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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

The indigenous healthcare model in Brazil is premised on comprehensive care combined with the notion of differentiated care and provides for respect for cultural diversity, seeking to incorporate traditional therapeutic practices into the health services that serve indigenous peoples. This study aimed to determine how to reconcile universal access to health goods and services with a model of care that guarantees differentiation, without interfering in the quality of services. It is also necessary to define which parameters should be used for evaluating the quality and efficacy of such services in an intercultural context. Based on a case study - the implementation of health services in the Upper Xingu - the author addresses some issues related to the political uses and "dangers" associated with "health spaces" and the distinct concepts (indigenous and non-indigenous) of what constitutes health and quality of health services. These issues affect not only health services but also the local political situation. Source

Fonseca M.G.P.,Diretoria Regional de Brasilia | Fonseca M.G.P.,Institute Pesquisa Clinica Evandro Chagas | Coeli C.M.,Federal University of Rio de Janeiro | de Araujo Lucena F.F.,Ministerio do Desenvolvimento Social e Combate a Fome | And 2 more authors.
Cadernos de Saude Publica | Year: 2010

Since record linkage errors can bias measures of disease occurrence and association, it is important to assess their accuracy. The aim of this study is to assess the accuracy of a multiple pass probabilistic record linkage strategy to identify deaths among persons reported to the Brazilian AIDS surveillance database. An HIV/AIDS national surveillance database (N = 559,442) was linked to a total of 6,444,822 deaths registered (all causes) in the Brazilian mortality database. To estimate standard measures of accuracy, we selected all AIDS cases with a date of death registered in the surveillance database from 2002 to 2005 (N = 19,750) and 38,675 cases known to be alive in 2006. The linkage strategy presented a sensitivity of 87.6% (95%CI: 87.1-88.2), a specificity of 99.6% (95%CI: 99.6-99.7), and a positive predictive value of 99.2% (95%CI: 99.1-99.3). We observed a small variation in the validity measures according to some putative predictors of mortality. Our findings suggest that even large and heterogeneous databases can be linked with a satisfactory accuracy. Source

de Carvalho A.T.,Federal University of Paraiba | de Almeida E.R.,Federal University of Paraiba | Nilson E.A.F.,Ministerio do Desenvolvimento Social e Combate a Fome | Ubarana J.A.,Ministerio do Desenvolvimento Social e Combate a Fome | And 3 more authors.
Journal of Human Growth and Development | Year: 2014

Objective: To describe the nutritional situation of children under five years old resident in three cities of Brazil's northeastern region. Methods: A transversal epidemiological study was undertaken with the participation of 1,378 children. The anthropometric measurements height/age, weight/age and weight/height were calculated in terms of the Z score. Children's growth curves of the World Health Organization were used as reference. Results: Higher proportions were found of overweight/height (8.3% in Barra de São Miguel, 10.3% in Cabedelo and 5.9% in Tibau do Sul) than of deficit (1.5% in Barra de São Miguel, 1.9% in Cabedelo and 0.9% in Tibau do Sul). A higher prevalence of the height deficit was observed (5.9% in Barra de São Miguel, 5.5% in Cabedelo and 4.6% in Tibau do Sul) than of the weight deficit (3.6% in Barra de São Miguel, 2.5 % in Cabedelo and 1.5% in Tibau do Sul). CONCLUSION: The nutritional status of the group studied was unfavorable. Actions to promote adequate eating habits within the context of food and nutrition programs and policies should, therefore, be prioritized. The high prevalence of height deficit and overweight highlights the vulnerability of this group and the sum of the necessary actions should produce an impact by reversing this nutritional profile. Source

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