Epidemiological profile of Adolescents living with HIV/AIDS in Espirito Santo, Brazil: A cross-sectional study / Perfil epidemiológico de adolescentes vivendo com HIV/AIDS no Espírito Santo, Brasil: um estudo transversal

Introduction: The AIDS epidemic has undergone several transformations, and, in recent years, there has been an increase in cases of HIV/AIDS among adolescents and young people. Thus, it is essential to know this population to base health actions scientifically.Objective: This study aims to analyze the epidemiological profile of adolescents living with HIV/AIDS in Espírito Santo, Brazil.Methods: A descriptive, sectional study in which notifications of HIV/AIDS among adolescents aged 13 to 19 between 2010 and 2020 were analyzed.Results: 523 adolescents with HIV/AIDS were found in the analyzed period (an average of 47 cases/year). There was a predominance of male adolescents (68.8%), older than 16 years (mean=18.0 years), of mixed race/colour (54.6%), living in the metropolitan region near the capital. It was observed that the schooling of females is lower, with 47.2% of them in elementary school, while 45.0% of the boys are in high school. In most cases, the infection occurred via sexual intercourse, among men, through homosexual relations (55.0%), and among women, through heterosexual relations (82.2%). The HIV viral load was detectable in almost all (84.8%) cases, and 11 (6.8%) of these adolescents died.Conclusion: The epidemiological profile of HIV and AIDS cases among adolescents in Espírito Santo shows a higher frequency of cases in males aged 16 to 19 years, with incomplete high school education, who acquired HIV through unprotected sex in homosexual relationships. We highlight the high percentage of young people with detectable viral loads and deaths due to complications of AIDS

Introdução: A epidemia da AIDS passou por diversas transformações e, nos últimos anos, observa-se aumento de casos de HIV/AIDS entre adolescentes e jovens. Assim, é fundamental conhecer essa população para embasar cientificamente as ações em saúde. Objetivo: analisar o perfil epidemiológico de adolescentes que vivem com HIV/AIDS no Estado do Espírito Santo, Brasil. Método: estudo descritivo, seccional, no qual foram analisadas notificações de HIV/AIDS entre adolescentes de 13 a 19 anos, entre 2010 e 2020.Resultados: foram encontrados 523 adolescentes vivendo com HIV/AIDS no período analisado (média de 47 casos/ano). Prevaleceu os adolescentes do sexo masculino (68,8%), com mais de 16 anos (média=18,0 anos), de raça/cor parda (54,6%), residentes na região metropolitana, próxima a capital. Foi observado que a escolaridade do sexo feminino é menor, estando 47,2% delas no ensino fundamental, enquanto 45,0% dos rapazes já estão no ensino médio. Em grande parte dos casos a infecção ocorreu via sexual, sendo, entre os homens, através de relações homossexuais (55,0%) e entre as mulheres por meio de relações heterossexuais (82,2%). A carga viral de HIV foi detectável em quase totalidade (84,8%) dos casos e 11 (6,8%) destes adolescentes evoluíram para óbito. Conclusão: O perfil epidemiológico dos casos de HIV e AIDS, entre os adolescentes, no Estado do Espírito Santo, demonstra maior frequência de casos no sexo masculino, na faixa etária de 16 a 19 anos, com ensino médio incompleto, que adquiriram HIV por via sexual desprotegida, em relações homossexuais. Destaca-se a alta porcentagem de jovens com carga viral detectável e os óbitos em decorrência de complicações da AIDS.

Subnational certification of elimination of mother-to-child transmission of HIV and/or syphilis: a Brazilian experience report / Certificação subnacional da eliminação da transmissão vertical de HIV e/ou sífilis: relato da experiência brasileira / Certificación subnacional de la eliminación de la trasmisión vertical de VIH y/o sífilis: relato de la experiencia brasileña

Abstract Objective: to describe the subnational implementation process of the certification for elimination of mother-to-child transmission of HIV and/or syphilis, its main barriers, challenges and opportunities. Methods: in 2022, indicators from the last full year for impact targets and the last two full years for process targets, available in national information systems, were evaluated; descriptive reports were analyzed and actions were acknowledged within four thematic axes, according to PAHO/WHO recommendations. Results: 43 municipalities ≥ 100,000 inhabitants were certified, covering 24.6 million inhabitants; one municipality achieved dual elimination (HIV-syphilis), 28 municipalities achieved elimination of HIV and 10 received silver tiers; regarding syphilis, one elimination was observed, along with 4 gold tiers, 13 silver tiers and 4 bronze tiers; a higher number of certifications was identified in the Southeast and South regions. Conclusion: barriers and challenges of the process were overcome through tripartite collaboration; the experience provided better integration of surveillance with care and improved actions aimed at preventing mother-to-child transmission.

