How the COVID-19 Pandemic Influenced HIV Care: Are We Prepared Enough for Future Pandemics? An Assessment of Factors Influencing Access, Utilization, Affordability, and Motivation to Engage with HIV Services amongst African, Caribbean, and Black Women.

The COVID-19 pandemic resulted in disruption in healthcare delivery for people living with human immunodeficiency virus (HIV). African, Caribbean, and Black women living with HIV (ACB WLWH) in British Columbia (BC) faced barriers to engage with HIV care services prior to the COVID-19 pandemic that were intensified by the transition to virtual care during the pandemic. This paper aims to assess which factors influenced ACB WLWH's access to, utilization and affordability of, and motivation to engage with HIV care services. This study utilized a qualitative descriptive approach using in-depth interviews. Eighteen participants were recruited from relevant women's health, HIV, and ACB organizations in BC. Participants felt dismissed by healthcare providers delivering services only in virtual formats and suggested that services be performed in a hybrid model to increase access and utilization. Mental health supports, such as support groups, dissolved during the pandemic and overall utilization decreased for many participants. The affordability of services pertained primarily to expenses not covered by the provincial healthcare plan. Resources should be directed to covering supplements, healthy food, and extended health services. The primary factor decreasing motivation to engage with HIV services was fear, which emerged due to the unknown impact of the COVID-19 virus on immunocompromised participants.

[Strategies for health services in women, newborns, children, and adolescents during the COVID-19 pandemic in countries of Americas]. / Estrategias de servicios de salud en mujeres, recién nacidos/as, niños/as y adolescentes durante la pandemia de COVID-19 en países de las Américas.

The article analyzes the perceived challenges and strategies implemented in five Latin American and Caribbean countries to ensure continuity of care and access to health services for women, newborns, children, and adolescents during the COVID-19 pandemic. The study corresponds to a quick assessment based on semi-structured interviews with key informants in countries selected by convenience: Colombia, Ecuador, Guatemala, Grenada, and the Dominican Republic. Interviews were conducted with 23 key informants: (a) decision makers at the national and/or subnational level, (b) healthcare professionals, and (c) representatives of civil society organizations; from December 2020 to January 2021. Among the findings, at the beginning of the pandemic, priority was given to the COVID-19 care, with measures to limit the flow of people to health facilities in the countries involved, closing or limiting outpatient visits and restricting care schedule. For women, this affected family planning services and access to contraceptive methods, implying a reduction in prenatal check-ups. As a result of this deinstitutionalization of care, among newborns, a decrease in pediatric check-ups, a decrease in timely immunization and late detection of pathologies or growth problems were reported. Among adolescents, a strong restriction of family planning services, the limitation of other friendly counseling spaces and difficulties in accessing contraceptives were observed.

El artículo analiza los desafíos percibidos y las estrategias implementadas en cinco países de América Latina y el Caribe para garantizar la continuidad de los cuidados y el acceso a servicios de salud de mujeres, recién nacidos/as, niños/as y adolescentes durante la pandemia por COVID-19. El estudio corresponde a una evaluación rápida basada en entrevistas semi-estructuradas a informantes clave de países seleccionados por conveniencia: Colombia, Ecuador, Guatemala, Granada y República Dominicana. Se realizaron entrevistas con 23 informantes clave: (a) referentes de la toma de decisión a nivel nacional y/o subnacional, (b) referentes de servicios de salud, y (c) representantes de organizaciones de la sociedad civil, durante diciembre de 2020 y enero de 2021. Entre los hallazgos, al inicio de la pandemia se priorizó la atención del COVID-19, con medidas para limitar la afluencia de personas a los establecimientos de salud en los países involucrados, procediendo al cierre o limitación de consultas externas y restricción de horarios de atención. Para las mujeres, esto impactó en los servicios de planificación familiar y el acceso a métodos anticonceptivos, e implicó una reducción de los controles prenatales. Por esta desinstitucionalización de la atención, entre recién nacidos/as fue reportada una disminución de los controles pediátricos, una disminución de su vacunación oportuna y una detección tardía de patologías o problemas de crecimiento. Entre adolescentes, se señaló una fuerte restricción de los servicios de planificación familiar, la limitación de otros espacios amigables de consejería y dificultades para acceder a anticonceptivos.

