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Dos Santos C.G.,University of the State of Amazonas | Sabido M.,Fundacao de Medicina Tropical Doutor Heitor Vieira Dourado FMT HVD | Sabido M.,University of Girona | Sabido M.,CIBER ISCIII | And 4 more authors.
Journal of Medical Microbiology | Year: 2017

Purpose. To improve the screening of Chlamydia trachomatis (C. trachomatis) in Brazil, an accurate and affordable method is needed. The objective of this study was to develop and assess the performance and costs of a new in-house real-time PCR (qPCR) assay for the diagnosis of C. trachomatis infection. Methodology. Asymptomatic women aged 14-25 years who attended primary health services in Manaus, Brazil, were screened for C. trachomatis using the Digene Hybrid Capture II CT-ID (HCII CT-ID) DNA test. A subset of cervical specimens were tested using an in-house qPCR and a commercial qPCR, Artus C. trachomatis Plus RG PCR 96 CE (Artus qPCR) kit, as a reference test. A primer/probe based on the sequence of cryptic plasmid (CP) was designed. An economic evaluation was conducted from the provider’s perspective. Results. The primers were considered specific for C. trachomatis because they did not amplify any product from nonsexually transmitted bacterial species tested. Overall, 292 specimens were tested by both the commercial kit (Artus qPCR) and the in-house qPCR. Of those, one resulted in no amplification and was excluded from the analysis. The sensitivity, specificity, and positive and negative predictive values of the in-house qPCR were 99.5% [95% confidence interval (CI): 97.1-100], 95.1% (95% CI: 89-98.4), 97.4% (95% CI: 94-99.1) and 99.0% (95% CI: 94.5-100), respectively. The cost per case of C. Trachomatis was £0.44 ($0.55) for HCII CT-ID, £1.16 ($1.45) for Artus qPCR and £1.06 ($1.33) for in-house qPCR. Conclusion. We have standardized an in-house qPCR to detect cervical C. trachomatis targeting CP. The in-house qPCR showed excellent accuracy and was more affordable than the commercial qPCR kit. © 2017 The Authors.


Sabido M.,Fundacao de Medicina Tropical Doutor Heitor Vieira Dourado FMT HVD | Sabido M.,University of Girona | Kerr L.R.F.S.,Federal University of Ceará | Mota R.S.,Federal University of Ceará | And 6 more authors.
AIDS and Behavior | Year: 2015

We estimated the prevalence of sexual violence (SV) experience among men who have sex with men (MSM) in Brazil and identified its associated risk factors. We recruited 3859 MSM through respondent driven sampling. A multivariable hierarchical analysis was performed using an ecological model. The prevalence of having ever experienced SV was 15.9 % (95 % confidence interval [CI] 14.7–17.1). SV experience was independently associated with discrimination due to sexual orientation (odds ratio [OR] 3.05; 95 % CI 2.10–4.42), prior HIV testing (OR 1.81; 95 % CI 1.25–2.63), ≤14 years at first sex (OR 1.86; 95 % CI 1.28–2.71), first sex with a man (OR 1.89; 95 % CI 1.28–2.79), presenting STI symptoms (last year) (OR 1.66; 95 % CI 1.12–2.47), and having suicidal ideas (last 6 months) (OR 2.08; 95 % CI 1.30–3.35). The high levels of SV against MSM in Brazil place them at a markedly higher risk of SV than the general population. Homophobic prejudice is the strongest determinant of SV and urgently needs to be included at the forefront of the national response to SV. © 2015, Springer Science+Business Media New York.


Ruffinen C.Z.,Swiss Tropical and Public Health Institute | Sabido M.,University of Girona | Diaz-Bermudez X.P.,University of Brasilia | Lacerda M.,Fundacao de Medicina Tropical Doutor Heitor Vieira Dourado FMT HVD | And 3 more authors.
BMC Health Services Research | Year: 2015

