A Scoping Review of Biobehavioural Interventions to Improve PrEP Continuum of Care in Latin America

According to the literature, biobehavioural interventions or combined strategies would reduce the risk of HIV infection by more than 7,000 new cases each day, which would contribute to the battle facing Latin America, where despite the high incidence and prevalence of HIV in the region, access to PrEP (pre-exposure prophylaxis) is very limited. The objective of this research was, consistent with the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), to conduct a scoping review to assess the evidence of available outcome data on biobehavioural interventions and programs to address gaps in the PrEP continuum of care in Latin America. The search was conducted in the databases EBSCOhost, WoS, Scopus, and ProQuest, and include all studies published from 2010 to 2021. One hundred eighty-six studies were identified and evaluated according to the eligibility criteria in six stages starting with the elimination of duplicates until the selection of studies that met the previously mentioned criteria; at the end five studies were chosen which were submitted to the methodological quality assessment including compliance with ethical guidelines. Results show that biobehavioural interventions promoting PrEP in Latin America are effective in increasing condom use, decreasing HIV risk, and increasing PrEP awareness, uptake, adherence, and retention. The limited number of interventions in the PrEP continuum of care indicates a need for the uptake of dissemination and implementation science (D&I) frameworks. D&I could help facilitate the translation of evidence-based practices, interventions, and policies to address the HIV crisis in Latin America.

Según la literatura, las intervenciones bioconductuales o estrategias combinadas reducirían el riesgo de infección por VIH en más de 7000 nuevos casos cada día, lo que contribuiría a la batalla que enfrenta América Latina, región en la que, a pesar de la alta incidencia y prevalencia del VIH, el acceso a la PrEP (profilaxis preexposición) es muy limitado. De acuerdo con las directrices de PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), el objetivo de esta investigación fue realizar una revisión de alcance para evaluar la evidencia de los datos de resultados disponibles sobre intervenciones bioconductuales y programas para abordar las brechas en el continuo de atención de PrEP en América Latina. La búsqueda se realizó en las bases de datos EBSCOhost, WoS, Scopus y ProQuest, e incluyó todos los estudios publicados de 2010 a 2021. Se identificaron ciento ochenta y seis estudios, y se evaluaron de acuerdo con los criterios de elegibilidad en seis etapas, iniciando por la eliminación de duplicados hasta la selección de estudios que cumplieran los criterios previamente mencionados; al final se eligieron cinco estudios, los cuales fueron sometidos a la evaluación de calidad metodológica, incluyendo el cumplimiento de los lineamientos éticos. Los resultados muestran que las intervenciones bioconductuales que promueven la PrEP en América Latina son efectivas para aumentar el uso del condón, disminuir el riesgo de VIH y aumentar la conciencia, la aceptación, la adherencia y la retención de la PrEP. El número limitado de intervenciones en el continuo de atención de la PrEP indica la necesidad de adoptar marcos científicos de difusión e implementación (D&I); marcos que podrían ayudar a facilitar la traducción de prácticas, intervenciones y políticas basadas en la evidencia para abordar la crisis del VIH en América Latina.

Clinical significance of high-risk HPV-DNA detection combined with TCT in screening and follow-up of cervical lesions / 上海预防医学

ObjectiveTo explore the application value of high-risk HPV-DNA detection combined with TCT in cervical lesion screening and follow-up. MethodsThis study was conducted from February 2019 to February 2021. During this period， 241 subjects who were the patients referred from the primary community hospitals to the center for re-examination of cervical lesions. Of which 80 were patients with cervical intraepithelial neoplasia. Liquid-based cytology （TCT） technology was used to examine the cervical cytological morphology. The second-generation high-throughput sequencing technology and time-of-flight mass spectrometry technology， independently developed by BGI， were used to screen for HPV-DNA typing. At the same time， biopsy sampling was carried out， and the final pathological diagnosis was made. TCT detection and combined HPV-DNA detection were performed on 80 patients to compare the relationship between TCT alone and TCT/HPV-DNA combined test for the diagnosis and prognosis of CIN Ⅱ and CIN Ⅲ. Follow-up was conducted， and the HPV infection and TCT were re-tested. ResultsAmong the 80 cases of cervical intraepithelial neoplasia， 41 cases （51.25%） were between 35 and 44 years old， higher than the other age groups （P<0.001）. Compared with either TCT or HPV-DNA， TCT combined with HPV-DNA had obvious advantages in sensitivity， specificity， positive predictive value， and negative predictive value （P<0.05）. The recurrence rate in CIN Ⅱ and CIN Ⅲ groups was 9.52% and 16.67% respectively after 18 months of the follow-up. ConclusionTCT detection plays a positive role in cervical pre-cancer screening. By combining high-risk HPV-DNA typing and TCT detection， the detection values of sensitivity and specificity are significantly higher， which can improve the accuracy of cervical lesion screening and is of great significance for the follow-up work.

Saúde, aprimoramento e estilo de vida: o uso da profilaxia pré-exposição ao HIV (PrEP) entre homens gays, mulheres trans e travestis / Health, enhancement and lifestyle: the use of the HIV pre-exposure prophylaxis (PrEP) among gay men, trans women and travestis

Resumo O artigo objetiva analisar os significados do uso da PrEP entre gays, mulheres trans e travestis no Rio de Janeiro, com base em uma pesquisa sobre a biomedicalização da resposta à Aids. A análise e interpretação dos registros de diário de campo e das entrevistas nos permitiram descrever como o uso dessa tecnologia de prevenção ao HIV se dá simultaneamente com outros recursos biomédicos, intervenções estéticas, dietéticas e exercícios físicos. Argumentamos que tais cuidados de si são conformados em função das expectativas de gênero e classe e dos ideais de saúde de seus/as usuários/as. Os resultados do estudo permitem uma discussão sobre as fronteiras entre saúde, estilo de vida e aprimoramento. Conclui-se que a PrEP parece produzir uma singularização nas formas de produção de si, via aprimoramento biomédico e estético-cosmético, em um encontro sinérgico entre diferentes tecnologias, percebido tanto na rotina de uso do medicamento como no manejo de seus efeitos. Para a maioria das pessoas entrevistadas, a PrEP se acopla a um cuidado de si prévio, o que indica a localização social de seus usuários em termos de classe e gênero e a forma reflexiva a partir da qual descrevem sua saúde e a si próprias.

