ABSTRACT
OBJECTIVE: The TB/HIV in Rio (THRio) study was launched in September 2005 to assess the impact of integrated tuberculosis (TB) and HIV treatment strategies in 29 HIV clinics in Rio de Janeiro, Brazil. DESIGN: THRio is a cluster-randomized trial (CRT) to determine whether routine screening for and treatment of latent TB in HIV clinic patients with access to antiretroviral therapy will reduce TB incidence at the clinic level. THRio is part of the Consortium to Respond Effectively to AIDS/TB Epidemic that is implementing research studies to assess the impact of bold, new public health paradigms for controlling the AIDS/TB epidemic. METHODS: Twenty-nine public primary HIV clinics were randomly assigned a date to begin implementing TB screening procedures and provision of isoniazid preventive therapy (IPT) for TB/HIV coinfected patients. Final analysis of the CRT is expected in 2011. RESULTS: Starting at date of tuberculin skin test (TST)/IPT implementation at each clinic through August 2010, 1670 HIV-infected patients initiated IPT, of which 215 are still receiving treatment. Of the remaining 1455 patients, 1230 (85%) completed therapy and only 20 (1.2%) patients initiating IPT reported adverse reactions leading to discontinuation of therapy. IPT completion was higher among HIV-infected patients receiving HAART (87%) than those not yet receiving HAART (79%, P < 0.01). Times to TST and IPT have markedly decreased postintervention, but remain considerably long. The richness of the THRio database has resulted in several analyses of this expansive cohort of HIV-infected patients that are reviewed here. CONCLUSIONS: The national implementation of TST and IPT for HIV-positive patients in Brazil has been invigorated partly due to THRio's baseline results. Expanded use of IPT in HIV patients in Rio de Janeiro is achievable with high adherence and low adverse events, although this effort requires a package of activities including training, advocacy and reorganization of services.
Subject(s)
Antitubercular Agents/therapeutic use , Delivery of Health Care, Integrated/organization & administration , HIV Infections/drug therapy , HIV-1 , Isoniazid/therapeutic use , Tuberculosis/drug therapy , Brazil/epidemiology , Delivery of Health Care, Integrated/standards , Female , HIV Infections/epidemiology , Humans , Incidence , Male , Tuberculosis/epidemiology , Viral LoadABSTRACT
Busca compreender as implicações éticas da oferta do teste rápido anti-HIV a gestantes em trabalho de parto. Interessou-nos conhecer os fatores que teriam influenciado as políticas públicas de saúde na escolha de determinadas estratégias para a prevenção da transmissão do vírus da AIDS, da mulher para o bebê, durante a gravidez e, particularmente, durante o trabalho de parto. Embora lançando mão de ferramentas utilizadas pela teoria principialista, nossa abordagem incorporou elementos da bioética de inspiração feminista. Assim, trilhamos nosso debate em torno do dilema autonomia da gestante em trabalho de parto versus beneficência do futuro bebê. Por entender que no plano dos dilemas estão, também, em jogo as motivações humanas, nos impusemos responder à seguinte pergunta: Haveria, no cotidiano, elementos que anotassem para o reconhecimento da existência de um conflito entre diferentes interesses? Realizamos nosso trabalho de campo, entrevistando gestores de políticas públicas, profissionais de saúde que ofereceram os testes rápidos às parturientes e, também, mulheres que passaram pela experiência. Desta forma, foi possível apreender algumas ambigüidades presentes nesta política de saúde e dar visibilidade aos dilemas morais da oferta do teste anti-HIV às gestantes em trabalho de parto.