O artigo analisa os desafios observados e as estratégias implementadas em cinco países da América Latina e do Caribe para garantir a continuidade do atendimento e o acesso aos serviços de saúde para mulheres, recém-nascidos/as, crianças e adolescentes durante a pandemia de COVID-19. O estudo é uma avaliação rápida baseada em entrevistas semiestruturadas com informantes-chave em países selecionados por conveniência: Colômbia, Equador, Guatemala, Granada e República Dominicana. Foram realizadas entrevistas com 23 informantes-chave: (a) tomadores de decisão em nível nacional e/ou subnacional, (b) prestadores de serviços de saúde e (c) representantes de organizações da sociedade civil; durante dezembro de 2020 e janeiro de 2021. Entre as conclusões encontrou-se que, no início da pandemia, foi dada prioridade à COVID-19, com medidas para limitar o fluxo de pessoas às instalações de saúde nos países envolvidos, fechando ou limitando as consultas ambulatoriais e restringindo o horário de atendimento. Para as mulheres, a medida impactou os serviços de planejamento familiar e o acesso à contracepção, significando uma redução nos check-ups pré-natais. Como resultado desta desinstitucionalização dos cuidados, uma diminuição dos check-ups pediátricos, uma diminuição das vacinações no período correto e uma detecção tardia de patologias ou problemas de crescimento foram relatados entre os/as recém-nascidos/as. Entre os adolescentes, foi observada uma restrição severa dos serviços de planejamento familiar, a limitação de acesso a espaços de aconselhamento amigável e dificuldades de acesso a contraceptivos.

Repercussions of COVID-19 on psychiatric inpatient care in Latin America and the Caribbean.

OBJETIVE: To characterise the impact of the COVID-19 pandemic on psychiatric hospitalisations in the Latin American and Caribbean (LAC) region. METHODS: Descriptive study. 85 semi-structured interviews were conducted with health workers involved with psychiatric hospitalisations in general hospitals (GHs) and specialised psychiatric hospitals (SHs) from 18 LAC countries. The interviews were done between 8 May and 30 June 2020. The data were analysed quantitatively and qualitatively. RESULTS: An initial decrease in the demand for hospitalisation is reported, attributed to the population's fear of approaching health services as well as restrictions on mobility. Stricter criteria for hospitalisation were reported with a double focus on the acute within the acute. The length of hospitalisations were mixed, with both increases and decreases in GHs and SHs. The therapeutic offer was drastically reduced, and interaction between hospitalised people and their support networks was restricted. CONCLUSIONS: In the COVID-19 context, hospitalisation seems to be not the last but the only alternative for psychiatric treatment. The decrease in the number of beds in SHs could be a positive aspect for the reform of psychiatric care, but it is questioned since this reduction also occurs in GHs.

Monitoring of SARS-CoV-2 RNA in wastewater: A surveillance tool to foresee infection's evolution in the Mexican Caribbean.

The study aims to determine SARS-CoV-2 RNA in sewage of Cancun wastewater treatment plants, the main touristic destination of Mexico, and to estimate the infected persons during the sampling period. SARS-CoV-2 RNA traces were detected in the inlet of the five plants during almost all the sampling months. However, there is no presence of SARS-CoV-2 RNA traces in the effluent of the five WWTPs during the study period. ANOVA analysis showed differences in the concentrations of RNA traces of SARS-CoV-2 between the sample dates, but no differences were found from one WWTP to another. Estimated infected individuals by Markov chain Monte Carlo simulation are higher (between 77% and 91%) than the cases reported by the health authority. Wastewater monitoring and the estimation of infected individuals are a helpful tool, because estimation provides early warning signs on how broadly SARS-CoV-2 is circulating in the city, and led to the authorities to take measures wisely. PRACTITIONER POINTS: There is no presence of SARS-CoV-2 RNA traces in the effluent of the facilities, suggesting the effectiveness of treatment. Surveillance of viral RNA concentrations at treatment plants revealed presence in the influent of five plants Estimated infected individuals by MCMC simulation are higher than cases reported by health authority Environmental surveillance approach in wastewater influent is helpful to identify the clusters and to take informed decisions.