Resumo Objetivo: descrever o processo de implantação subnacional da certificação da eliminação da transmissão vertical de HIV e/ou sífilis, suas principais barreiras, desafios e oportunidades. Métodos: em 2022, foram avaliados indicadores do último ano completo para meta de impacto, e dos dois últimos anos completos para metas de processo, disponíveis nos sistemas nacionais de informações; foram analisados relatórios descritivos e reconhecidas ações em quatro eixos temáticos, conforme recomendações da OPAS/OMS. Resultados: 43 municípios ≥ 100 mil habitantes foram certificados, abrangendo 24,6 milhões de habitantes; um município alcançou dupla eliminação (HIV-sífilis), 28 alcançaram eliminação para HIV e 10, selos prata; para sífilis, houve uma eliminação, 4 selos ouro, 13 prata e 4 bronze; identificou-se maior número de certificações nas regiões Sudeste e Sul. Conclusão: barreiras e desafios do processo foram superados pela colaboração tripartite; a experiência proporcionou melhor integração da vigilância com a assistência e qualificação das ações para prevenção da transmissão vertical.

Resumen Objetivo: describir el proceso de implementación subnacional de la certificación de eliminación de la transmisión vertical (TV) de sífilis y/o VIH, barreras, oportunidades y desafíos. Métodos: en 2022, se evaluaron indicadores del último año completo para la meta de impacto y de los dos últimos años para las de proceso en los sistemas de información; se analizaron informes descriptivos y se reconocieron acciones de cuatro ejes, según las recomendaciones de la OPS/OMS. Resultados: se certificaron 43 municipios ≥ 100.000 mil habitantes, cubriendo 24,6 millones de habitantes; un municipio logró la doble eliminación (VIH-sífilis), 28 la eliminación del VIH y 10 sellos plata; para sífilis, hubo una eliminación, 4 sellos oro, 13 plata y 4 bronce; las regiones Sudeste y Sur obtuvieron más certificaciones. Conclusión: barreras y desafíos fueron superados mediante la colaboración tripartita; la experiencia permitió la integración de la vigilancia con la atención y la cualificación de acciones para la prevención de la TV.

Detection of HPV DNA in vaginal samples self-collected by women living with HIV treated through the Brazilian public health system: Prevalence and analysis of risk factors

ABSTRACT Background: Women living with human immunodeficiency virus (HIV) (WLWH) are more likely to be infected with the oncogenic human papillomavirus (HPV). We assessed the prevalence of high-risk (HR) (16/18/31/33/35/39/45/51/52/56/58/59/68/73/82), probable high-risk (pHR) (26/53/66), and low-risk (LR) (6/11/40/42/43/44/54/61/70) HPV types and their associated risk factors. Methods: This cross-sectional study of WLWH aged 18-64 years included one laboratory and eight HIV-specialty healthcare facilities in the pilot network. Descriptive statistics were used to assess sociodemographic and behavioral characteristics. Adjusted analyses were conducted to evaluate risk factors associated with HR and/or pHR HPV infection in WLWH. Results: From May/2021 to May/2022, 1,914 (92.5%) WLWH participated in the pilot study and had valid HPV-DNA results of self-collected vaginal samples. The median age of the participants was 45 years, 60.1% had ≥ 9 years of schooling, 80.5% were ≤ 18 years at first sexual intercourse, and 51.7% had > 4 sexual partners throughout life. The prevalence of any HPV type, HR HPV, pHR HPV, and LR HPV was 65.8%, 49.6%, 16.7%, and 40.0%, respectively. Age was inversely associated with pHR and/or HR-HPV (p < 0.001), and education level was inversely associated with HR-HPV (p = 0.003) types. Any HR or pHR was associated with being single (p = 0.029) and exchanging sex for drugs (p = 0.037). Conclusions: The prevalence of HPV, especially HR HPV, among WLWH is high in Brazil, highlighting the need for HPV screening in this population. Self-collection of vaginal samples is an important strategy for increasing testing access.

Sensitivity and specificity of a syphilis rapid diagnostic test in blood donors' samples

Abstract Rapid Diagnostic Tests (RDT) are useful to identify syphilis cases, particularly for hard-to-reach populations and if laboratory services are scarce. However, RDT performance may be suboptimal. We aimed to assess the sensitivity and specificity of a syphilis RDT using well-characterized blood donors' samples. We categorized samples from 811 blood donors into five groups: 1 - Samples with reactive Chemiluminescence (QML), FTA-Abs, and VDRL; 2 - Samples with reactive QML and FTA-Abs, and nonreactive VDRL; 3 - Samples with reactive QML, and nonreactive for other markers (false-positives); 4 - Controls with nonreactive QML; and 5 - Samples reactive for HIV, with nonreactive QML. Sensitivity was tested in groups 1 (overall and according to VDRL titers) and 2; specificity was tested in groups 3‒5. The RDT had high specificity, even in samples reactive for HIV. The sensitivity was high (91.9%) in samples with reactive VDRL but varied between 75.0%‒100% according to VDRL titers. The overall sensitivity was lower (81.3%) in samples with reactive FTA-Abs and nonreactive VDRL. The RDT is a useful tool to detect active syphilis but may be more limited for cases with very early or remote infection, or those with prior treatment. When higher sensitivity is needed, additional strategies including recurrent testing or laboratory-based tests may be required.