Background: Point-of-care (POC) screening for HIV and syphilis using rapid testing was implemented in indigenous communities in the triple-border area of the Brazilian Amazon. We describe the context of the early introduction of POC screening, explore hindering and enabling factors for POC implementation, and recommend strategies for feasible, viable, and sustainable syphilis and HIV screening interventions. Methods: This was a qualitative study based on grounded theory methodology. Data were collected using in-depth interviews, semi-structured questionnaires, and field observations and were analysed using the framework approach. Qualitative information was complemented by quantitative data for descriptive purposes. Results: An overall high score for vulnerability to acquiring HIV and syphilis was observed among the indigenous communities. Health professionals reported satisfactory rapid testing acceptance, although concerns were raised about the pain of the fingerprick. Counselling-related challenges included ensuring the accuracy of translations, collaborating with translators and communicating positive test results. Over 3 months, 86.7 % of the syphilis-positive individuals began treatment, and all of them notified their partners. Accessibility, measured as travel time via the local transportation network, was a barrier to health care access. A lack of gasoline for boats and other transportation was also a hindering factor at all levels of implementation. Conclusions: The recommendations address the preparation phase at the coordination level as well as at the training level. Tools such as strengths, weaknesses, opportunities, and threats (SWOT) analyses; checklists; context-adapted protocols; and fact sheets are very simple methods to facilitate implementation. The findings of this study are important because they may inform the implementation of new health technologies in low-resource national disease control programmes in remote communities. © 2015 Ruffinen et al.


PubMed | Fundacao Alfredo da Mata, Swiss Tropical and Public Health Institute, Fundacao de Medicina Tropical Doutor Heitor Vieira Dourado FMT HVD, University of Brasilia and London School of Hygiene and Tropical Medicine
Type: | Journal: BMC health services research | Year: 2015

Point-of-care (POC) screening for HIV and syphilis using rapid testing was implemented in indigenous communities in the triple-border area of the Brazilian Amazon. We describe the context of the early introduction of POC screening, explore hindering and enabling factors for POC implementation, and recommend strategies for feasible, viable, and sustainable syphilis and HIV screening interventions.This was a qualitative study based on grounded theory methodology. Data were collected using in-depth interviews, semi-structured questionnaires, and field observations and were analysed using the framework approach. Qualitative information was complemented by quantitative data for descriptive purposes.An overall high score for vulnerability to acquiring HIV and syphilis was observed among the indigenous communities. Health professionals reported satisfactory rapid testing acceptance, although concerns were raised about the pain of the fingerprick. Counselling-related challenges included ensuring the accuracy of translations, collaborating with translators and communicating positive test results. Over 3 months, 86.7% of the syphilis-positive individuals began treatment, and all of them notified their partners. Accessibility, measured as travel time via the local transportation network, was a barrier to health care access. A lack of gasoline for boats and other transportation was also a hindering factor at all levels of implementation.The recommendations address the preparation phase at the coordination level as well as at the training level. Tools such as strengths, weaknesses, opportunities, and threats (SWOT) analyses; checklists; context-adapted protocols; and fact sheets are very simple methods to facilitate implementation. The findings of this study are important because they may inform the implementation of new health technologies in low-resource national disease control programmes in remote communities.


Gomes Naveca F.,Fundacao Alfredo da Matta | Gomes Naveca F.,Instituto Leonidas e Maria Deane Fiocruz Amazonia | Sabido M.,Fundacao de Medicina Tropical Doutor Heitor Vieira Dourado FMT HVD | Amaral Pires de Almeida T.,Instituto Leonidas e Maria Deane Fiocruz Amazonia | And 5 more authors.
PLoS ONE | Year: 2013

Objectives:To determine the etiology and factors associated with genital ulcer disease (GUD) among patients presenting to a sexually transmitted infections clinic in Manaus, Brazil; and to compare a multiplex polymerase chain reaction (M-PCR) assay for the diagnosis of GUD with standard methods.Methods:Ulcer swabs were collected and used for Tzanck test and processed in an M-PCR to detect herpes simplex virus (HSV-1/2), Treponema pallidum (T. pallidum), and Haemophilus ducreyi (H. ducreyi). Sera were tested for HIV and syphilis antibodies. Multivariable analysis was used to measure the association between clinical aspects and GUD. M-PCR results were compared with syphilis serology and Tzanck tests.Results:Overall, 434 GUD samples were evaluated, 84.8% from men. DNA from HSV-2 was detected in 55.3% of GUD samples, T. pallidum in 8.3%, HSV-1 in 3.2%, and 32.5% of GUD specimens were negative for the DNA of all three pathogens. No cases of H. ducreyi were identified. HIV serology among GUD patients was 3.2%. Treponemal antibodies and Tzanck test positivity for genital herpes was detected in 25 (5.8%) and in 125 (30.3%) of GUD patients, respectively. In multivariable analysis genital herpes etiology by M-PCR was associated with the vesicular, multiple and recurrent lesions whereas T. pallidum with non-vesicular, non-recurrent lesions. Compared to M-PCR, syphilis serology was 27.8% sensitive and 96.2% specific whereas Tzanck test was 43.8% sensitive and 88.9% specific.Conclusions:The predominance of genital herpes etiology suggests a revision of existing national syndromic treatment guidelines in Brazil to include antiherpetic treatment for all GUD patients. The use of M-PCR can significantly improve the diagnosis of GUD and provide a greater sensitivity than standard diagnostics. © 2013 Gomes Naveca et al.