A selectivity index for public-private partnership projects in the urban water and sanitation sector in Latin America and the caribbean.

The rapid urban development, the Agenda 2030, the climate change adaptation and the COVID 19 crisis highlight the need to increase investment in public infrastructure and improve water supply and sanitation services. For this, an alternative to traditional public procurement is the participation of the private sector under the public-private partnership (PPP) model. The objective of this article is to develop a tool based on critical success factors (CSFs) that allows for evaluation during early stages of the convenience of developing a PPP project for W&S in urban areas of Latin America and the Caribbean. The index was developed based on literature review (779 variables), review of cases (20 variables) and expert opinion to assign them an estimated value of importance. The results were analysed by exploratory and confirmatory factor analysis, selecting 17 main variables grouped into 6 CSFs, the most relevant of which are Convenience, Certainty, Leadership, Attraction, Performance and Reliability. The application of this index allows an early assessment of the feasibility of a PPP project and/or the selection of the alternatives with the best chances of success. On the other hand, this study contributes to the international discussion on the most relevant elements related to the success of PPP in W&S projects.

A comprehensive review of viruses in terrestrial animals from the Caribbean islands of Greater and Lesser Antilles.

Viruses pose a major threat to animal health worldwide, causing significant mortalities and morbidities in livestock, companion animals and wildlife, with adverse implications on human health, livelihoods, food safety and security, regional/national economies and biodiversity. The Greater and Lesser Antilles consist of a cluster of islands between the North and South Americas and is habitat to a wide variety of animal species. This review is the first to put together decades of information on different viruses circulating in companion animals, livestock and wildlife from the Caribbean islands of Greater and Lesser Antilles. Although animal viral diseases have been documented in the Caribbean region since the 1940s, we found that studies on different animal viruses are limited, inconsistent and scattered. Furthermore, a significant number of the reports were based on serological assays, yielding preliminary data. The available information was assessed to identify knowledge gaps and limitations, and accordingly, recommendations were made, with the overall goal to improve animal health and production, and combat zoonoses in the region.

Health and economic benefits of achieving contraceptive and maternal health targets in Small Island Developing States in the Pacific and Caribbean.

INTRODUCTION: Reducing unmet need for modern contraception and expanding access to quality maternal health (MH) services are priorities for improving women's health and economic empowerment. To support investment decisions, we estimated the additional cost and expected health and economic benefits of achieving the United Nations targets of zero unmet need for modern contraceptive choices and 95% coverage of MH services by 2030 in select Small Island Developing States. METHODS: Five Pacific (Kiribati, Samoa, Solomon Islands, Tonga and Vanuatu) and four Caribbean (Barbados, Guyana, Jamaica and Saint Lucia) countries were considered based on population survey data availability. For each country, the Lives Saved Tool was used to model costs, health outcomes and economic benefits for two scenarios: business-as-usual (BAU) (coverage maintained) and coverage-targets-achieved, which scaled linearly from 2022 (following COVID-19 disruptions) coverage of evidence-based family planning and MH interventions to reach United Nations targets, including modern contraceptive methods and access to complete antenatal, delivery and emergency care. Unintended pregnancies, maternal deaths, stillbirths and newborn deaths averted by the coverage-targets-achieved scenario were converted to workforce, education and social economic benefits; and benefit-cost ratios were calculated. RESULTS: The coverage-targets-achieved scenario required an additional US$12.6M (US$10.8M-US$15.9M) over 2020-2030 for the five Pacific countries (15% more than US$82.4M to maintain BAU). This additional investment was estimated to avert 126 000 (40%) unintended pregnancies, 2200 (28%) stillbirths and 121 (29%) maternal deaths and lead to a 15-fold economic benefit of US$190.6M (US$67.0M-US$304.5M) by 2050. For the four Caribbean countries, an additional US$17.8M (US$15.3M-US$22.4M) was needed to reach the targets (4% more than US$405.4M to maintain BAU). This was estimated to avert 127 000 (23%) unintended pregnancies, 3600 (23%) stillbirths and 221 (25%) maternal deaths and lead to a 24-fold economic benefit of US$426.2M (US$138.6M-US$745.7M) by 2050. CONCLUSION: Achieving full coverage of contraceptive and MH services in the Pacific and Caribbean is likely to have a high return on investment.

