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Brasília, Brazil

Damacena G.N.,Institute Comunicacao e Informacao Cientifica | Szwarcwald C.L.,Institute Comunicacao e Informacao Cientifica | Barbosa Jr. A.,AIDS e Hepatites Virais
Cadernos de Saude Publica | Year: 2011

Female sex workers are known in Brazil and elsewhere in the world as one of the most-at-risk populations for risk of HIV infection, due to their social vulnerability and factors related to their work. However, the use of conventional sampling strategies in studies on most-at-risk subgroups for HIV is generally problematic, since such subgroups are small in size and are associated with stigmatized behaviors and/or illegal activities. In 1997, a probabilistic sampling technique was proposed for hard-to-reach populations, called Respondent-Driven Sampling (RDS). The method is considered a variant of chain sampling and allows the statistical estimation of target variables. This article describes some assumptions of RDS and all the implementation stages in a study of 2,523 female sex workers in 10 Brazilian cities. RDS proved appropriate for recruiting sex workers, allowing the selection of a probabilistic sample and the collection of previously missing information on this group in Brazil. Source

de Araujo C.L.,Secretaria de Atencao a Saude | Shimizu H.E.,University of Brasilia | de Sousa A.I.A.,AIDS e Hepatites Virais | Hamann E.M.,University of Brasilia
Revista de Saude Publica | Year: 2012

OBJECTIVE: To estimate the incidence of congenital syphilis and identify its relationship with Family Health Strategy coverage. METHODS: An observational ecological study was carried out with both descriptive and analytical components, by two different approaches: one that explores a temporal series (2003 to 2008) and one that focuses on the 2008 data. The secondary data (epidemiological, demographic, and socioeconomic) were obtained from the Department of Informatics of the Unifi ed Health System and the Brazilian Institute of Geography and Statistics. Analysis of the possible effects of the implementation of the Family Health Strategy on the prevention of congenital syphilis was performed on selected subgroups of municipalities according to two approaches: a) the variation of the average annual rate of incidence of congenital syphilis in different strata of Family Health coverage between 2003 and 2008 and the calculation of the simple linear regression coeffi cient; and b) a negative binomial regression analysis of data from 2008 to control for confounding factors. RESULTS: Increasingly trends of congenital syphilis notifi cation in Brazil refl ect social inequalities in the distribution of cases. The incidence of congenital syphilis was lower in the municipalities with high Family Health Strategy coverage; however, after controlling for the co-variables, such an effect might be attributed to the coverage of prenatal care and the demographic characteristics of the municipalities where the implementation of the Strategy was a priority. CONCLUSIONS: Despite the increase in prenatal care coverage, the actions implemented still exhibit low effectiveness in the prevention of congenital syphilis. Prenatal care performed by Family Health Strategy teams did not control syphilis better than the prenatal care performed within the context of other models of assistance. Source

Lazarini F.M.,AIDS e Hepatites Virais | Melchior R.,State University Londrina | Gonzalez A.D.,State University Londrina | Matsuo T.,State University Londrina
Revista de Saude Publica | Year: 2012

Objective: To describe trends in the incidence of Aids cases according to age and gender from 1986 to 2008. Methods: Analyses of Aids trends according to age group and to gender was carried out Londrina, Southern Brazil. The timeframe was divided into two periods (1986-1995 and 1996-2008). Of the polynomial models, it was the fi rst-degree polynomial model which best explained the Aids epidemic within the two periods. The incidence rate of Aids among men who have sex with other men (MSM), injecting drug users (IDU), heterosexual men and women was calculated. Results: During the fi rst period, from 1986 to 1995, there was an increase in the incidence of Aids in almost all age groups and the epidemic spread across both sexes (p < 0.001), although this was more marked in men aged 14-39. The second period (1996-2008) did not show a positive or negative statistical increase, indicating that the epidemic had stabilized. A significant fall in the rate for the male 14 to 29 age group was found, with increases of 0.88 and 0.87 for the fi rst and second period respectively. Cases in women aged 50 and over showed a marked increase (p = 0.019). The IDU and MSM groups predominated as the categories with the most exposure, with MSM taking over from IDU in the last three years of the study. From 2000 onwards, incidences in females aged 15 to 49 overtook that of heterosexual men. Conclusions: The study showed a decrease in incidence in the younger age groups and stabilization in the other age groups. There is a need for different approaches in order to reach groups with several characteristics due to the increase in the proportion of women and MSM within the exposure categories. Source

