Two-year Decay of Zika Virus Neutralizing Antibodies in People Living in an Endemic Region in Brazil.

It is currently not clear whether humoral immunity to Zika virus (ZIKV) elicited upon natural ZIKV infection is long-lasting. In addition, cross-reactivity of anti-ZIKV antibodies with antigenically related dengue viruses (DENV) may have biological implications in nonnaive individuals who subsequently acquire a heterotypic infection. Cross-reactive humoral immunity between ZIKV and DENV also complicates the interpretation of serological tests to evaluate previous exposure to either virus. Here, we have measured the 2-year decay of ZIKV neutralizing antibodies in people living in a ZIKV/DENV endemic area in Brazil who were identified as having an acute infection (group 1) or past (but recent) infection (group 2) with ZIKV in 2015-16. The titers of neutralizing antibodies to ZIKV decreased 9.1 and 2.3 times in groups 1 and 2, respectively. We also show that the plaque reduction neutralization assay (PRNT) is a reliable method to measure past exposure to ZIKV in coendemic areas.

Experiences of women raising children with congenital Zika syndrome along a trajectory of prevention, care and support in Brazil.

Social science research investigating the social dynamics of Zika and congenital Zika syndrome (CZS) is essential to inform future services related to Zika and other infectious diseases. We sought to understand lived experiences with Zika during pregnancy, birth, and post-partum by conducting in-depth interviews with a sample of 31 women infected with Zika during the 2015-16 outbreak who had a child with CZS in Pernambuco, Brazil. Transcripts were coded using thematic content analysis. Many women experienced shock when their children were born with CZS given the lack of information they were provided during the antenatal period. Stigma from loved ones and community members was a salient theme as were financial difficulties arising from women having to stop working to care for their child. While women experienced significant challenges caring for a child with CZS, they also exhibited resiliency in their ability to move from shock and sorrow to focusing on the needs of their child. While support services were generally available, they were often located at a significant distance. Results underscore the need for interventions to improve patient-provider communication, address socio-structural stressors, and support individual and collective resilience in women and families affected by Zika in lower resource settings.

Association between alcohol and crack: Prevalence, effects, associated factors and experiences of combined use.

OBJECTIVE: To estimate the prevalence and factors associated with the effect of alcohol on crack cocaine use and to analyze experiences related to combined use. Materials and methods: sequential mixed methods (qualitative and quantitative) research, carried out between August 2014 and August 2015 with people who use crack. In the quantitative approach, a cross-sectional study was conducted with 1,062 participants. Factors associated with "alcohol use with the effect of increasing the effect of crack/crack craving" were estimated by multiple regression. In the qualitative approach, 39 interviews were conducted using Bardin's content analysis technique. RESULTS: 871 (82.0%) participants reported consuming alcohol, among them, 668 (76.7%) used alcohol combined with crack: 219 (32.8%) reported feeling an effect of reduction in paranoia and/or crack craving and 384 (57.5%) reported feeling an increase in the effect of crack and in the craving to consume the drug. This relationship was also observed in the narratives of the people who use crack, with the possibility of a cyclic effect of consumption of the two substances. Those who related alcohol use to the effect of increasing crack craving (384) were more likely to use alcohol before crack (OR: 1.81; 95%CI: 1.13-2.89); to consume more than 20 stones daily (OR: 1.48; 95%CI: 1.01-2.16); to remain in abstinence from crack for less than one month (OR: 3.20; 95%CI: 1.91-5.35); to use dependence treatment services (OR: 1.85; 95%CI: 1.26-2.71); and to commit physical violence (OR:1.67; 95%CI:1.08-2.56). CONCLUSION: The findings of this study indicate that the modulation of the effect of alcohol use on crack cocaine depends on the moment when the drugs are consumed, and the use of alcohol before crack consumption is associated with characteristics that suggest a greater vulnerability to patterns of harmful crack use. Even though combined use is referred to as a way of reducing the negative effects of crack, the damage of this association may be greater than its possible benefits.

High Incidence of Zika or Chikungunya Infection among Pregnant Women Hospitalized Due to Obstetrical Complications in Northeastern Brazil-Implications for Laboratory Screening in Arbovirus Endemic Area.