Gonorrhea prevalence in adults in Brazil: Spectrum-STI trend estimation, 2000-2020

ABSTRACT Background: Gonorrhea is not a notifiable disease in Brazil, and the national health information system does not collect data on reported cases or infection prevalence. Methods: We compiled published data on gonorrhea prevalence in Brazil from cross-sectional surveys and clinical trials between 2000 and 2020. The study entry criteria included a sample size of 50 or more, and Neisseria gonorrhoeae infection detected in urine, urethral, anal, or cervicovaginal specimens using either Nucleic Acid Amplification Test or culture. Gonorrhea prevalence trends between 2000 and 2020 were generated using Spectrum-STI, a statistical trend-fitting model. Results: Forty-five studies with 59 gonorrhea prevalence data points were identified. Fifty data points were for women and represented 21,815 individuals, eight for men encompassing a total of 4,587 individuals, and one for transgender people comprising 345 individuals. The Spectrum-STI estimate for the prevalence of urogenital infection with gonorrhea in women 15-49 in 2020 was 0.63% (95% confidence interval (CI): 0.13-2.23) and was lower than the 1.05% estimated value for 2000 (95% CI: 0.36-2.79). The corresponding figures for men were 0.70% (95% CI: 0.16-2.44) and 1.14% (95% CI: 0.34-3.15). Anal prevalence estimates could not be generated because of insufficient data (three data points). Conclusions: These results suggest that the overall prevalence of genitourinary gonococcal infections in Brazil is less than 1%. Data on gonorrhea prevalence in men and in populations at increased STI vulnerability are limited.

The fight against sexually transmitted infections cannot stop in the COVID-19 era: a brazilian experience in online training for sexually transmitted infections guidelines / A luta contra as infecções sexualmente transmissíveis não pode parar na era COVID-19: experiência brasileira em treinamento on-line para diretrizes em infecções sexualmente transmissíveis

Introduction: The Brazilian Ministry of Health had planned face-to-face workshops for professional training about the Clinical Protocols and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections for the year 2020. Due to the COVID-19 pandemic, the workshops were cancelled, and a new strategy was adopted: virtual meetings, called Webinars ­ Clinical Protocols and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections 2020. Objective: To report the experience at the Ministry of Health in online training about the clinical protocol and therapeutic guidelines for comprehensive care for people sexually transmitted infections for health professionals in 2020. Methods: The webinars were held in partnership with the Brazilian Society of Sexually Transmitted Diseases and the Pan American Health Organization. Each chapter of the Clinical Protocols and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections ­ 2020 was converted into a webinar, with the participation of at least three experts, two speakers, and a moderator. Results: In total, 16 webinars were presented, covering topics such as sexually transmitted infections surveillance, prevention, diagnosis, treatment, public policies, and sexual violence. The initiative had more than 77,000 hits, with an average of 4,900 hits per webinar and the topic "syphilis" being the most accessed. The event reached all 27 federative units of Brazil, as well as 27 other countries. About 500 questions were received from the audience and answered during the sessions and/or through a document published later on by the Ministry of Health. Conclusion: Given the high number of hits and inquiries received, we can conclude that health professionals remained engaged in the topic of sexually transmitted infections during the pandemic. This experience shows the great potential of innovative methods for distance learning to promote continuing education, including a series of webinars aimed at strengthening the fight against sexually transmitted infections.

Introdução: O Ministério da Saúde do Brasil planejou para o ano de 2020 oficinas presenciais para capacitação profissional sobre o Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis. Em função da pandemia de COVID-19, as oficinas foram canceladas, optando-se pela estratégia de encontros virtuais, denominados Webinares ­ Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis ­ 2020. Objetivo: Descrever a experiência do Ministério da Saúde em capacitações on-line para profissionais de saúde no contexto dos Webinares ­ Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis ­ 2020. Métodos: Os webinares foram realizados em parceria com a Sociedade Brasileira de Doenças Sexualmente Transmissíveis e Organização Pan-Americana da Saúde. Cada capítulo do Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis ­ 2020 foi convertido em um webinar, com a participação de pelo menos três especialistas, sendo dois palestrantes e um moderador. Resultados: No total, foram apresentados 16 webinares, que abordaram temas como vigilância, prevenção, diagnóstico, tratamento das infecções sexualmente transmissíveis, políticas públicas e violência sexual. Foram mais de 77 mil acessos, com média de 4.900 acessos por webinar, sendo a que a sífilis foi a temática mais acessada. O evento alcançou todos as 27 unidades federativas do Brasil, bem como outros 27 países. Cerca de 500 perguntas foram recebidas, as quais foram respondidas durante as sessões e/ou por meio de um documento publicado pelo Ministério da Saúde. Conclusão: Dado o elevado número de acessos e questionamentos recebidos, conclui-se que os profissionais da saúde permaneceram engajados no tema infecções sexualmente transmissíveis durante a pandemia. Essa experiência demonstrou o grande potencial de métodos inovadores de ensino à distância para promoção da educação permanente, como a realização de uma série de webinares, visando ao fortalecimento do combate às infecções sexualmente transmissíveis.

