Evaluation of a strategy for identification of hepatitis C virus carriers in outpatient and emergency units: contribution to the microelimination of hepatitis C in Brazil

ABSTRACT Introduction: Hepatitis C virus (HCV) infection continues to be an important public health problem worldwide. Despite the availability of drugs that promote the cure of infection in more than 95% of cases, the identification of HCV carriers remains a major challenge. Objective: To evaluate a strategy for identifying HCV carriers based on combined criteria: screening in emergency units and specialty outpatient clinics of a tertiary hospital and among older adults (≥45 years), both suggested as efficient in epidemiological studies. Methods: A cross-sectional, analytical and descriptive study was conducted on individuals of both sexes, aged 45 years and older, attending the emergency department and specialty outpatient clinics of a University Hospital in São Paulo, Brazil, from January 2016 to June 2018. After giving formal consent, the patients were submitted to a standardized interview and rapid testing for the identification of HCV antibodies (SD BIOLINE® anti-HCV). Results: A total of 606 adult patients (62% women and 37% men) were evaluated. The mean age was 62 ± 10 years. Four positive tests were identified, with confirmation by conventional serology and HCV-RNA determination. Thus, the prevalence of HCV identified in the sample was 0.66%. All patients had a history of risk factors for infection. Conclusion: The strategies of birth-cohort testing and screening in emergency medical services for the identification of HCV carries, both suggested in the literature as efficient for the diagnosis of hepatitis C, resulted in a low rate of HCV infection. These findings highlight the magnitude of the challenge of identifying asymptomatic HCV carriers in Brazil.

Psychoactive substances and the provision of specialized care: the case of Espirito Santo

OBJECTIVE: In this study, we conducted a survey of all the institutions that provide treatment for psychoactive substances in the state of Espirito Santo, Brazil during the period 2004-2005. METHOD: We used a snowball sampling technique to include all the treatment facilities in our State in which we employed a semi-structured interview instrument for key informants at each institution. We present descriptive results and test differences between groups using the Chi-square test. RESULTS: In Espirito Santo, 250 institutions provide treatment for psychoactive substances and are distributed as follows: governmental (17.6 percent), nongovernmental (22.8 percent), and self-help groups (59.6 percent). Of these 250 institutions, 85 provide direct care, with the majority found in the Central region (70.6 percent) and followed by the Northern (15.3 percent) and Southern (14.1 percent) regions. The majority of those that provide direct care are private nonprofit centers (16.8 percent) institutions with ties to religious organizations make up nearly one-third (30.6 percent) of direct care providers. The drugs most consumed by those seeking care are alcohol (82.4 percent), tobacco (81.2 percent) and marijuana (68.2 percent). The institutions generally give assistance to people in the 26-45 years age group (89.4 percent); with regard to gender, the institutions take care of: men (31.8 percent), women (5.9 percent), and both sexes (56.5 percent). The treatment models most used are psychosocial (58.8 percent), therapeutic community (47.1 percent) and biomedical (43.5 percent) and the work is evaluated through the team technique (72.9 percent). CONCLUSIONS: In the state of Espirito Santo, indirect care services are many times greater than those that offer direct care and the majority of all services are in the Central region. The populations in the mainland have a comparative disadvantage when it comes to treatment options for psychoactive substance...

OBJETIVO: Foi realizado um levantamento de todas as instituiçõesque proporcionam tratamento para dependência de substâncias psicoativas no Estado do Espírito Santo, Brasil, durante o período de 2004-2005. MÉTODO: Foi utilizado o método de amostragem bola-de-neve para incluir todos os estabelecimentos de tratamento no Estado e empregada uma entrevista semi-estruturada para informantes-chave em cada instituição. Os resultados descritivos foram apresentados e as diferenças testadas entre os grupos, utilizando o teste de qui-quadrado. RESULTADOS: No Espírito Santo, 250 instituições proporcionam tratamento para dependência de substâncias psicoativas e se distribuem da seguinte forma: governamentais (17,6 por cento), não-governamentais (22,8 por cento) e grupos de auto-ajuda (59,6 por cento). Destas 250 instituições, 85 proporcionam assistência direta e a maioria se encontra na região Central (70,6 por cento), seguido pela região Norte (15,3 por cento) e Sul (14,1 por cento). A maioria daquelas que fazem o atendimento direto são instituições privadas e sem fins lucrativos (16,8 por cento); as que possuem vínculos com organizações religiosas compõem quase um terço do total (30,6 por cento) de prestadores de serviços diretos. As drogas mais consumidas pelos que buscaram atendimento são álcool (82,4 por cento), tabaco (81,2 por cento) e maconha (68,2 por cento). As instituições geralmente atendem pessoas na faixa etária entre 26 e 45 anos (89,4 por cento); com relação ao sexo, as instituições que atendem somente homens perfazem 31,8 por cento; as que só atendem mulheres, 5,9 por cento; e ambos os sexos, 56,5 por cento. Os modelos de tratamento mais utilizados são o psicossocial (58,8 por cento), a comunidade terapêutica (47,1 por cento) e o biomédico (43,5 por cento), sendo o trabalho avaliado por meio da técnica de grupo (72,9 por cento). CONCLUSÕES: No Estado do Espírito Santo, os serviços de atendimento indireto são muito maiores do que os...