Pinto I.C.,Fundacao de Medicina Tropical Doutor Heitor Vieira Dourado FMT HVD | Sabido M.,Fundacao de Medicina Tropical Doutor Heitor Vieira Dourado FMT HVD | Sabido M.,University of Girona | Pereira A.B.,Facultade La Salle | And 5 more authors.
PLoS ONE | Year: 2015

Objective: To evaluate the accuracy of the PIMA point-of-care CD4 analyzer (PIMA) under field conditions in comparison to the current CD4 count system (FACSCalibur), and to evaluate the operational suitability and acceptability of health professionals (HP) and HIV-patients in using the PIMA in health clinics in the Amazon Region. Methods: CD4 counts were measured onsite by the PIMA using fingerprick blood and in the reference laboratory by both the PIMA and FACSCalibur using venous blood. We used the Bland-Altman method to estimate the mean bias, and calculated the sensitivity and specificity at <200 and <500 cell/μL thresholds. Patients (n = 404) and HP (n = 7) were interviewed on the acceptability and operational suitability of the PIMA. Results: Using fingerprick blood (n = 337), the PIMA showed a concordance correlation coefficient (Rc) of 0.81, mean difference of -111.9 cell/μL, 93.1%/98.5% sensitivity, and 89.2%/56.7% specificity at <200 and <500 cell/μL thresholds, respectively. Venous blood (n = 340) showed an Rc of 0.89, mean difference of -83.4 cell/μL, 98.3%/97.5% sensitivity, and 93.9%/66.0% specificity at <200 and <500 cell/μL thresholds, respectively. The capillary PIMA was well accepted and found operationally appropriate by patients and HP. Conclusions: The agreement between both instruments was poor and the PIMA underestimated CD4 cell counts, which was more pronounced at CD4 counts ≥500 cell/μl. The PIMA's performance with fingerprick blood was less reliable than its performance with venous blood. In Brazil where antiretroviral treatment is initiated regardless of CD4 counts, the PIMA's systematic bias towards CD4 underestimation may limit its role for monitoring HIV-patients. © 2015 Pinto et al.


PubMed | Facultade la Salle, University of Girona, Oswaldo Cruz Foundation, Aids e Hepatites Virais and 2 more.
Type: Journal Article | Journal: PloS one | Year: 2015

To evaluate the accuracy of the PIMA point-of-care CD4 analyzer (PIMA) under field conditions in comparison to the current CD4 count system (FACSCalibur), and to evaluate the operational suitability and acceptability of health professionals (HP) and HIV-patients in using the PIMA in health clinics in the Amazon Region.CD4 counts were measured onsite by the PIMA using fingerprick blood and in the reference laboratory by both the PIMA and FACSCalibur using venous blood. We used the Bland-Altman method to estimate the mean bias, and calculated the sensitivity and specificity at <200 and <500 cell/L thresholds. Patients (n = 404) and HP (n = 7) were interviewed on the acceptability and operational suitability of the PIMA.Using fingerprick blood (n = 337), the PIMA showed a concordance correlation coefficient (Rc) of 0.81, mean difference of -111.9 cell/L, 93.1%/98.5% sensitivity, and 89.2%/56.7% specificity at <200 and <500 cell/L thresholds, respectively. Venous blood (n = 340) showed an Rc of 0.89, mean difference of -83.4 cell/L, 98.3%/97.5% sensitivity, and 93.9%/66.0% specificity at <200 and <500 cell/L thresholds, respectively. The capillary PIMA was well accepted and found operationally appropriate by patients and HP.The agreement between both instruments was poor and the PIMA underestimated CD4 cell counts, which was more pronounced at CD4 counts 500 cell/l. The PIMAs performance with fingerprick blood was less reliable than its performance with venous blood. In Brazil, where antiretroviral treatment is initiated regardless of CD4 counts, the PIMAs systematic bias towards CD4 underestimation may limit its role for monitoring HIV-patients.