Latin America and the Caribbean SARS-CoV-2 Surveillance: Longitudinal Trend Analysis.

BACKGROUND: The COVID-19 pandemic has placed unprecedented stress on economies, food systems, and health care resources in Latin America and the Caribbean (LAC). Existing surveillance provides a proxy of the COVID-19 caseload and mortalities; however, these measures make it difficult to identify the dynamics of the pandemic and places where outbreaks are likely to occur. Moreover, existing surveillance techniques have failed to measure the dynamics of the pandemic. OBJECTIVE: This study aimed to provide additional surveillance metrics for COVID-19 transmission to track changes in the speed, acceleration, jerk, and persistence in the transmission of the pandemic more accurately than existing metrics. METHODS: Through a longitudinal trend analysis, we extracted COVID-19 data over 45 days from public health registries. We used an empirical difference equation to monitor the daily number of cases in the LAC as a function of the prior number of cases, the level of testing, and weekly shift variables based on a dynamic panel model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R. COVID-19 transmission rates were tracked for the LAC between September 30 and October 6, 2020, and between October 7 and 13, 2020. RESULTS: The LAC saw a reduction in the speed, acceleration, and jerk for the week of October 13, 2020, compared to the week of October 6, 2020, accompanied by reductions in new cases and the 7-day moving average. For the week of October 6, 2020, Belize reported the highest acceleration and jerk, at 1.7 and 1.8, respectively, which is particularly concerning, given its high mortality rate. The Bahamas also had a high acceleration at 1.5. In total, 11 countries had a positive acceleration during the week of October 6, 2020, whereas only 6 countries had a positive acceleration for the week of October 13, 2020. The TAC displayed an overall positive trend, with a speed of 10.40, acceleration of 0.27, and jerk of -0.31, all of which decreased in the subsequent week to 9.04, -0.81, and -0.03, respectively. CONCLUSIONS: Metrics such as new cases, cumulative cases, deaths, and 7-day moving averages provide a static view of the pandemic but fail to identify where and the speed at which SARS-CoV-2 infects new individuals, the rate of acceleration or deceleration of the pandemic, and weekly comparison of the rate of acceleration of the pandemic indicate impending explosive growth or control of the pandemic. Enhanced surveillance will inform policymakers and leaders in the LAC about COVID-19 outbreaks.

Current status of nuclear cardiology practice in Latin America and the Caribbean, in the era of multimodality cardiac imaging approach: 2022 update.