Fonseca M.G.P.,Institute Pesquisa Cliinica Evandro Chagas | Forsythe S.,FutuResearch Institute | Menezes A.,International AIDS Vaccine Initiative | Vuthoori S.,Rabin Strategic Partners | And 4 more authors.
PLoS ONE | Year: 2010

Background:The AIDS epidemic in Brazil remains concentrated in populations with high vulnerability to HIV infection, and the development of an HIV vaccine could make an important contribution to prevention. This study modeled the HIV epidemic and estimated the potential impact of an HIV vaccine on the number of new infections, deaths due to AIDS and the number of people receiving ARV treatment, under various scenarios. Methods and Findings:The historical HIV prevalence was modeled using Spectrum and projections were made from 2010 to 2050 to study the impact of an HIV vaccine with 40% to 70% efficacy, and 80% coverage of adult population, specific groups such as MSM, IDU, commercial sex workers and their partners, and 15 year olds. The possibility of disinhibition after vaccination, neglecting medium- and high-risk groups, and a disease-modifying vaccine were also considered. The number of new infections and deaths were reduced by 73% and 30%, respectively, by 2050, when 80% of adult population aged 15-49 was vaccinated with a 40% efficacy vaccine. Vaccinating medium- and high-risk groups reduced new infections by 52% and deaths by 21%. A vaccine with 70% efficacy produced a great decline in new infections and deaths. Neglecting medium- and high-risk population groups as well as disinhibition of vaccinated population reduced the impact or even increased the number of new infections. Disease-modifying vaccine also contributed to reducing AIDS deaths, the need for ART and new HIV infections. Conclusions: Even in a country with a concentrated epidemic and high levels of ARV coverage, such as Brazil, moderate efficacy vaccines as part of a comprehensive package of treatment and prevention could have a major impact on preventing new HIV infections and AIDS deaths, as well as reducing the number of people on ARV. Targeted vaccination strategies may be highly effective and cost-beneficial. © 2010 Fonseca et al. Source

Pinto V.M.,AIDS e Hepatites Virais | Golub J.E.,Johns Hopkins University | Tancredi M.V.,Programa Estadual de DSTe Aids de Sao Paulo | Alencar R.S.,Programa Estadual de DSTe Aids de Sao Paulo | Miranda A.E.,Federal University of Espirito Santo
Journal of Acquired Immune Deficiency Syndromes | Year: 2011

Background: Women living with HIV/AIDS present with a higher prevalence of human papillomavirus (HPV) infection, higher rates of squamous intraepithelial lesions, and are more susceptible to invasive cervical carcinoma progression. Objective: We assessed the frequency of precursory cervical lesions of cancer and its risk factors for women living with HIV/AIDS. Methods: Sociodemographic, clinical, behavioral, and laboratory data were collected from medical records from 2008 to 2009 and analyzed using forward stepwise logistic regression. Results: Medical records of 631 women were reviewed; mean age at AIDS diagnosis was 34 years old (interquartile range = 29-40 years old), 32% were <16 years old at first sexual intercourse; 61% had ≤5 sexual partners during life; 43% had been living with AIDS for 9 years; 47% reported previous sexually transmitted infections; 44% presented with HPV infection; and 10% presented with high squamous intraepithelial lesions. Presenting high squamous intraepithelial lesions was significantly associated with home district Human Development Index, age at AIDS diagnosis (>40 years old), time of AIDS diagnosis (>8 years), CD4 cell count <350/mm, and HPV infection. Conclusions: Frequent squamous intraepithelial neoplasia in these women shows the importance of gynecologic examinations in routine care and follow-up required by those who present with cervical lesions. Copyright © 2011 by Lippincott Williams & Wilkins. Source

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