Abstract The article has analyzed the meanings of the use of PrEP among gay man, trans women, and travestis in Rio de Janeiro, based on research on the biomedicalization of the response to AIDS. The analysis and interpretation of the field diary entries and interviews allowed us to describe how the use of this HIV prevention technology occurs simultaneously with other biomedical resources, aesthetics, dietary interventions, and physical exercises. We argue that such self-care is shaped according to the expectations of gender and class and the health ideals of their users. The results of the study allow us to discuss the boundaries between health, lifestyle, and enhancement. It is concluded that PrEP seems to produce a singularization in the forms of self-production, via biomedical and aesthetic-cosmetic enhancement, in a synergistic encounter between different technologies; perceived both in the routine use of the drug and in the management of its effects. For most of the people interviewed, PrEP is coupled with a previous self-care, which indicates the social location of its users in terms of class and gender and the reflexive way from which they describe their health and themselves.

Evaluación de la competencia pragmática de cuatro adultos españoles con discapacidad auditiva congénita a través del Protocolo Rápido de Evaluación Pragmática - Revisado / Assessing the pragmatic competence of four spanish adults with congenital hearing loss through Protocolo Rápido de Evaluación Pragmática - Revisado

Numerosos estudios apuntan a las dificultades del lenguaje oral que pueden presentar las personas con discapacidad auditiva a lo largo de su desarrollo. No obstante, se conoce poco acerca del nivel de competencia pragmática que alcanzan y cómo esta área se desarrolla. En esta investigación se pretenden abordar las características pragmáticas de cuatro adultos españoles con discapacidad auditiva congénita a través del Protocolo Rápido de Evaluación Pragmática Revisado (PREP-R), que evalúa diferentes niveles de pragmática: textual, enunciativa e interactiva y, además,aporta un índice de habilidad pragmática general, específica y de base gramatical. Los participantes fueron evaluados mediante videograbaciones de muestras de lenguaje espontáneo en conversación con un familiar. Los resultados indican que, en general, los cuatro sujetos presentan un buen nivel de competencia pragmática, que se manifiesta a la hora de ajustar los actos de habla. Sin embargo, para regular su lenguaje, tienden a utilizar conductas compensatorias como: estrategias verbales que les permiten ganar tiempo extra para la construcción de sus emisiones, empleo de actos verbales y/o paraverbales compensatorios y el uso de gestos que completan su producción verbal. Estos datos indican que, aunque los participantes de este estudio presentan buenas habilidades pragmáticas, es necesario seguir desarrollando estrategias a nivel de intervención que les permitan comunicarse sin dificultades en diferentes contextos y con distintos interlocutores.

Numerous studies reveal the oral language difficulties that people with hearing loss may present throughout their development. However, little is known about the level of pragmatic competence they achieve and how this area evolves. This research aims to address the pragmatic characteristics of four Spanish adults with congenital hearing loss through Protocolo Rápido de Evaluación Pragmática -Revisado (PREP-R, which can be translated as Quick Protocol for Pragmatic Evaluation -Revised). This test assesses different levels of pragmatics: textual, enunciative, and interactional, and also provides an indicator for general, specific, and grammatically-based pragmatic ability. The participants were assessed by videotaping spontaneous speech samples in conversation with a family member. The results indicate that, in general, the four subjects present an adequate level of pragmatic competence, which is manifested in their adjustment of speech acts. Nevertheless, they show a tendency to use compensatory behaviors toregulate their speech, such as verbal strategies that allow them to gain extra time to construct their utterances, compensatory verbal and/or paraverbal acts, and gestures that complement their verbal productions. These data indicate that, although the participants of this study show good pragmatic skills, it is necessary to continue developing intervention strategies that allow them to communicate without difficulties in different contexts and with different communication partners.

Encuesta en línea de comportamiento sexual y prácticas de prevención del virus de inmunodeficiencia humana en varones gais y hombres que tienen sexo con hombres en Uruguay / Web-based survey on sexual behavior and HIV prevention practices in gay men and men who have sex with men in Uruguay / Pesquisa online de comportamento sexual e práticas de prevenção do Vírus da Imunodeficiência Humana em gays e homens que fazem sexo com homens no Uruguai