Violence in Quilombola women living in rural communities in Brazil

ABSTRACT OBJETIVE To estimate the prevalence of psychological, physical, and sexual violence perpetrated against women by their intimate partner (IP) in Quilombola communities located in Espírito Santo State, Brazil. METHODS The data is from a population-based cross-sectional study of Quilombola women conducted from 2017 to 2018. In-person interviews collected information on women's sociodemographic characteristics, behaviors, and their experience of violence perpetrated by their IP. The analysis used chi-square test and hierarchical logistic regression. RESULTS 219 women (94.8% of the invited ones) agreed to participate in the study. 59.0% (95%CI: 5.25-65.5) reported psychological violence; 41% (95%CI: 34.5-47.5) physical violence; and 8.2% (95%CI: 4.6-11.8) sexual violence. Psychological violence was associated with having three or more sexual partners in life, when compared to those who had up to two partners (p = 0,009), and previous violence involving other people outside of family increased the chance of suffering psychological violence by an IP more than nine times (p ≤ 0.001). Regarding physical violence, the association with use of barrier contraception (p = 0.031) and having a partner with other sexual partners (p = 0.024) were protective factors for IP violence. Having 3 or more sexual partners in the last 12 months (p = 0.006), partner using illicit drugs (p = 0,006), and alcoholism in the family (p = 0,001), increased the chance of suffer physical violence by the partner. Sexual violence perpetrated by the IP was associated with miscarriage (p = 0.016), partner using drugs (p = 0.020), and gynecological symptoms (p = 0.045). CONCLUSIONS These results showed the high frequency of intimate partner violence in Quilombola women and highlight the importance of reducing social and race inequities for interrupting the culture of violence against women.

Características epidemiológicas e clínicas dos casos de monkeypox no Brasil em 2022: estudo transversal / Características epidemiológicas y clínicas de los casos de viruela del mono en Brasil em 2022: un estudio transversal / Epidemiological and clinical characteristics of monkeypox cases in Brazil in 2022: a cross-sectional study

Objetivo: descrever características epidemiológicas e clínicas da monkeypox (MPX) no Brasil desde a identificação do primeiro caso, em 7 de junho de 2022, até a semana epidemiológica (SE) 39, encerrada em 1º de outubro de 2022. Métodos: estudo descritivo dos casos notificados ao Ministério da Saúde; as tendências foram analisadas sobre o número de casos confirmados e prováveis, por SE; os casos foram descritos segundo variáveis demográficas e variáveis clínicas. Resultados: das 33.513 notificações, 23,8% foram confirmadas, 91,8% eram do sexo masculino e 70,6% de homens cis com idade mediana de 32 anos; febre (58,0%), adenomegalia (42,4%), cefaleia (39,9%) e erupções (37,0%) foram os sintomas mais frequentes; 27,5% declararam ser imunossuprimidos, 34,6% viviam com HIV e 10,5% possuíam infecção sexualmente transmissível; três óbitos foram registrados. Conclusão: o perfil de casos de MPX foi semelhante ao de outros países; ações de vigilância devem ser reforçadas para o controle do surto.

Objetivo: Describir las características epidemiológicas y clínicas de la viruela del mono (MPX) en Brasil, desde la identificación del primer caso, el 7 de junio de 2022, hasta la semana epidemiológica (SE) 39, finalizando el 1° de octubre de 2022. Métodos: Las tendencias de los casos notificados al Ministerio de Salud se analizaron como el número de casos notificados confirmados y probables, por SE. Los casos se describieron según variables demográficas y clínicas. Resultados: se confirmaron 33.513 notificaciones un 23,8%; 91,8% del sexo masculino; un 70,6% de hombres cis; con edad promedio de 32 años. Fiebre (58,0%), adenomegalia (42,4%), cefalea (39,9%) y exantema (37,0%) fueron los síntomas más frecuentes. Un 27,5% declaró estar inmunodeprimido, 34,6% vivía con VIH y 10,5% tenía alguna infección de transmisión sexual. Se registraron 3 muertes. Conclusión: El perfil de los casos MPX fue similar al de otros países. Se deben reforzar las acciones de vigilancia para controlar el brote.

Objective: to describe epidemiological and clinical characteristics of monkeypox (MPX) in Brazil, from the identification of the first case, on June 7, 2022, to Epidemiological Week (EW) 39, ending on October 1, 2022. Methods: this was a descriptive study of cases notified to the Ministry of Health; trends were analyzed based on the number of confirmed and probable cases per EW; the cases were also described according to demographic and clinical variables. Results: out of 31,513 notifications, 23.8% were confirmed; 91.8% were male; 70.6% were cis men; and median age was 32 years. Fever (58.0%), adenomegaly (42.4%), headache (39.9%) and rash (37.0%) were the most frequent symptoms; 27.5% reported being immunosuppressed, 34.6% were living with HIV and 10.5% had a sexually transmitted infection; three deaths were recorded. Conclusion: the MPX case profile was similar to that of other countries; surveillance actions must be strengthened to control the outbreak.

Prevalence of syphilis and associated factors in the adult population treated at healthcare facilities in Vitória (ES), Brazil / Prevalência e fatores associados à sífilis em adultos atendidos em unidades de saúde de Vitória (ES), Brasil