The diagnostic of arbovirus-related obstetric complications in high-risk pregnancy and childbirth care is challenging, especially in endemic areas. We conducted a prospective study to track active or recent Zika (ZIKV), dengue (DENV), or chikungunya (CHIKV) virus infection among hospitalized pregnant women (PW) with obstetric complications in a hospital at the epicenter of Zika outbreak and ZIKV-related microcephaly in Brazil. Clinical data and blood samples were collected at enrollment and 10 days after the admission of study participants, between October 2018 and May 2019. Further clinical data were extracted from medical records. Samples were screened by molecular and serological tests. Out of 780 participants, 93.1% (95% CI: 91.1-94.7%) presented previous DENV exposure (IgG). ZIKV, CHIKV, and/or DENV laboratory markers of recent or active infection were detected in 130 PW, yielding a prevalence of 16.6% (95% CI: 14.2-19.5%); 9.4% (95% CI: 7.4-11.7%), 7.4% (95% CI: 5.7-9.7%), and 0.38% (95% CI: 0.1-1.2%) of CHIKV, ZIKV, and DENV infections, respectively. Most ZIKV infections were detected by molecular assays (89.6%), while CHIKV infections were detected by serology (95.9%). Our findings highlight the need for arbovirus infections screening in PW with obstetrical complications, potentially associated to these infections in endemic areas regardless of the signs or symptoms suggestive of arboviral disease.

Follow-Up Household Serosurvey in Northeast Brazil for Zika Virus: Sexual Contacts of Index Patients Have the Highest Risk for Seropositivity.

BACKGROUND: Zika virus (ZIKV) is a mosquito-borne virus that is also transmitted sexually; however, the epidemiological relevance of ZIKV sexual transmission in endemic regions is unclear. METHODS: We performed a household-based serosurvey in Northeast Brazil to evaluate the differential exposure to ZIKV and chikungunya virus (CHIKV) among households. Individuals who participated in our previous arboviral disease cohort (indexes) were recontacted and enrolled, and their household members were newly enrolled. RESULTS: The relative risk of sexual partners being ZIKV-seropositive when living with a ZIKV-seropositive index participant was significantly higher, whereas this was not observed among nonsexual partners of the index. For CHIKV, both sexual and nonsexual partner household members living with a CHIKV-seropositive index had a significantly higher risk of being seropositive. In the nonindex-based dyadic and generalized linear mixed model analyses, the odds of sexual dyads having a concordant ZIKV plaque reduction neutralization test result was significantly higher. We have also analyzed retrospective clinical data according to the participants' exposure to ZIKV and CHIKV. CONCLUSIONS: Our data suggest that ZIKV sexual transmission may be a key factor for the high ZIKV seroprevalence among households in endemic areas and raises important questions about differential disease from the 2 modes of transmission.

[The use of "virado" as a harm reduction strategy among crack users in the State of Pernambuco, Brazil]. / El uso de "virado" como estrategia de reducción de daños entre los usuarios de crack del estado de Pernambuco, Brasil.

The aim of the study is to discuss the use of crack in the form of "virado" as a harm reduction strategy in Pernambuco, Brazil. This is a cross-sectional study with a qualitative approach in which semi-structured interviews were conducted regarding aspects related to the culture of crack use with 39 crack users between March and August 2016. Participants were recruited using saturation criteria and data were analyzed through content analysis. Respondents discussed the use of "virado" and compared its effects in relation to crack, addressing improvement in interpersonal relationships, libido, and non-compulsive drug use, which can all be understood as harm reduction strategies. On the other hand, equipment sharing for the use of "virado" was identified as a high-risk practice with regards to the transmission of infectious diseases. Knowing about the culture of crack use in different contexts is essential in order to plan and develop health care actions.

El objetivo del estudio es discutir uno de los usos del crack denominado "virado", como estrategia de reducción de daños entre las personas que usan crack en Pernambuco, Brasil. Se realizó una investigación cualitativa y transversal. Desde marzo hasta agosto de 2016, se realizaron entrevistas semiestructuradas sobre la cultura del uso de crack a 39 personas que usan esta substancia. El límite de participantes se estableció por el criterio de saturación. Los datos se analizaron con la técnica de análisis de contenido. Las personas que participaron relataron que el virado es una manera distinta de utilizar el crack y, al comparar su efecto con el uso fumado o inhalado, mencionaron que el virado produce menos impacto en las relaciones interpersonales y en la libido, además de reducir el uso compulsivo de crack, cuestiones que se podrían considerar como estrategias de reducción de daños. Un aspecto negativo es que comparten los canutos para aspirar el virado, lo cual es una situación de riesgo para la transmisión de enfermedades infecciosas. Conocer la cultura del uso del crack en distintas formas y situaciones es imprescindible para la planificación y desarrollo de acciones de atención a la salud.