Cardiovascular diseases (CVDs) are the leading cause of mortality in Latin America and the Caribbean (LAC), with the risk in men being slightly higher than in women. The coronavirus disease 2019 (COVID-19) pandemic caused a significant reduction in the number of cardiac diagnostic procedures globally and in particular in LAC. Nuclear cardiology is available in the region, but there is variability in terms of existing technology, radiopharmaceuticals, and human resources. In the region, there are 2385 single photon emission computed tomography (SPECT) and 315 PET scanners, Argentina and Brazil have the largest number. There is an increasing number of new technologies such as cadmium-zinc-telluride (CZT) cardiac-dedicated gamma cameras, SPECT/computed tomography (CT), and PET/CT. All countries performed myocardial perfusion imaging studies, mainly gated-SPECT; the rest are multi-gated acquisition, mainly for cardiac toxicity; detection of viability; rest gated SPECT in patients with dilated cardiomyopathy, and bone-avid tracer cardiac scintigraphy for transthyretin cardiac amyloidosis diagnosis. Regarding other non-nuclear cardiac imaging modalities, Argentina, Colombia, and Chile have the highest ratio of CT scanners, while Brazil, Argentina, and Chile show the highest ratio of MRI scanners. The development of nuclear cardiology and other advanced imaging modalities is challenged by the high cost of equipment, lack of equipment maintenance and service, insufficient-specific training both for imaging specialists and referring clinicians, and lack of awareness of cardiologists or other referring physicians on the clinical applications of nuclear cardiology. Another important aspect to consider is the necessity of implementing cardiac imaging multimodality training. A joint work of nuclear medicine specialists, radiologists, cardiologists, and clinicians, in general, is mandatory to achieve this goal. National, regional, and international cooperation including support from scientific professional societies such as the American Society of Nuclear Cardiology and Latin American Association of Biology and Nuclear Medicine Societies, cardiological societies, and organizations such as the International Atomic Energy Agency, and Pan American Health Organization, as well as government commitment are key factors in the overall efforts to tackle the burden of cardiovascular diseases in the region.

Environmental risks due to the presence of microplastics in coastal and marine environments of the Colombian Caribbean.

Microplastics (MPs) are plastic sediments that are released into the environment by various sources, their abundance and distribution increase as their size decreases, they represent a risk to ecological processes and their abundance is related to their proximity to human activities and The Anthropocene era, in addition to the Covid-19 pandemic, has exacerbated the emitting sources of plastics such as face masks, disinfectant container bottles, among others, all due to all the biosafety measures required globally. Over time, the transformation of plastics into microplastics generates particles transported by atmospheric and water dynamics, being accumulated in soils, bodies of water and incorporated into ecosystems and the food chains of organisms, including humans. Marine-coastal environments such as coastal lagoons, which in addition to hosting strategic ecosystems, being areas of convergence of different ecological flows and with important ecosystem services, have also become sinks for MP particles, putting their productivity and value at risk. Socio-ecological that they have. The purpose of this research is to evaluate and zone the environmental risks derived from contamination by microplastics in a coastal lagoon system, since once the MPs enter the environment they can cause harmful effects, in this case in the Caribbean Sea and in the lagoon complex. To this end, a comprehensive study of planetary systems was carried out to better understand their disturbances due to the presence of microplastics.

Mixed-methods implementation study of a virtual culturally tailored diabetes self-management programme for African and Caribbean communities (HEAL-D) in south London and its scaling up across NHS regions in England: study protocol.

INTRODUCTION: The National Health Service Insight Prioritisation Programme was established to accelerate the implementation and evaluation of innovation that supports post-pandemic working. Supporting this, the Academic Health Science Network and National Institute for Health and Care Research Applied Research Collaboration in South London are testing and evaluating the implementation and scale-up of a type 2 diabetes (T2D) intervention.T2D is estimated to be three times more prevalent in UK African and Caribbean communities than in white Europeans. To tackle ethnic inequities in T2D healthcare access, an evidence-based, culturally tailored self-management and education programme for African and Caribbean adults (Healthy Eating & Active Lifestyles for Diabetes, HEAL-D) has been codeveloped with people with lived experience. Initially a face-to-face programme, HEAL-D pivoted to virtual delivery in response to COVID-19.The purpose of this study is to explore the (1) feasibility and acceptability of a virtual delivery model for HEAL-D in south London and (2) factors affecting its scale-up across other areas in England. METHODS AND ANALYSIS: The study will have two strands: (1) mixed-methods prospective evaluation of HEAL-D virtual delivery in south London using routinely collected service-level data, service delivery staff and service user interviews and observations; and (2) prospective qualitative study of the scale-up of this virtual delivery comprising interviews and focus groups with members of the public, and diabetes services commissioners and providers across England. Qualitative data will be analysed using thematic analysis. Quantitative analysis will use descriptive statistics and reporting summary tables and figures. The study will be grounded in well-established implementation frameworks and service user involvement. ETHICS AND DISSEMINATION: 'Minimal Risk Registration' ethical clearance was granted by King's College London's Research Ethics Office (ref: MRA-21/22-28498). Results will be published in a peer-reviewed journal and summaries provided to the study funders and participants.