Introduction: There are few population-sampling studies on the prevalence of syphilis in Brazil. Objectives: We aim to determine the seroprevalence of syphilis and identify factors associated with the infection in adult patients observed at six regional healthcare facilities in Vitória city, state of Espírito Santo, Brazil. Methods: A cross-sectional study was conducted between September 2010 and December 2011. For individuals included in the study, a Venereal Disease Research Laboratory (VDRL) test and two treponemal tests (immunochromatographic and IgG ELISA assays) were performed. Demographic data, history of sexually transmitted infections, and behavioral data were collected. Results: Of the 1,502 subjects included in the study, 47% were men and 53% were women. The mean age was 41.63±14.57 years. The prevalence of syphilis was (0.9%; 95%CI 0.4­1.3) when a diagnosis of syphilis was considered with VDRL titers equal to or greater than 1:8. However, the prevalence was higher (2.8%) when a positive VDRL test, regardless of the titer, was considered. A multivariate analysis showed a significant association between syphilis and homosexual or bisexual behavior [OR=6.80; 95%CI 1.00­46.20], prior history of sexually transmitted infection [OR=16.30; 95%CI 3.61­73.41], the presence of a tattoo [OR=6.21; 95%CI 1.49­ 25.84], and cocaine use [OR=6.80; 95%CI 1.15­40.30]. The prevalence of positive treponemal test was 10.4%. Conclusion: The seroprevalence of active syphilis in this population was similar to that observed in other populational studies in Brazil. The high prevalence of positive treponemal tests may be due to the positive serological memory of a cured infection, but the results may also be due to cases of early or late syphilis that were not detected by the VDRL test.

Introdução: Existem poucos estudos em amostras populacionais sobre a prevalência da sífilis no Brasil. Objetivos: Determinar a soroprevalência de sífilis e identificar fatores associados à infecção em pacientes adultos atendidos nas unidades das seis regiões de saúde do Município de Vitória, Estado do Espírito Santo. Métodos: Foi realizado um estudo transversal entre setembro de 2010 e dezembro de 2011. Para os indivíduos incluídos no estudo, foram realizados o teste Venereal Disease Research Laboratory (VDRL) e dois testes treponêmicos (imunocromatográfico e IgG ELISA). Foram coletados dados demográficos, histórico de infecções sexualmente transmissíveis e dados comportamentais. Resultados: Dos 1.502 indivíduos incluídos no estudo, 47% eram homens e 53% eram mulheres. A média de idade foi de 41,63±14,57 anos. A prevalência de sífilis foi de 0,9% (IC95% 0,4­1,3) quando considerado diagnóstico de sífilis com títulos de VDRL iguais ou superiores a 1:8. Porém, a prevalência foi maior (2,8%) quando considerado VDRL positivo, independente do título. Análise multivariada mostrou associação significativa da sífilis com comportamento homo ou bissexual [OR=6,80; IC95% 1,00­46,20], história prévia de infecções sexualmente transmissíveis [OR=16,30; IC95% 3,61­73,41], tatuagem [OR=6,21; IC95% 1,49­25,84] e uso de cocaína [OR=6,80; IC95% 1,15­40,30]. A prevalência de teste treponêmico positivo foi de 10,4%. Conclusão: A soroprevalência de sífilis ativa nesta população foi semelhante à observada em outros estudos populacionais no Brasil. A alta prevalência nos testes treponêmicos positivos pode ser devida a cicatriz sorológica de infecção curada, mas pode também estar associada a casos de sífilis primária ou tardia, que não foram detectados pelo teste de VDRL.

Desfechos adversos perinatais e apoio matricial em Vitória, Espírito Santo, 2013-2014: um estudo de coorte / Perinatal adverse outcomes and matrix support in Vitória, Espírito Santo, Brazil, 2013-2014: a cohort study

RESUMO Introdução O apoio matricial (AM) em saúde da mulher é um processo normativo de trabalho que visa qualificar e aumentar a resolubilidade dos profissionais inseridos no contexto da assistência pré-natal na Atenção Primária à Saúde (APS). Objetivo Avaliar o efeito do AM sobre os desfechos perinatais adversos mais prevalentes em uma capital da região Sudeste do Brasil. Método Estudo de coorte que avalia prematuridade, baixo peso ao nascer e mortalidade neonatal precoce em filhos de mulheres acompanhadas nos serviços de APS do município de Vitória, de 2013 a 2014. Resultados O modelo final de análise hierarquizada, que incluiu 443 recém-nascidos, inferiu que a chance de uma gravidez evoluir para um desfecho perinatal adverso aumenta quanto maior o número de gestações anteriores (OR 4,39; IC: 1,93-10,0) e menor o número de consultas pré-natais realizadas (OR 4,99; IC: 2,18-11,42). Não foi observado efeito do AM sobre os desfechos. Conclusão O modelo hierárquico proposto não demonstrou influência do AM nos desfechos perinatais adversos estudados.

ABSTRACT Background Matrix support (MS) in women's health is a normative work process that aims to qualify and increase the resolvability of professionals working in prenatal care in Primary Health Care (PHC). Objective To evaluate the effect of MS on the most prevalent adverse perinatal outcomes in a state capital city in the Southeast region of Brazil. Method A cohort study evaluating prematurity, low birth weight, and early neonatal mortality in infants of women followed up in PHC services in the city of Vitória from 2013 to 2014. Results The final hierarchical analysis model, which included 443 newborns, showed that the larger the number of previous pregnancies (OR 4.39, CI 1.93-10.0) and the smaller the number of prenatal consultations (OR 4.99, CI 2.18-11.42), the greater the chances of a pregnancy progressing to an adverse perinatal outcome. No effect of MS on outcomes was observed. Conclusion The proposed hierarchical model demonstrated that MS has no influence on the adverse perinatal outcomes studied.