Resumen: Introducción: por ser los varones gais y los hombres que tienen sexo con hombres (HSH) una población con mayor incidencia de virus de inmunodeficiencia humana (VIH), ONUSIDA recomienda el monitoreo periódico mediante encuestas que releven información para reportar indicadores de prevención. La implementación de estos estudios en nuestro medio es limitada debido a la complejidad y costos de las metodologías tradicionales. Objetivo: generar información actualizada sobre prevención del VIH, con énfasis en uso de condón y realización de pruebas de tamizaje en gais/HSH de 15 a 49 años en Uruguay, implementando una estrategia metodológica innovadora. Material y método: estudio de corte transversal y analítico, en base a una encuesta online disponible entre octubre y diciembre de 2019. Resultados: se incluyeron 693 varones, 67% de Montevideo y 67% con nivel educativo terciario. Un 17% fue forzado a mantener relaciones sexuales alguna vez, 20% sufrió maltrato por su orientación y 68,4% ocultaba su orientación sexoafectiva en algún grado. Un 57,2% usó condón en la última relación sexual anal casual, observándose un descenso respecto al año 2012 (67,6%), mientras que la tendencia en la cobertura de prueba de VIH (66%) fue creciente comparada con estudios previos. La proporción de positividad de VIH fue de 13,3%. El análisis multivariado mostró que la menor probabilidad de uso de condón se asocia a: pareja estable en el último año, autoidentificación gay, prueba de VIH en el último año y vacunación para virus papiloma humano. La mayor probabilidad de uso se asoció a: participación en actividades de información, relaciones sexuales con personas con ITS/VIH. La menor probabilidad de realización de prueba de VIH se asoció con pareja estable y la mayor con el conocimiento de lugares de acceso a prueba y conocimiento de la profilaxis posexposición. Entre quienes conocían la profilaxis preexposición (375), 46,1% estaba dispuesto a recibirla y 1,3% había accedido. Conclusiones: la persistencia de situaciones de discriminación y violencia hacia varones gais/HSH necesita acciones más efectivas de promoción de derechos. Es necesario integrar innovaciones biomédicas en prevención que se complementen y potencien para el control de la epidemia. El uso de una encuesta en línea fue eficiente en el reclutamiento, aunque con sesgos en la selección, lo que desafía a mejorar esta estrategia metodológica.

Summary: Introduction: as gay men and men who have sex with men (MSM) constitute a population with a greater incidence of HIV, UNAIDS recommends regular surveillance by means of surveys that provide information that allows reporting prevention indicators. The implementation of these studies is limited in our context given the high complexity and costs of traditional methodologies. Objectives: to generate updated information about HIV prevention, with an emphasis on condom use and to implement screening tests in gay/MSM population between 15 and 49 years old in Uruguay, using an innovative methodological strategy. Method: transversal, analytical study by means of a web-based survey available between October and December 2019. Results: 693 men were included in the study, 67% from Montevideo and 67% of which had university studies. 17% of them had been forced to have sex in the past, 20% had suffered abuse because of their sexual orientation and 68.4% concealed their sex-affective orientation to some extent. 57.2% used condoms in their last casual anal sexual relationship, what evidences a decrease with regard to 2012 (67.6%), whereas a growing tendency in the HIV test coverage (66%) was observed, when compared to previous studies. HIV positivity rate was 13.3%. The multivariate analysis revealed a lower probability of condom use was associated to: a stable partner in the last year, gay self-identification, HIV test in the last year and having the HPV vaccine. The greater likelihood of use was associated to: participating in informative activities, having sex with people with STD/HIV. The lowest probability of having an HIV test was associated to a stable partner and the highest was associated to knowing where they could get tested for HIV and also knowing about the post-exposure prophylaxis. When considering those who knew about the pre-exposure prophylaxis (375), 46.1% was willing to receive it and 1.3% had agreed to it. Conclusions: the continuation of discrimination and violence towards gay men and MSM needs more effective right promoting actions. We need to integrate into prevention biomedical innovations that complement and leverage one another. The web-based survey was effective in terms of recruiting, although there were bias in the selection, what results challenging to improve the methodological strategy.

Resumo: Introdução: como gays e homens que fazem sexo com homens (HSH) são uma população com maior incidência de HIV, o UNAIDS recomenda o monitoramento regular por meio de pesquisas que coletem informações para calcular indicadores de prevenção. A implementação desses estudos em nosso ambiente é limitada devido à complexidade e custo das metodologias tradicionais. Objetivo: gerar informações atualizadas sobre prevenção do HIV, com ênfase no uso de preservativos e testes de triagem em gays/HSH de 15 a 49 anos no Uruguai, implementando uma estratégia metodológica inovadora. Método: estudo transversal e analítico, baseado em questionário online disponível entre outubro e dezembro de 2019. Resultados: foram incluídos 693 homens, 67% de Montevidéu e 67% com nível superior. 17% foram obrigados a ter relações sexuais em algum momento, 20% sofreram maus-tratos devido à sua orientação e 68,4% ocultaram sua orientação sexual-afetiva em algum grau. 57,2% usaram preservativo na última relação anal casual, mostrando um decréscimo em relação a 2012 (67,6%), enquanto a tendência da cobertura do teste anti-HIV (66%) foi de aumento em relação a estudos anteriores. A taxa de positividade do HIV foi de 13,3%. A análise multivariada mostrou menor probabilidade de uso de preservativo associado a: parceiro estável no último ano, autoidentificação gay, teste de HIV no último ano e vacinação para papiloma vírus humano. A maior probabilidade de uso esteve associada a: participação em atividades informativas, relações sexuais com pessoas com IST/HIV. A menor probabilidade de realização do teste anti-HIV foi associada ao parceiro estável e a maior ao conhecimento dos locais de acesso ao teste e conhecimento da profilaxia pós-exposição. Entre os que conheciam a profilaxia pré-exposição (375), 46,1% estavam dispostos a recebê-la, 1,3% já haviam recebido. Conclusões: a persistência de situações de discriminação e violência contra gays/HSH requer ações mais efetivas de promoção de direitos. É necessário integrar inovações biomédicas na prevenção que se complementem e se fortaleçam para o controle da epidemia. A utilização de uma pesquisa online foi eficiente no recrutamento, embora com vieses de seleção, o que desafia a melhorar essa estratégia metodológica.