El uso de "virado" como estrategia de reducción de daños entre los usuarios de crack del estado de Pernambuco, Brasil / The use of "virado" as a harm reduction strategy among crack users in the State of Pernambuco, Brazil

RESUMEN El objetivo del estudio es discutir uno de los usos del crack denominado "virado", como estrategia de reducción de daños entre las personas que usan crack en Pernambuco, Brasil. Se realizó una investigación cualitativa y transversal. Desde marzo hasta agosto de 2016, se realizaron entrevistas semiestructuradas sobre la cultura del uso de crack a 39 personas que usan esta substancia. El límite de participantes se estableció por el criterio de saturación. Los datos se analizaron con la técnica de análisis de contenido. Las personas que participaron relataron que el virado es una manera distinta de utilizar el crack y, al comparar su efecto con el uso fumado o inhalado, mencionaron que el virado produce menos impacto en las relaciones interpersonales y en la libido, además de reducir el uso compulsivo de crack, cuestiones que se podrían considerar como estrategias de reducción de daños. Un aspecto negativo es que comparten los canutos para aspirar el virado, lo cual es una situación de riesgo para la transmisión de enfermedades infecciosas. Conocer la cultura del uso del crack en distintas formas y situaciones es imprescindible para la planificación y desarrollo de acciones de atención a la salud.

ABSTRACT The aim of the study is to discuss the use of crack in the form of "virado" as a harm reduction strategy in Pernambuco, Brazil. This is a cross-sectional study with a qualitative approach in which semi-structured interviews were conducted regarding aspects related to the culture of crack use with 39 crack users between March and August 2016. Participants were recruited using saturation criteria and data were analyzed through content analysis. Respondents discussed the use of "virado" and compared its effects in relation to crack, addressing improvement in interpersonal relationships, libido, and non-compulsive drug use, which can all be understood as harm reduction strategies. On the other hand, equipment sharing for the use of "virado" was identified as a high-risk practice with regards to the transmission of infectious diseases. Knowing about the culture of crack use in different contexts is essential in order to plan and develop health care actions.

Histórico de violência entre mulheres que fazem uso de crack no estado de Pernambuco, Brasil / History of violence among women who use crack in the state of Pernambuco, Brazil

RESUMO Neste artigo, abordou-se o histórico de violência contra mulheres em contexto de uso abusivo de crack. Trata-se de um estudo transversal, envolvendo 243 usuárias de crack atendidas pelo Programa Atitude, em Pernambuco, entre 2014 e 2015. Observou-se que a maioria era jovem, negra, com baixa escolaridade e renda, início precoce da vida sexual, em uso compulsivo de crack, morando na rua e comercializando o corpo como a principal fonte de renda. A maioria (96,2%) relatou histórico de violência: psicológica (83,5%), física (87,7%) e sexual (55,1%), praticadas por parentes/amigos. Fatores como desigualdades sociais e de gênero foram relevantes nas situações de violência observadas.

ABSTRACT In this article, it was discussed the history of violence against women in the context of abusive use of crack. It is a cross-sectional study, involving 243 crack users attended by the Atitude Program, in Pernambuco, between 2014 and 2015. It was observed that they were mostly young, black, with low schooling and low-income, early start of sexual life, in compulsive use of crack, living on the street and commercializing the body as the main source of income. The majority (96.2%) reported a violence history: psychological (83.5%), physical (87.7%) and sexual (55.1%), practiced by relatives/friends. Factors such as social and gender inequalities were relevant in the situations of violence observed.

Relações sexuais desprotegidas entre usuários de crack no Estado de Pernambuco / Unprotected sex among crack users in the Pernambuco state

Introdução: Altas prevalências de HIV e relações sexuais desprotegidas têm sido frequentemente verificadas entre usuários de drogas, mesmo nas formas não injetáveis, como o crack, sendo, portanto, uma das práticas, persistentes de disseminação desse vírus no Brasil. Objetivos: Estimar a prevalência de relações sexuais desprotegidas e seus fatores associados, entre sexo, em usuários de crack no Estado de Pernambuco. Materiais e métodos: Estudo de corte-transversal, de uma amostra de usuários de crack atendidos pelo Programa ATITUDE em Pernambuco, realizado entre 2014 e 2015. Foram considerados usuários de crack aqueles indivíduos que atenderam ao critério da Organização Pan-americana de Saúde para definição de usuários de drogas de alto risco de transmitir HIV. Para verificação de diferenças por sexo foi empregado o teste qui quadrado. O efeito dos fatores estudados sobre as relações sexuais desprotegidas foi estimado por meio do modelo de regressão simples e as variáveis com p 0,20 foram selecionados para análise multivariada, sendo considerado o nível de significância de 5 por cento. Resultados: Foram analisados 1.062 casos (819 do sexo masculino e 243 do sexo feminino). O maior percentual tinha de 25 a 34 anos (46 por cento), de cor parda (65,1 por cento), e vivendo em situação de rua (56,9 por cento). O uso inconsistente do preservativo entre os homens (74,7 por cento) foi associado a está na vigência de drogas; não uso do preservativo na primeira relação sexual; autopercepção de grande chance de infectar-se por HIV; ter parceiro fixo; e não ter acesso a preservativo...