Sexually transmitted infections among women living with HIV in a Brazilian city

ABSTRACT Background: Clinical improvements following highly active antiretroviral therapy (HAART) may increase high-risk behaviors resulting in sexually transmitted infections (STI). Optimism related to the success of HAART in slowing disease progression, reducing viral load, and improving health status might be important factors for increasing sexual risk behaviors such as less use of condoms. Objective: To determine the prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, syphilis, hepatitis B and C, high-risk HPV, and cervical cytological abnormalities among women living with HIV (WLHIV) who attended a Reference Center for STI/AIDS in Brazil. Methods: A cross-sectional study was conducted among 151 WLHIV attending an STI Clinic in Vitória city, Brazil. A structured questionnaire, including demographic, behavioral, and clinical information, was used for data collection. Serological tests for HIV, syphilis, hepatitis C and B, CD4 counts, and viral load determination were performed. Cervical samples were collected for cytology and real-time PCR for HPV, Chlamydia, and Neisseria gonorrhoeae. Results: In this study, 59% of women had at least one diagnosed STI at the time of the first clinic visit; 31% had clinical forms of anogenital HPV, 10% syphilis, 8%Neisseria gonorrhoeae, 5.0% trichomoniasis, 3% Chlamydia trachomatis, 1% hepatitis B, and 1% hepatitis C; 6.7% of the women presented with cervical cytological abnormalities. Furthermore, 46.3% of women had HR-HPV, and 17.6% had HPV 16/18. Only 5% of the women had a CD4 count <200 cells/mm3, 61.6% had undetectable HIV viral load, and 81.3% were currently on HAART. Conclusion: A high prevalence of STI and HR-HPV infections were observed among HIV-infected women in this investigation. Prevention programs need to focus on counseling WLHIV and their regular partners with focused interventions such as couples counseling and education programs.

Brazilian protocol for sexually transmitted infections, 2020: infections that cause cervicitis

Abstract Infections that cause cervicitis are a topic presented in the "Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections", published by the Brazilian Ministry of Health in 2020. The document was developed based on scientific evidence and validated in discussions with experts. This article presents epidemiological and clinical aspects of infections that cause cervicitis and recommendations on screening, diagnosis, and treatment of affected people and their sexual partnerships. Also, it discusses strategies for surveillance, prevention, and control of these infections for health professionals and health service managers involved in the programmatic and operational management of sexually transmitted infections. Expanding access to diagnostic tests and early treatment are crucial for controlling the spread of pathogens that cause cervicitis.

Brazilian Protocol for Sexually Transmitted Infections, 2020: HIV infection in adolescents and adults

Abstract HIV infection is presented in the chapters of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. Health professionals and managers must learn the signs and symptoms of HIV infection and know how to diagnose it to provide appropriate treatment and reduce complications. HIV infection has become a chronic disease. Its treatment includes addressing common comorbidities such as arterial hypertension, diabetes, and dyslipidemia, in addition to cardiac risk assessment, cancer prevention, and guidance on immunization. Initiation of treatment for HIV patients is recommended regardless of clinical or immunological criteria as adopted by the Ministry of Health since 2013. Lately, it has been simplified with more tolerable first-line medications and fewer drug interactions, making its management easy to implement, including by primary health care.

Prevalence of infection by human T Cell lymphotropic viruses (HTLV-1/2) in adult population in Vitoria-ES

ABSTRACT Introduction: Brazil has a high number of HTLV-1/2 infections which are unequally distributed in the country. Most prevalence studies have focused on specific populations, such as blood donors and pregnant women. Some areas, for example the state of Bahia, have robust information about HTLV-1/2 infection, however there is no information available about this infection in the general population of Vitoria, Espírito Santo, Brazil. Objective: To determine the prevalence of HTLV-1/2 infection in adults from the municipality of Vitoria, ES. Methods: A cross sectional study was performed from September 2010 to December 2011, in individuals of both sexes, aged 18 or older living in Vitoria-ES. Venous blood samples were collected and tested for anti-HTLV-1/2 antibodies by chemiluminescent immunoassay (CMIA). Individuals with CMIA reactive results were submitted to a new blood collection for retesting by CMIA, followed by PCR to confirm infection and discriminate the viral type. Results: From 1502 tested samples, eight were reactive in CMIA and all were confirmed by PCR. Therefore, the prevalence of HTLV-1/2 was 0.53% (8/1502, 95% CI: 0.2-1.0%). The infection rate was 0.7% in men (5/711, 95% CI: 0.17-1.51%), and 0.38% in women (3/791, 95% CI: 0 -0.81%). Conclusions: The prevalence of HTLV-1/2 infection was 0.53% (8/1502; 95% CI: 0.2 -0.9%). Confirmatory test using real-time PCR (qPCR) identified seven individuals positive for HTLV-1 and one for HTLV-2. Considering the risk of infected individuals to develop high morbidity and mortality diseases, it would be important to implement public health policies aimed at stopping transmission of these viruses in this municipality. 2021 Sociedade Brasileira de Infectologia. Published by Elsevier España, S.L.U. This is an open access article under the CC BY-NC-ND license

Factors associated with prematurity in reported cases of congenital syphilis / Fatores associados à prematuridade em casos notificados de sífilis congênita

