Human immunodeficiency virus infection and syphilis among homeless people in a large city of Central-Western Brazil: prevalence, risk factors, human immunodeficiency virus-1 genetic diversity, and drug resistance mutations

ABSTRACT Homeless people are at high risk for sexually transmitted infections (STIs), such as human immunodeficiency virus (HIV) infection and syphilis. We investigated the epidemiology of HIV-1 infection and syphilis among homeless individuals in a large city in Central-Western Brazil. In this cross-sectional study, we interviewed and tested 355 individuals from September 2014 to August 2015. Rapid test samples positive for syphilis were retested using the Venereal Disease Research Laboratory (VDRL) test. Blood samples from HIV-infected participants were collected for POL sequencing using HIV-1 RNA extracted from plasma, reverse transcription, and nested polymerase chain reaction. Anti-HIV-1-positive samples were subtyped by sequencing the nucleotides of HIV-1 protease and part of the HIV-1 reverse transcriptase genes. Transmitted and acquired drug resistance mutations and susceptibility to antiretroviral drugs were also analyzed. Anti-HIV was positive in 14 patients (3.9%; 95% confidence interval [CI]: 2.3-6.4). HIV-1 RNA was detected in 8 of the 14 samples. Two of the eight (25%) isolates showed HIV-1 drug resistance mutations. Furthermore, 78 (22%; 95% CI: 17.9-26.5) and 29 (8.2%; 95% CI: 5.6-11.4) homeless individuals tested positive for syphilis using the rapid test and VDRL test, respectively. Two individuals were anti-HIV-1 and VDRL test positive. Daily alcohol use (adjusted odds ratio [AOR]: 3.2, 95% CI: 1.0-10.4), sex with people living with HIV (PLWH) infection (AOR: 6.8, 95% CI: 1.9-25.0), and sex with people of the same sex (AOR: 5.4, 95% CI: 1.7-17.5) were predictors of HIV infection. Age ≤35 years (AOR: 3.8, 95% CI: 1.4-10.8), previous syphilis testing (AOR: 3.5, 95% CI: 1.4-8.4), history of genital lesions (AOR: 4.9, 95% CI: 1.3-19.1), and crack use in the last six months (AOR: 3.1, 95% CI: 1.3-7.6) were predictors of syphilis. Our findings highlight the importance of STI prevention and control strategies among the homeless.

Enfermagem sob a ótica de cuidadores principais de indivíduos com doença crônica no ambiente hospitalar / Nursing as seen by primary caregivers of individuals with chronic disease in the hospital environment / Enfermería desde la perspectiva de los cuidadores principales de personas con enfermedad crónica en el ambiente hospitalario

Objetivo: identificar os significados do cuidado de enfermagem para cuidadores principais de indivíduos adultos com doenças crônicas não transmissíveis em hospital da Região Central do Brasil. Método: estudo descritivo, com abordagem qualitativa, realizado por meio de entrevistas semiestruturadas, no período de maio a novembro de 2014, em 220 cuidadores principais, sendo utilizada a técnica de análise de conteúdo. Investigação aprovada pelo Comitê de Ética em Pesquisa (parecer 031/2009). Resultados: foram identificadas as seguintes categorias nos depoimentos: relações afetivas e o cuidado; enfermagem e o modelo vocacional-religioso; subalternidade profissional e satisfação do cliente e o cuidado. Conclusão: os cuidadores ainda possuem visão restrita e limitada a respeito da enfermagem, não considerando que a profissão atua com rigor científico baseado em evidências, e articulado à utilidade social. Os achados oferecem ponto de partida para o planejamento de intervenções que traduzam o conhecimento produzido pela enfermagem aos cuidadores principais no ambiente hospitalar, grupo formador de opinião intra e extra-hospitalar.

Objective: to identify the meanings of nursing care to primary caregivers of adults with chronic noncommunicable diseases at a hospital in the Central Region of Brazil. Method: this qualitative, descriptive study was conducted by semi-structured interviews of 220 primary caregivers, from May to November 2014, and using content analysis technique. The study had research ethics committee approval (opinion 031/2009). Results: the following categories were identified in the transcriptions: affective relationships and care; nursing and the vocational-religious model; professional subordination and client satisfaction and care. Conclusion: caregivers still have a narrow and limited view of nursing, and do not consider that the profession acts with scientific evidence-based rigor and in articulation with social utility. The findings offer a starting point for planning interventions that translate the knowledge produced by nursing to primary caregivers in the hospital setting, who are opinion leaders, as a group, inside and outside the hospital.

Objetivo: identificar los significados del cuidado de enfermería para cuidadores principales de individuos adultos con enfermedades crónicas no transmisibles en un hospital de la Región Central de Brasil. Método: estudio descriptivo, con enfoque cualitativo, realizado por medio de entrevistas semiestructuradas en el período de mayo a noviembre de 2014, junto a 220 cuidadores principales, siendo utilizada la técnica de análisis de contenido. Investigación aprobada por el Comité de Ética en Investigación (dictamen 031/2009). Resultados: se identificaron las siguientes categorías de resultados: relaciones afectivas y el cuidado, enfermería y el modelo vocacionalreligioso, subalternidad profesional y satisfacción del cliente y el cuidado. Conclusión: los cuidadores todavía tienen visión restringida y limitada respecto a la enfermería, no considerando que la profesión actúe con rigor científico basado en evidencias y articulada a la utilidad social. Los hallazgos ofrecen un punto de partida para la planificación de intervenciones que traduzcan el conocimiento producido por la enfermería a los cuidadores principales en el ambiente hospitalario, grupo formador de opinión intra y extrahospitalario.