OR adj: 3.37; 95% CI: 1.10 to 10.34). Conclusions This study shows the high frequency of SARS-CoV2 infection among HCW presumably due to workplace exposures. In our setting, nursing assistant comprised the most vulnerable category. Our findings highlight the need for improving healthcare facility environments, specific training and supervision to cope with public health emergencies

Understanding the barriers to successful adoption and use of a mobile health information system in a community health center in São Paulo, Brazil: a cohort study

BACKGROUND: Mobile technology to support community health has surged in popularity, yet few studies have systematically examined usability of mobile platforms for this setting. METHODS: We conducted a mixed-methods study of 14 community healthcare workers at a public healthcare clinic in São Paulo, Brazil. We held focus groups with community healthcare workers to elicit their ideas about a mobile health application and used this input to build a prototype app. A pre-use test survey was administered to all participants, who subsequently use-tested the app on three different devices (iPhone, iPad mini, iPad Air). Usability was assessed by objectively scored data entry errors and through a post-use focus group held to gather open-ended feedback on end-user satisfaction. RESULTS: All of the participants were women, ranging from 18–64 years old. A large percentage (85.7%) of participants had at least a high school education. Internet (92.8%), computer (85.7%) and cell phone (71.4%) use rates were high. Data entry error rates were also high, particularly in free text fields, ranging from 92.3 to 100%. Error rates were comparable across device type. In a post-use focus group, participants reported that they found the app easy to use and felt that its design was consistent with their vision. The participants raised several concerns, including that they did not find filling out the forms in the app to be a useful task. They also were concerned about an app potentially creating more work for them and personal security issues related to carrying a mobile device in low-income areas. CONCLUSION: In a cohort of formally educated community healthcare workers with high levels of personal computer and cell phone use, we identified no technological barriers to adapting their existing work to a mobile device based system. Transferring current data entry work into a mobile platform, however, uncovered underlying dissatisfaction with some data entry tasks. This dissatisfaction may be a more significant barrier than the data entry errors our testing revealed. Our results highlight the fact that without a deep understanding of local process to optimize usability, technology-based solutions in health may fail. Developing such an understanding must be a central component in the design of any mHealth solution in global health