Prevalence and factors associated with not receiving the booster dose of the COVID-19 vaccine in adults in Latin America and the Caribbean.

BACKGROUND: Booster doses have been described as effective in reducing hospitalizations and deaths from the new variants. However, its coverage is heterogeneous in Latin America and the Caribbean (LAC), one of the regions most affected by the pandemic. We aimed to assess the factors associated with not receiving a coronavirus disease 2019 (COVID-19) vaccine booster dose in adults from LAC. METHODS: We analyzed a secondary database compiled by the University of Maryland and Facebook assessing the global impact of COVID-19. We included Facebook users over 18 years of age who resided in LAC and responded to the survey between February 13, 2022, and March 14, 2022. We evaluated sociodemographic characteristics, comorbidities, food, and economic insecurity, mental health, and vaccination-related practices. We calculated crude (cPR) and adjusted (aPR) prevalence ratios with their respective 95% confidence intervals (95%CI). RESULTS: The sample included 154,841 adults from 20 LAC countries. 33.7% (n = 46,459) reported not receiving the COVID-19 booster vaccine. Being under 75 years old, having a college, high school, pre-university, primary, or lower education, having no or 1 to 2 comorbidities, living in a town, having food insecurity, depressive symptoms, and having had COVID-19, were associated with a higher prevalence of not receiving the booster dose. In contrast, being female or non-binary and having anxiety symptoms were associated with a lower prevalence of not receiving the booster dose. CONCLUSIONS: Approximately three out of 10 adults surveyed in LAC reported not having received the booster vaccine. Authorities must design campaigns that promote receiving a booster dose considering the factors found.

Impact of Social Support on Perceived Stress in Latin American and Caribbean Dental Students and Dental Practitioners during Mandatory Social Isolation within the Coronavirus Pandemic in 2020.

OBJECTIVE: To determine the impact of social support on perceived stress in Latin American and Caribbean dental students and dental practitioners during mandatory social isolation within the coronavirus (COVID-19) pandemic in 2020. METHODS: A cross-sectional study was conducted with a sample of 1812 dental students and dental practitioners from 21 Latin American and Caribbean countries. Perceived stress was assessed using the perceived stress scale (PSS-14), and the influence of social support was addressed using the Duke-UNC-11. Additionally, sociodemographic variables, knowledge of and preventive behaviour against COVID-19 and health status were considered. A descriptive, bivariate and multivariate analysis was performed through multiple linear regression. RESULTS: In the multivariate analysis, model 4 presented R2% = 21.20 (P < 0.001), a constant of 40.049; within the model, the social support variable had a non-standardised regression coefficient (b) of -4,527 (95% CI - 5.646 to -3,408; P < 0.001), the self-perceived level of concern regarding COVID-19 was b = 1.838 (95% confidence interval [CI] 0.887 to 2.790; P < 0.001), the self-perceived health status was b = -2.191(95% CI -2.944 to -1.437; P < 0.001), the number of days in compulsory isolation was b = -0.965 (95% CI -1.908 to -0.022; P = 0.045), while the level of confinement was b = 0.923 (95%CI: 0.106-1.740; P = 0.027), age was b = -1.743 (95% CI -2.625 to -0.860; P < 0.001), sex was b = 1.324 (95% CI 0.311 to 2.337; P = 0.011) and the economic income level was b = -1.539 (95% CI -2.434 to -0.644; P = 0.001). CONCLUSION: An association was determined between perceived stress and social support, as well as the variables of concern about the disease, self-perceived health status, number of days and level of confinement, age, sex and economic income level, based on the experience of dental practitioners and dental students in mandatory isolation.