Othering discourse and stigma amidst the identity formation process among gays, bisexuals and other men who have sex with men on HIV pre-exposure prophylaxis (PrEP) / Discurso do Outro e estigma no processo de formação de identidade entre gays, bissexuais e outros homens que fazem sexo com homens que utilizam a profilaxia pré-exposição ao HIV (PrEP)

Abstract With the global emergence of the HIV pre-exposure prophylaxis (PrEP), questions have emerged on which ways the social identity formation process among gays, bisexuals and other men who have sex with men on PrEP arise and constitute beyond exclusive sexual orientation expressions. We conducted a content analysis with thematic categories in a PrEP online group guided by group-web affiliation and individualization approaches. Individuals identify themselves as PrEPsters as part of a PrEP club, while dealing with conflicts on serosorting sexual partners and stigmatizing reactions towards people living with HIV/AIDS (PLWH). Self-worth and othering discourses towards PLWH emerged as complex themes in men's production of identity processes across four overlapping domains: (1) self-worth as a strategy to challenge individual HIV-acquisition-related anxiety and fear, (2) group-worth and group empowerment, (3) body control and reclaiming power on sexual health, and (4) othering discourses, HIV/AIDS stigma and criminalization of PLWH. Paradoxically, internal and external discourses to the group constitute and challenge identity differentiation; individuals on PrEP claim to fight against the HIV/AIDS stigma, while this reverberates alongst HIV-related discriminatory expressions in their discourses.

Resumo Com o avanço global da Profilaxia Pré-exposição ao HIV (PrEP) questões sobre a formação do processo (bio)identitário de gays, bissexuais e outros homens que fazem sexo com homens usuários de PrEP complexificam-se para além de expressões de orientação sexual. Realizamos uma análise de conteúdo com categorias temáticas em um grupo online de usuários de PrEP orientada por abordagens de redes sociais e individualização social. Os indivíduos veem-se como PrEPsters como parte de um clube de PrEP, enquanto lidam com conflitos nas relações sexuais soro-discordantes. Discursos de autovalorização e de estigma contra pessoas que vivem com HIV/Aids (PVHA) surgiram como temas complexos na produção dos processos de identidade em quatro domínios interconectados: (1) autovalorização como uma estratégia para minorar ansiedade e o medo relacionados à aquisição de HIV, (2) valorização de grupo e expressões de empoderamento individual, (3) controle do corpo e poder de decisão sobre saúde sexual, e (4) discursos de diferenciação, estigma e criminalização das PVHA. Paradoxalmente, discursos internos e externos ao grupo constituem e desafiam a diferenciação de identidade; indivíduos em PrEP afirmaram lutar contra o estigma do HIV/Aids, enquanto reproduzem expressões discriminatórias relacionadas a HIV/Aids em seus discursos.

Clinical application value of human papillomavirus typing combined with cervical thin-prep cytology test in cervical cancer screening / 上海预防医学

Objective To explore the clinical value of the third-generation hybrid capture nucleic acid detection technology （DH3） typing detection of human papillomavirus （HPV） combined with thin-prep cytology test （TCT） in screening cervical cancer. Methods A total of1 582 female patients who received HPV and TCT cervical screening in Liuzhou Workers Hospital， Fourth Affiliated Hospital of Guangxi Medical University， from October 2020 to March 2021， were selected for this retrospective analysis. The cervical histopathological diagnosis was used as the gold standard to evaluate the diagnosis accuracies of HPV and TCT test results. Results Among the 1 582 patients， 334 were positive for HPV and 1 248 were negative； 234 were positive for TCT and 1 348 were negative； 180 were positive for histopathological diagnostic and 1 402 were negative. The sensitivity of HPV detection was 100%， the positive predictive value was 53.9%， the specificity was 89.0%， and the negative predictive value was 100.0%. In the HPV typing test， the positive rate for high-risk types 16/18 was 94.8%， and the positive rate for other 12 high-risk types was 73.8%. There was a little difference between TCT test and pathological test， and the detection consistency rate of high-grade squamous intraepithelial lesions and squamous carcinoma was same. Conclusion HPV testing combined with TCT to screen cervical cancer can reduce the misdiagnosis rate by a single test. The classification test is helpful for the hierarchical management of patients， and has a high clinical value for examination triage and grade screening.

Impact of covid-19 on people living with HIV-1: care and prevention indicators at a local and nationwide level, Santo André, Brazil

ABSTRACT The world has been dealing with Aids for forty years, covid-19 accentuated societal inequalities and promoted a rupture in care and prevention, including for people living with HIV. We compiled official HIV indicators, analyzed the impact of covid-19 in Brazil, at São Paulo State (SP), and compared it to the municipality of Santo André (in the state of São Paulo), which adopted linkage/retention strategies to mitigate the impact of covid-19. From 2019 to 2020, suppression/adhesion rates remained stable. The number of new treatments decreased both in Brazil (-19.75%) and São Paulo (-16.44%), but not in Santo André, where 80% of new patients started treatment within 30 days from their first TCD4 test (70% in São Paulo and 64% in Brazil). However, PrEP dispensing increased during this period. The distribution of 2,820 HIV self-tests in Santo André lead to only one documented new HIV diagnosis linked to care. Synergistic strategies to swiftly diagnose and connect new cases, ensuring retention as well as rescuing missing patients deserve priority in the fight against HIV, especially in times of covid-19.