ABSTRACT OBJECTIVE: To analyze the factors associated with prematurity in reported cases of congenital syphilis in the city of Fortaleza, Ceará, Brazil. METHODS: Cross-sectional study conducted in ten public maternity hospitals in Fortaleza, Ceará, Brazil. A total of 478 reported cases of congenital syphilis were included in 2015, and data were collected from notification forms, from mothers' and babies' medical records and from prenatal cards. For the bivariate analysis, Pearson's chi-squared and Fisher's exact tests were used, considering p < 0.05. Multiple logistic regression was conducted, presenting odds ratio (OR) with a 95% confidence interval. RESULTS: We found 15.3% prematurity in pregnant women with syphilis. The titration of the VDRL test > 1:8 at delivery (OR 2.46; 95%CI: 1.33-4.53; p = 0.004) and the non-treatment of the pregnant women or treatment with drugs other than penicillin during prenatal care (OR 3.52; 95%CI: 1.74-7.13; p< 0.001) were associated with higher chances of prematurity. CONCLUSION: The prematurity due to congenital syphilis is a preventable condition, provided that pregnant women with syphilis are treated appropriately. Weaknesses in prenatal care are associated with this outcome, which highlights the importance of public policies oriented to improve the quality of prenatal care.

RESUMO OBJETIVO: Analisar os fatores associados à prematuridade em casos notificados de sífilis congênita no município de Fortaleza, Ceará, Brasil. MÉTODOS: Estudo transversal realizado em dez maternidades públicas de Fortaleza, Ceará, Brasil. Foram incluídos 478 casos notificados de sífilis congênita em 2015, e os dados foram coletados das fichas de notificação, dos prontuários das mães e dos bebês e do cartão de pré-natal. Para a análise bivariada, foram utilizados os testes do qui-quadrado de Pearson e exato de Fisher, considerando p < 0,05. Realizou-se regressão logística múltipla, apresentando razão de chances (OR) com intervalo de confiança de 95%. RESULTADOS: Encontrou-se 15,3% de prematuridade em gestantes com sífilis. A titulação do teste VDRL > 1:8 no parto (OR 2,46; IC95%: 1,33-4,53; p = 0,004), o não tratamento da gestante ou tratamento realizado com drogas diferentes da penicilina durante o pré-natal (OR 3,52; IC95%: 1,74-7,13; p < 0,001) estiveram associados a maiores chances de prematuridade. CONCLUSÃO: A prematuridade decorrente da sífilis congênita é um agravo evitável, desde que as gestantes com sífilis sejam tratadas adequadamente. As fragilidades na assistência pré-natal estão associadas a este desfecho, o que ressalta a importância de implementar políticas públicas voltadas a melhorar a qualidade do pré-natal.

Infecções sexualmente transmissíveis em mulheres afrodescendentes de comunidades quilombolas no Brasil: prevalência e fatores associados / Sexually transmissible infections in African-descendant women in maroon communities in Brazil: prevalence and associated factors / Enfermedades de transmisión sexual en mujeres afrodescendientes de comunidades quilombolas en Brasil: prevalencia y factores asociados

Resumo: O objetivo do estudo foi estimar a prevalência de infecções sexualmente transmissíveis (IST) e fatores associados sobre mulheres quilombolas no Brasil. Trata-se de estudo transversal de base populacional com mulheres quilombolas no período de março de 2017 a janeiro de 2019. Utilizou-se um questionário com informações sociodemográficas, comportamentais e clínicas. Foi realizado exame ginecológico para coleta de células cervicais para citologia oncótica e para detecção de Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis e papilomavírus humano (HPV), por meio de teste de reação em cadeia pela polimerase. Foi realizado teste rápido para HIV e sífilis. O desfecho principal foi definido como a infecção por um ou mais agentes infecciosos de transmissão sexual. Para a análise, utilizou-se o teste do qui-quadrado e regressão logística hierárquica. De um total de 380 mulheres, 352 (92,6%) foram incluídas no estudo. A prevalência de, pelo menos, uma IST foi de 18,5% (IC95%: 14,76-22,85). A maior prevalência foi de 11,1% por HPV, seguido de 6,3% por T. vaginalis e de 4,3% por C. trachomatis. Não houve nenhum caso de N. gonorrhoeae. Para o HIV, a prevalência foi de 0,3%, e de sífilis foi de 4,3%. A citologia cervicovaginal estava alterada em 7,7%. A detecção de uma ou mais IST foi significativamente associada a idade entre 25 e 44 anos (OR = 2,33; IC95%: 1,05-5,18), a consumo de álcool (OR = 1,96; IC95%: 1,06-3,64), a resultado alterado da citologia (OR = 3,96; IC95%: 1,65-9,48) e a vaginose bacteriana (OR = 3,61; IC95%: 2,01-6,47). Em mulheres quilombolas houve elevada prevalência de uma ou mais IST, o que torna importante a elaboração de estratégias de prevenção direcionadas a essas mulheres.