Prevalence and Factors Associated with Gaming Disorder in Latin America and the Caribbean: A Systematic Review.

We aimed to determine the prevalence and factors associated with gaming disorder (GD) in the population of Latin America and the Caribbean (LAC). A systematic review was performed (PROSPERO protocol registration: CRD42021230565). We included studies that identified participants with GD and/or factors associated with this condition, reported the prevalence of GD, or contained data that assisted in its estimation, were published after 2013 (the year of inclusion of GD in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders) and were carried out in a population residing in an LAC country. Evaluation of the quality of the studies was carried out using the Joanna Briggs Institute Critical appraisal checklist tool. A qualitative synthesis of the data was performed. Of the total of 1567 records identified, 25 passed the full-text review phase, and 6 met the selection criteria. These studies were published between 2018 and 2021 and had a cross-sectional design (three in Brazil, one in Ecuador, Mexico, and the other was multi-country, including a LAC country [Peru]). The prevalence of GD ranged from 1.1% to 38.2%. The three studies in Brazil had the highest figures of GD prevalence (20.4-38.2%). Four studies evaluated factors associated with GD. Characteristics regarding the game (type), pattern of use (hours played), as well as gender (higher in men), tobacco and alcohol consumption, poor interpersonal relationships, and the presence of mental disorders were found to be associated with GD in LAC. Evidence on the prevalence and factors associated with GD in LAC is limited. Studies on GD in LAC evaluate different population subgroups, describing a wide prevalence of this condition (present in up to 38 out of 100 evaluated). Characteristics such as the type and hours of use of the games, sociodemographic data, lifestyles, interpersonal relationships, and the presence of mental disorders increase the probability of presenting GD.

Acceptance towards COVID-19 vaccination in Latin America and the Caribbean: A systematic review and meta-analysis.

INTRODUCTION: Vaccination represents an important strategy to mitigate COVID-19 related morbidity and mortality by protecting against severe forms of the disease and reducing hospitalization and death rates. In this sense, the objective of this study is to estimate the prevalence of Vaccination Intention (VI) against COVID-19 in Latin America and Caribbean (LAC). METHODS: We conducted a systematic review with a comprehensive search strategy for the following databases: PubMed, Scopus and Web of Science. A random-effect model meta-analysis was carried out using observational studies assessing the intention to vaccines against COVID-19 in LAC countries. The Clopper-Pearson method was used to estimate 95% Confidence Intervals. The quality assessment was developed using the Newcastle-Ottawa Scale adapted for cross-sectional studies. A subgroup analysis by study location and a sensitivity analysis were developed. RESULTS: Nineteen cross-sectional studies were included. Five meta-analyzes were performed according to the target population of the included studies. The VI in the general population of LAC was 78.0% (95%CI: 74.0%-82.0%). The VI for non-pregnant women was 78.0% (95%CI: 58.0%-99.0%), for elderly population was 63.0% (95%CI: 59.0%-69.0%), for pregnant women was 69.0% (95%CI: 61.0%-76.0%) and for health-personnel was 83.0% (95% CI: 71.0%-96.0%). The sensitivity analysis for general population meta-analysis that included only low risk of bias studies showed a 77.0% VI (95%CI: 73.0%-82.0%) and for non-pregnant women, 85.0% VI (95%CI: 79.0%-90.0%). CONCLUSION: Despite the high prevalence of VI in general population found in our study, VI prevalence from elderly people and pregnant women are lower than other population groups and overall population.