SARS-CoV-2 testing among patients and healthcare professionals in an HIV outpatient clinic in Brazil

ABSTRACT The COVID-19 pandemic in Brazil has been marked by high infection and death rates. The immune response generated by current vaccination might be influenced by previous natural infection, and baseline estimates may help in the evaluation of vaccine-induced serological response. We evaluated previous SARS-CoV-2 testing (RT-PCR), and performed rapid diagnostic tests (RDT) and high throughput electrochemiluminescence immunoassay (ECLIA) before vaccination among people living with HIV (PLWH), users of antiretroviral prophylaxis (PrEP/PEP), and healthcare professionals in an HIV outpatient clinic (HCP-HC). RDT was positive in 25.7% (95% CI: 19-33%) overall, 31.3% (95% CI : 18-45%) among PLWH, 23.7% (95% CI : 14-34%) in PrEP/PEP users and 21.4% (95% CI : 05-28%) in HCP-HC (p=0.548). Diagnostic RT-PCR testing was very limited, even for symptomatic individuals, and whereas all HCP-HC had one test perfomed, only 35% of the patients (PREP/PEP/PLWH) were tested (p<0.0001). Adequate monitoring of post-vaccination humoral response and breakthrough infections including those in asymptomatic cases are warranted, especially in immunologically compromised individuals.

Aceptabilidad a usar profilaxis pre-exposición para VIH en hombres gay y otros hombres que tienen sexo con hombres: indagación en LAMIS 2018 Chile / Acceptability of pre-exposure prophylaxis for HIV prevention among gay men and other men who have sex with men: analysis of LAMIS 2018-Chile

INTRODUCCIÓN: Chile enfrenta una reemergencia de la epidemia del VIH concentrada en hombres gay y otros HSH. La profilaxis pre exposición (PrEP) es una intervención biomédica que ha resultado ser efectiva en la prevención del VIH en el grupo de HSH. OBJETIVO: Estimar niveles de aceptabilidad del uso de PrEP en hombres gay y otros HSH participantes en estudio LAMIS 2018 - Chile, identificando características y factores asociados a la aceptabilidad del uso de PrEP. MATERIAL Y MÉTODOS: Estudio basado en datos de LAMIS-2018 Chile, encuesta transversal por internet dirigida a hombres gay, bisexual, trans y otros HSH. La submuestra de este estudio consiste en 3.976 participantes que se auto-reportaron ser VIH negativos o desconocer su estado serológico, quienes respondieron preguntas sociodemográficas, de comportamiento, sobre su aceptabilidad a usar PrEP y otros aspectos relacionados. Se realizó análisis bivariados y regresión logística multivariable para identificar los factores asociados a la aceptabilidad a usar PrEP. RESULTADOS Y DISCUSIÓN: Se identificó que 55,7% de la muestra reportó una alta aceptabilidad a usar la PrEP. La regresión logística multivariable mostró que tener relaciones sexuales sin condón (ORa = 1,67, IC 95% 1,42-1,97) y haber intentado usar PrEP (ORa = 1,99, IC 95% 1,41-1, 62) se asociaron positivamente a la aceptabilidad a usar PrEP mientras que tener una relación con pareja estable, se asoció negativamente. Se identificó una aceptabilidad a usar la PrEP relativamente alta en los participantes. No obstante, se hace necesario considerar intervenciones relacionada a aumentar el conocimiento y promover la demanda de la PrEP. Además, el presente estudio muestra la necesidad de considerar la participación de las organizaciones de la sociedad civil en su implementación, fenómenos emergentes y la pertinencia territorial.

BACKGROUND: Chile is facing a re-emergence of the HIV epidemic, concentrated among men who have sex with men (MSM). Pre-exposure prophylaxis (PrEP) is a biomedical intervention that effectively prevents HIV transmission among MSM. AIM: The study was designed to estimate acceptability of PrEP and identify factors associated with PrEP-related attitudes and behaviors among MSM using LAMIS 2018 - Chile study data. Methods: Data were taken from the LAMIS 2018 - Chile study, a cross-sectional study of gay, bisexual, transgender, and other MSM. Our subsample included 3976 participants with self-reported HIV-negative or unknown status who responded to sociodemographic questions and items related to PrEP. Bivariate analysis and multivariate logistic regression analysis were performed to identify factors associated with acceptability of PrEP. RESULTS AND DISCUSSION: A total of 55.7% of the sample reported high PrEP acceptability. Logistic regression indicated that engaging in sex without a condom (ORa = 1.67, IC 95% 1.42-1.97) and having previously used PrEP (ORa = 1.99, IC 95% 1.41-1.62) were associated with high acceptability to use PrEP, while having a stable partner was associated with low acceptability. The estimate of PrEP acceptability was relatively high among participants. However, interventions to increase awareness and promote demand for PrEP may be beneficial. Furthermore, this study demonstrates the need for non-governmental organizations to participate in such strategies and for measures that address regionally-relevant emerging phenomena.

High acceptability of PrEP teleconsultation and HIV self-testing among PrEP users during the COVID-19 pandemic in Brazil

ABSTRACT In March 2020, telemedicine and HIV self-testing were adopted by Brazilian Public Health services to minimize disruptions in pre-exposure prophylaxis (PrEP) access and delivery during the COVID-19 pandemic. To understand the acceptability of PrEP teleconsultation and HIV self-testing, we conducted a web-based study during social distancing period (April-May, 2020) among men who have sex with men and transgender/non-binary individuals using social media. Out of the 2375 HIV negative respondents, 680 reported PrEP use and were included in this analysis. Median age was 33 years (IQR: 28-40), 98% cisgender men, 56% white, 74% high education, and 68% middle/high income. Willingness to use HIVST was 79% and 32% received an HIV self-testing during social distancing period. The majority reported preference for PrEP/HIV self-testing home delivery instead of collecting at the service. PrEP teleconsultation was experienced by 21% and most reported feeling satisfied with the procedures. High acceptability of PrEP teleconsultation was reported by 70%. In ordinal logistic model, having higher education was associated with high aceptability of PrEP teleconsultation (aOR:1.62; 95%CI: 1.07-2.45). Our results point out that PrEP teleconsultation and PrEP/HIV self-testing home delivery could be implemented by PrEP services in Brazil to avoid PrEP shortage during the COVID-19 pandemic and thereafter as an option to increase retention and adherence.