Abstract: The study aimed to estimate the prevalence of sexually transmissible infections (STIs) and associated factors in women in quilombola (maroon) communities in Brazil. This was a population-based cross-sectional study of quilombola women from March 2017 to January 2019. A questionnaire was used with sociodemographic, behavioral, and clinical information. A gynecological examination was performed for the collection of uterine cervical cells for oncotic cytology and the detection of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and human papillomavirus (HPV) via polymerase chain reaction. Rapid tests for HIV and syphilis were performed. The main outcome was defined as infection with one or more sexually transmissible pathogens. The analysis used chi-square test and hierarchical logistic regression. From a total of 380 women, 352 (92.6%) were included in the study. Prevalence of at least one STI was 18.5% (95%CI: 14.76-22.85). The highest prevalence was for HPV, with 11.1%, followed by 6.3% for T. vaginalis and 4.3% for C. trachomatis. There were no cases of N. gonorrhoeae. Prevalence was 0.3% for HIV and 4.3% for syphilis. Cervical-vaginal cytology was altered in 7.7% of the women. Detection of one or more STIs was significantly associated with age 25 to 44 years (OR = 2.33; 95%CI: 1.05-5.18), alcohol consumption (OR = 1.96; 95%CI: 1.06-3.64), altered cervical cytology (OR = 3.96; 95%CI: 1.65-9.48), and bacterial vaginosis (OR = 3.61; 95%CI: 2.01-6.47). Quilombola women showed high prevalence of one or more STIs, emphasizing the importance of organizing prevention strategies targeted to these women.

Resumen: El objetivo del estudio fue estimar la prevalencia de enfermedades de transmisión sexual (ETS) y sus factores asociados en mujeres quilombolas en Brasil. Estudio transversal de base poblacional con mujeres quilombolas durante el período de marzo de 2017 a enero de 2019. Se utilizó un cuestionario con información sociodemográfica, comportamental y clínica. Se realizó un examen ginecológico, a fin de recoger células cervicales para la citología oncótica, así como para la detección de Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, y virus del papiloma humano (VPH) mediante un test de reacción en cadena de la polimerasa. Se realizó un test rápido para VIH y sífilis. El resultado principal, se definió como infección por uno o más agentes infecciosos de transmisión sexual. Para el análisis, se utilizó el test de chi-cuadrado y regresión logística jerárquica. De un total de 380 mujeres, 352 (92,6%) se incluyeron en el estudio. La prevalencia de por lo menos una ETS fue de 18,5% (IC95%: 14,76-22,85). La mayor prevalencia fue por VPH 11,1%, seguida de 6,3% por T. vaginalis y 4,3% por C. trachomatis. No hubo casos de N. gonorrhoeae. Para el VIH, la prevalencia fue de 0,3% y de sífilis fue de 4,3%. La citología cérvico-vaginal estaba alterada en un 7,7%. La detección de una o más ETS estuvo significativamente asociada con la edad entre 25 a 44 años (OR = 2,33; IC95%: 1,05-5,18), el consumo de alcohol (OR = 1,96; IC95%: 1,06-3,64), resultado alterado de la citología (OR = 3,96; IC95%: 1,65-9,48) y vaginosis bacteriana (OR = 3,61; IC95%: 2,01-6,47). Las mujeres quilombolas presentaron una elevada prevalencia por una o más ETS, por lo que es importante la elaboración de estrategias de prevención dirigidas a estas mujeres.

Protocolo Brasileiro para Infecções Sexualmente Transmissíveis 2020: infecções que causam corrimento vaginal / Brazilian Protocol for Sexually Transmitted Infections 2020: infections causing vaginal discharge / Protocolo Brasileño para Infecciones de Transmisión Sexual 2020: infecciones que causan flujo vaginal

O tema corrimento vaginal é um dos capítulos que compõem o Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde do Brasil em 2020. Tal documento foi elaborado com base em evidências científicas e validado em discussões com especialistas. Neste artigo, são apresentados aspectos epidemiológicos e clínicos relacionados às situações de corrimento vaginal, bem como orientações aos gestores e profissionais de saúde na triagem, diagnóstico e tratamento desses agravos, que constituem uma das principais queixas entre mulheres que procuram serviços de saúde e que podem ser causados por fatores infecciosos ou não infecciosos. Além disso, são apresentadas informações sobre estratégias para as ações de vigilância, prevenção e controle, a fim de promover o conhecimento do problema e a oferta de assistência de qualidade e tratamento efetivo.

The topic of vaginal discharge is one of the chapters of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. The chapter has been developed based on scientific evidence and validated in discussions with specialists. This article presents epidemiological and clinical aspects related to vaginal discharge conditions, as well as guidelines for health service managers and health professionals about screening, diagnosing and treating these conditions, which are one of the main complaints among women seeking health services, and which may be caused by infectious or non-infectious factors. In addition, information is presented on strategies for surveillance, prevention and control actions, in order to promote knowledge of the problem and provision of quality care and effective treatment.

El tema del flujo vaginal es uno de los capítulos del Protocolo Clínico y Directrices Terapéuticas para la Atención Integral a las Personas con Infecciones de Transmisión Sexual, publicado por el Ministerio de Salud de Brasil en 2020. El documento fue desarrollado en base a evidencia científica y validado en discusiones con especialistas. En este artículo se presentan aspectos epidemiológicos y clínicos relacionados a las situaciones de flujo vaginal, así como pautas para gestores y profesionales de la salud en el cribado, diagnóstico y tratamiento de esas complicaciones, que son una de las principales quejas entre las mujeres que buscan servicios de salud y que pueden ser causadas por factores infecciosos o no infecciosos. Además, se presenta información sobre estrategias para acciones de vigilancia, prevención y control, con el fin de promover la comprensión del problema y la oferta de asistencia de calidad y tratamiento eficaz.