JACQUES, Iracema de Jesus Almeida Alves. Unprotected sex among crack users in the Pernambuco state. 2016. Dissertação (Mestrado Acadêmico em Saúde Pública) -Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife. 2016ABSTRACTIntroduction:High prevalence of HIV and unprotected sex have often been observed among drug users, even in non-injectable forms, such as crack, therefore, being considered one of the practices related to the dissemination of HIV in Brazil. Objectives: To estimate the prevalence of unprotected sex and its associated factors, among sex, in the crack users of the Pernambuco State. Materials and Methods: Cross-sectional cohort study from a sample of crack users assisted by ATTITUDE Program in Pernambuco, carried out between 2014 and 2015. Were considered as crack users those individuals who meet the criteria of the Pan American Health Organization for drug users with high risk of to transmit HIV. To verify differences according to sex we used the chi-squared test. The effect of the factors studied over unprotected sex was estimated by simple regression model and the variables with p <0.20 were selected for multivariate analysis, being considered the ignificance level of 5%. Results: Were analyzed 1,062 cases, being 819 (77.1%) male and 243 (22.9%) female. The highest percentage were between 25 and 34 years (46%), single (80.2%), skin color brown (65.1%), and living on the streets (56.9 %)...

Avaliação da Adesão à Terapia Antirretroviralentre Pacientes em Atendimento Ambulatorial / Assessment of Compliance to Antiretroviral Therapy among Patients Undergoing Ambulatory Care

Introdução: Os altos níveis de adesão à terapiamedicamentosa da aids são fundamentais para o sucessodos resultados clínicos relativos a essa doença. Objetivo:Avaliar o grau de adesão à Terapia Antirretroviral (TARV)entre pacientes em atendimento ambulatorial. Material eMétodos: Trata-se de estudo exploratório e descritivo comabordagem quantitativa. A amostra foi constituída por 152pessoas diagnosticadas com aids em um hospital público dereferência no Estado de Pernambuco. A coleta de dados foiviabilizada por meio da aplicação de dois questionários comquestões relativas ao objetivo proposto. Para as análises,foram empregados os testes de qui-quadrado e de diferençade médias. Resultados: Observou-se que 58,33% dosentrevistados eram do sexo masculino; 75,39% recebiam deum a três salários-mínimos; e quanto a adesão à terapia,75,66% apresentaram boa adesão. Na associação entre ograu de adesão e as variáveis sociodemográficas, umaamostra maior poderia indicar que, maior renda atua comofacilitador a melhor adesão. Conclusão: O predomínio dosexo masculino entre os participantes deste estudo e ainfluência da renda familiar na adesão ao tratamento, levamnosa sugerir um cuidado intensificado a esses grupos, comfoco em uma adesão satisfatória...

Introduction: High rates of compliance to AIDS drug therapyare a key to achieve successful clinical outcomes for thisdisease. Objective: To assess the degree of compliance toantiretroviral therapy (ART) among patients undergoingambulatory care. Material and Methods: This was anexploratory and descriptive study with a quantitativeapproach. The sample consisted of 152 people diagnosedwith AIDS in a public referral hospital in the state ofPernambuco, Brazil. Data collection was made possiblethrough the application of two questionnaires with questionsaimed at the proposed objective. The chi-square test and themeans difference test were used for data analysis. Results:58.33% of the interviewees were male; 75.39% earned fromone and three minimum wages; and with respect to therapycompliance, 75.66% showed good compliance. As to theassociation between compliance rates and sociodemographicvariables, a larger sample could indicate that higher incomeacts as a facilitator to better compliance. Conclusion: Thepredominance of males among the participants in this studyand the influence of family income on treatment compliancelead us to suggest an intensified care for these groupsfocusing on a satisfactory compliance...