Forensic Application of ForenSeqTM DNA Signature Prep Kit in Zhengjiang She Ethnic Group / 法医学杂志

OBJECTIVES@#To evaluate the ability of the ForenSeqTM DNA Signature Prep kit (ForenSeq kit) in analyzing the sequence information of STRs in Zhejiang She ethnic group and its forensic application efficacy.@*METHODS@#A total of 50 Zhejiang She ethnic group samples were sequenced with the ForenSeq kit on the MiSeq FGx platform. The data was analyzed using ForenSeqTM universal analysis software to obtain the motif structure and flank regions of the 58 STRs, then compared with PCR-CE typing results to test the consistency. At last, the allele frequency and population genetic parameters were calculated.@*RESULTS@#A total of 448 sequence polymorphic alleles were detected in 50 samples of Zhejiang She ethnic group. Compared with fragment length polymorphism detected by PCR-CE, 82 alleles were increased by MPS detection based on ForenSeq kit, and 7 SNPs variation were detected in the flanking regions of 6 loci. The 22 male individuals were genotyped, and total 19 haplotypes were detected in 24 Y chromosome STRs of these 22 males. The cumulative discrimination power of the 27 autosomal STRs was 1-8.87×10-30, the cumulative probability of exclusion of duo-testing was 0.999 999 962 640 657, the cumulative probability of exclusion of trios-testing was 0.999 999 999 999 633.@*CONCLUSIONS@#Based on MPS typing technology, using the ForenSeq kit greatly improves the detection efficiency. In addition, the 58 STRs have good genetic polymorphisms in Zhejiang She ethnic group, which are suitable for individual identification and paternity identification in forensic application.

Telemedicine as a tool for PrEP delivery during the COVID-19 pandemic in a large HIV prevention service in Rio de Janeiro-Brazil

Abstract COVID-19 public health responses such as social distancing and community containment measures protocols are critical to preventing and containing the spread of coronavirus. Brazil accounts for almost half of Latin American HIV cases and Rio de Janeiro is the city with the second largest number of AIDS. Clinical appointments and pharmacy antiretroviral refills may be impaired due to restricted traffic and possible lockdowns, preventing people living with HIV and those using PrEP from accessing needed antiretrovirals. We hereby describe the telemedicine procedures implemented in a large PrEP delivery service in Rio de janeiro in the context of the COVID-19 pandemic. At the initial teleconsultation, individuals undergoe HIV rapid testing and are assessed by phone for PrEP related procedures. Individuals receive a digital prescription to retrieve a 120-day PrEP supply plus two HIV self-test kits. Subsequent follow-up teleconsultations will be performed remotely by phone call, including instructions for the HIV self-test performance, which results are to be sent using a digital picture. Participants will attend the service only for PrEP refill. The use of telemedicine procedures is being effective to avoid PrEP shortage and reduce the time PrEP users spend at the service during the COVID-19 pandemic and social distancing recommendations.

Responsabilidade, consentimento e cuidado. Ética e moral nos limites da sexualidade / Responsibility, consent and care. Ethics and morals at the limits of sexuality / Responsabilidad, consentimiento y cuidado. Ética y moral en los límites de la sexualidad

Resumo Neste artigo pretendo apresentar alguns dos resultados de uma pesquisa de pós- -doutoramento, na qual acompanhei grupos virtuais e encontros presenciais de interlocutores adeptos de práticas sexuais tidas como "de risco", tais como o sexo bareback, em eventos exclusivos para homens cisgêneros. O objetivo aqui é analisar um certo regime de regulação ético-moral percebido em campo relativo à preocupação de se afirmar que essas práticas sexuais partem de valores como a "responsabilidade", o "consentimento" e o "cuidado". Nas dinâmicas observadas, esses valores se (re)constroem e fissuram a partir do atravessamento de elementos diversos como drogas e medicamentos, além de diversos tensores libidinais. É sobre a produção contextual desses conceitos e a sua relação frente às atuais políticas pública de prevenção que pretendo me debruçar no artigo.

Abstract This article presents some results of a postdoctoral research, in which I followed virtual groups and face-to-face meetings of interlocutors engaging at sexual practices considered "risky", such as bareback sex, in events exclusive for cisgender men. The objective here is to analyze a certain regime of ethical-moral regulation perceived in the fieldwork regarding a concern to assign to these sexual practices values such as "responsibility", "consent" and "care". In the observed dynamics, these values are (re)constructed and fissured at the intersection of diverse elements such as drugs and medications, in addition to several libidinal tensors. This article addresses these concepts contextual production and their relation to current public prevention policies.

Resumen En este artículo tengo la intención de presentar algunos de los resultados de una investigación posdoctoral, en la que seguí grupos virtuales y reuniones cara a cara de interlocutores que eran expertos en prácticas sexuales consideradas "en riesgo", como el sexo a pelo, en eventos exclusivos para hombres cisgénero. El objetivo aquí es analizar un cierto régimen de regulación ético-moral percibido en el campo con respecto a la preocupación de afirmar que estas prácticas sexuales parten de valores tales como "responsabilidad", "consentimiento" y "cuidado". En la dinámica observada, estos valores se (re) construyen y descifran a través del cruce de diferentes elementos, como drogas y medicamentos, además de varios tensores libidinales. Se trata de la producción contextual de estos conceptos y su relación con las políticas actuales de prevención pública que pretendo abordar en el artículo.