PubMed | Fundacao Alfredo da Matta, Fundacao de Medicina Tropical Doutor Heitor Vieira Dourado FMT HVD, London School of Hygiene and Tropical Medicine and University of Girona
Type: Evaluation Studies | Journal: Sexually transmitted infections | Year: 2015

Home-based, voluntary counselling and testing (HBCT) can help scale up early diagnosis. We aimed to evaluate the acceptance of HBCT for HIV and syphilis, estimate the prevalence among home-tested individuals and assess the performance of point-of-care testing by health staff using dried tube specimens (DTS) in a remote municipality of the Amazon region.Community health teams conducted door-to-door outreach in the urban area of So Gabriel da Cachoeira, Amazonas. HBCT for HIV and syphilis was offered to all residents aged 15years. To provide an external quality assurance (EQA) of the healthcare workers (HCW) ability to perform testing, DTS panels of reference samples were reconstituted and tested by the workers.HBCT was offered to 1752 individuals and accepted by 1501 (85.6%). Those tested had a median age 32.0years, 64.4% were women and 85.1% were indigenous; none were previously tested using a rapid test. The prevalence of HIV was 0.37% in men and 0.0% in women; the prevalence of syphilis was 1.12% in men and 2.69% in women. Eleven HCW tested 44 DTS samples for HIV and 44 for syphilis. EQA testing revealed that workers interpreted 55.8% and 90.7% of HIV and syphilis reference samples correctly.HBCT was acceptable and successful in reaching untested individuals. However, there were concerns with the quality of test performance, highlighting the need for continual evaluation and retraining of community HCW. As Brazil scales up HIV and syphilis testing, our findings highlight how HBCT can maximise coverage in similar remote areas and improve knowledge about prevalence of these infections.


Bastos T.C.,Fundacao de Medicina Tropical Doutor Heitor Vieira Dourado FMT HVD | Cruz K.S.,Fundacao de Medicina Tropical Doutor Heitor Vieira Dourado FMT HVD | Francesconi F.,Fundacao de Medicina Tropical Doutor Heitor Vieira Dourado FMT HVD
Anais Brasileiros de Dermatologia | Year: 2014

Chromoblastomycosis is a chronic subcutaneous mycotic infection caused by dematiaceous saprophytic moulds. The most frequently isolated agent is Fonsecae pedrosoi. This article reports a case of a man from the Amazon region in Northern Brazil who presented with a lesion of 12 months' duration, which gradually increased in size until covering the majority of his right leg. A successful treatment with itraconazole was performed. © 2014 by Anais Brasileiros de Dermatologia.


PubMed | Fundacao de Medicina Tropical Doutor Heitor Vieira Dourado FMT HVD
Type: Journal Article | Journal: AIDS and behavior | Year: 2015

We estimated the prevalence of sexual violence (SV) experience among men who have sex with men (MSM) in Brazil and identified its associated risk factors. We recruited 3859 MSM through respondent driven sampling. A multivariable hierarchical analysis was performed using an ecological model. The prevalence of having ever experienced SV was 15.9% (95% confidence interval [CI] 14.7-17.1). SV experience was independently associated with discrimination due to sexual orientation (odds ratio [OR] 3.05; 95% CI 2.10-4.42), prior HIV testing (OR 1.81; 95% CI 1.25-2.63), 14years at first sex (OR 1.86; 95% CI 1.28-2.71), first sex with a man (OR 1.89; 95% CI 1.28-2.79), presenting STI symptoms (last year) (OR 1.66; 95% CI 1.12-2.47), and having suicidal ideas (last 6months) (OR 2.08; 95% CI 1.30-3.35). The high levels of SV against MSM in Brazil place them at a markedly higher risk of SV than the general population. Homophobic prejudice is the strongest determinant of SV and urgently needs to be included at the forefront of the national response to SV.

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