Comparison of liquid-based cytology with conventional cytology in the evaluation of abdominal masses

Context: Liquid-based cytology. Aims: Utility of liquid-based cytology (LBC) was compared to conventional smear cytology in ultrasound-guided fine-needle aspirates of abdominal masses. Settings and Design: This was a prospective comparative study conducted in collaboration with surgery and pediatrics surgery departments of our institute. Subjects and Methods: Thirty patients presenting with evidence of abdominal mass were enrolled for the study and underwent fine-needle aspiration cytology. The material was processed for the preparation of conventional smears and residual material was rinsed into cytolyt for LBC by Thin Prep method and into cell block fluid. The smears prepared from both the methods were compared by two independent and experienced pathologists for adequacy, cellularity, architectural pattern, cytoplasmic preservation, nuclear preservation, and background. Results: Cellularity was frequently higher in the conventional smears than on Thin Prep slides (P value = 0.025). Recognition of architecture was better on the conventional smears (P value = 0.001). Cytoplasm was better preserved on the conventional smears (P value = 0.001) but difference in the preservation of nuclear details was not statistically significant on slides prepared from both the techniques. The background of Thin Prep slides is significantly cleaner than direct smears (P value = 0.001). Non epithelial elements such as mucin and neurofibrillary tangles were better preserved on direct smears (P value = 0.001) but diagnostic accuracy of both the methodologies showed no statistically significant difference (P value = 0.226). Conclusions: The Thin Prep technique utilizes expensive equipment and reagents. It also generates certain morphological artefacts in slides with which a cytologist needs to get familiar. When used in isolation, it may not consistently provide any added advantage in the diagnosis of such lesions and should be used as an adjunct to conventional smears. It may be preferred in situations where material has to be transported for processing or is required for ancillary tests.

O reaparecimento da homossexualidade masculina nas estratégias de prevenção da infecção por HIV: reflexões sobre a implementação da PrEP no Brasil / The male homosexuality reappearance in HIV infection prevention strategies: reflections on the PrEP implementation in Brazil

Resumo Este trabalho toma como ponto de partida o texto de Nestor Perlongher, intitulado "O desaparecimento da homossexualidade", que descreve um esvaziamento da identidade homossexual masculina com o surgimento da aids e propõe uma nova leitura a partir da implementação da profilaxia pré-exposição ao HIV (PrEP) pelo sistema público de saúde no Brasil. Distribuída a partir do início de 2018 e considerada como uma das mais novas medidas de prevenção ao HIV/aids, a PrEP se configura como um esquema antirretroviral de uso contínuo direcionado aos sujeitos que não foram infectados pelo vírus. Tomando como referência empírica o Protocolo Clínico de Diretrizes Terapêuticas para PrEP, identificamos como, a partir da noção de risco, a profilaxia possibilita o retorno da homossexualidade aos consultórios médicos e, mais do que isso, opera como objeto discursivo de problematizações de caráter sanitário e social. Diante disso, a PrEP produz uma nova categoria de homossexual, atrelada a tecnologias disciplinares e biopolíticas, que se apoiam na individualização e responsabilização dos indivíduos pelo cuidado de si.

Abstract This paper takes its starting point the text by Nestor Perlongher, entitled O desaparecimento da homossexualidade [The disappearance of homosexuality], depicting an emptying of male homosexual identity with the emergence of aids, and proposes a new reading about the pre-exposure prophylaxis (PrEP) implementation by the public health system in Brazil. Distributed from early 2018 and considered as one of the newest HIV/aids prevention measures, PrEP is a continuous antiretroviral therapy aimed for subjects who have not been infected with the virus. Taking as an empirical reference the Clinical Protocol of PrEP Therapeutic Guidelines, we identified how, from the notion of risk, prophylaxis enables the return of homosexuality to doctors' offices and, furthermore, operates as a discursive object of sanitary and social problematizations. Thus PrEP produces a new homosexual category, linked to disciplinary and biopolitical technologies, which rely on the individualization and accountability of individuals for self-care.

Profilaxis pre-exposición para la prevención de infección por VIH (PrEP) en mujeres de áreas vulnerables del conurbano de Buenos Aires / Pre-exposure prophylaxis for the prevention of HIV infection (PrEP) in women from vulnerable areas of the suburbs of Buenos Aires

Se describen una serie de casos desarrollados en la región oeste del conurbano bonaerense, en los cuales se presentaron situaciones de alto riesgo de infección por VIH, de modo de poder analizar y explorar el potencial uso de PrEP en mujeres como parte de la estrategia combinada de prevención. Si bien la eficacia de la PrEP está adecuadamente documentada, su implementación se encuentra demorada en la región. Las mujeres no parecen estar dentro de las poblaciones consideradas clave y por lo tanto son alejadas de esas estrategias. Incorporar el uso de PrEP en mujeres jóvenes con riesgo de infección puede contribuir al logro de los objetivos de control de la epidemia y evitar la transmisión vertical del VIH. La falta de un adecuado conocimiento y la baja percepción del riesgo de infección se describen como barreras para una implementación exito

A series of cases developed in the western region of Buenos Aires, in which there were situations of high risk of HIV infection, are described in order to analyze and explore the potential use of PrEP in women as part of the combined prevention strategy. Although the effectiveness of PrEP is well documented, its implementation is delayed in the region. Women do not seem to be within the considered key populations and therefore far from those strategies. Incorporating the use of PrEP in young women at risk of infection can contribute to the achievement of the objectives of epidemic control and avoid vertical transmission of HIV. The lack of adequate knowledge and the low perception of the risk of infection are described as barriers to a successful implementation. Keywords:

Pílulas diárias anti-HIV: a construção de uma narrativa antropológica sobre a Profilaxia de Pré-Exposição ao HIV (PrEP) / Daily anti-HIV drugs: the construction of an anthropological narrative on HIV Pre-Exposure Prophylaxis (PrEP)

Esta tese efetua uma análise antropológica sobre o fenômeno das Profilaxias Medicamentosas da Aids, em especial a PrEP (Profilaxia de Pré-Exposição ao HIV). O recorte incide sobre as narrativas hegemônicas em torno desta modalidade de prevenção sexual e a noção de sujeito subjacente às mesmas, bem como os fundamentos ideológicos dessa tecnologia, definida como uma "nova saída" preventiva do HIV. Foi empreendida uma análise documental de guias e diretrizes internacionais produzidas pela OMS e UNAIDS para a adoção global da PrEP, conjuntamente ao exame do protocolo brasileiro. Foram também realizadas entrevistas com atores-chave que participam ou participaram do processo de implementação nacional da PrEP. Os enunciados elaborados no âmbito das estratégias de escolha e legitimação da dita profilaxia foram descritos de modo a elucidar seu papel no processo, aqui definido como acirramento do individualismo contemporâneo. Tal feitio ocorre às expensas de determinados pressupostos centrais dos discursos preventivos e em meio a um contexto de biomedicalização da epidemia, quando são produzidas noções particulares de autonomia e gestão dos riscos e da sexualidade

This thesis presents an anthropological analysis on the Medical Prophylaxis of AIDS, in particular, the HIV Pre-Exposure Prophylaxis (PrEP). Regarding this studied object, our framework falls on hegemonic narratives concerning this mode of sexual prevention and its underlying notions of subject as well as the respective technology's fundamental ideologies. In this sense, such technology is defined as a new preventive solution for HIV infection. To achieve our conclusions, we undertake a documental analysis of international guidelines and policies from WHO and UNAIDS toward global adoption of PrEP, along with the Brazilian protocol. In addition, we conducted interviews with key actors who have performed a role in PrEP's implementation process in Brazil. Within the scope of HIV prophylaxis choice and legitimation strategies, we show the exacerbating ­ as we conclude ­ role played by the contemporary individualism. With specific notions of autonomy, risk control, and sexuality management at the core of it, this phenomenon occurs in the context of biomedicalization of the Aids epidemic at the expense of central assumptions in the preventive discourses

Factores asociados con la indicación de la profilaxis pre-exposición para HIV en médicos de Argentina / Associated factors with the indication for HIV prevention of pre-exposure prophylaxis for argentinian physicians

La profilaxis pre-exposición (PrEP) es una medida eficaz para la prevención de la transmisión del VIH. Con la implementación de la misma, algunos estudios señalan una reducción en la transmisión superior al 90%, cuando la adherencia es alta. Sin embargo, el uso de Emtricitabina/ Tenofovir alafenamida (FTC/TDF) en la Argentina aún no esta aprobado por las autoridades regulatorias. En profesionales de Argentina el conocimiento, aval y factores asociados con la prescripción de la PrEP no ha sido evaluada. Este es un estudio de corte transversal mediante una encuesta on line realizada en Agosto de 2017. La misma fue distrubuida entre profesionales de Argentina y valoró diferentes aspectos de la PrEP (conocimiento, aval e indicación de la misma). Los resultados obtenidos se expresaron en frecuencias y porcentajes. Para las asociaciones entre variables categóricas se realizó un análisis univariado (test de chi2 ) y de regresión logística binaria. Se consideró como significativo, un valor de p < 0.05. La encuesta fue realizada por 238 profesionales pertenecientes a 81 centros asistenciales. Los escenarios clínicos donde se observó mayor predisposición a la indicación de PrEP fueron: parejas discordantes (77%), trabajadores/as sexuales (61%), pacientes transgénero (32%), adictos a drogas intravenosas (31%), hombres que mantienen sexo con otros hombres (HSH) (23%). Los factores asociados con la prescripción de PrEP fueron: cargo asistencial de jefe de servicio (p<0.05), médicos especialistas en enfermedades infecciosas (p<0.05), atención de más de 200 pacientes seropositivos para el virus de la inmunodeficiencia humana (VIH) por año (p<0.009), prescripción previa de profilaxis post-exposición (p<0.008). Los autores concluyen señalando que, a pesar de no estar aprobado por los entes regulatorios, la PrEP ha sido prescripta off label por profesionales de Argentina. Entre ellos, aquellos que adoptaron la prescripción fueron los que mostraron mayor experiencia en la atención de pacientes VIH positivos, jefes/as de servicio y especialistas en infectología. Estos resultados podrían ser utilizados en un futuro para impulsar nuevas herramientas de prevención en la transmisión de VIH

Pre-exposure prophylaxis (PrEP) is an effective measure to prevent HIV transmission. If the adherence is high, transmission rates are reduced by more than 90%. In Argentina, FTC-TDF is not yet approved for PrEP by the local regulatory agency.  PrEP  awareness,  PrEP  adoption, and factors associated with adoption among argentine physicians had not been studied to date. We designed a cross-sectional online survey conducted in August 2017 among argentine physicians and valored differents items about PrEP, (knowledge, attitudes, and beliefs associated with adoption). Univariate analysis was performed; the associations between categorical variables were analyzed by means of the chi2  test. The level of significance was considered with p <0.05. A total of 238 surveys were received from 81 centers in Argentina. Clinical scenarios associated with the highest prescription were: serodiscordant couples 77%, sex workers 61%, transgender patients 32%, people who inject drugs 31%, and men who have sex with men (MSM) 23%. Factors associated with PrEP prescription between physicians were been chief of staff (p<0.05), been an infectious diseases specialist (p<0.05), assist more than 200 HIV seropositive patients per year (p<0.009) and having prescribed postexposure prophylaxis (PEP) (p<0.008). The authors concluded that in spite of not yet approved by the local regulatory agency, PrEP is been prescribed off- label by argentine physicians. Adopters were more likely to have experience providing HIV care, been chief of staff and ID specialist. These results could be used to plan future HIV prevention strategies in Argentina.