Telehealth effectiveness for pre-exposure prophylaxis delivery in Brazilian public services: the Combine! Study.

INTRODUCTION: Pre-exposure prophylaxis (PrEP) delivery based on user needs can enhance PrEP access and impact. We examined whether telehealth for daily oral PrEP delivery could change the indicators of care related to prophylactic use in five Brazilian public HIV clinics (testing centres, outpatient clinics and infectious disease hospitals). METHODS: Between July 2019 and December 2020, clients on PrEP for at least 6 months could transition to telehealth or stay with in-person follow-up. Clients were clinically monitored until June 2021. A desktop or mobile application was developed, comprising three asynchronous consultations and one annual in-person consultation visit. Predictors influencing telehealth preference and care outcomes were examined. The analysis encompassed intent-to-treat (first choice) and adjustments for sexual practices, schooling, age, duration of PrEP use and PrEP status during the choice period. RESULTS: Of 470 users, 52% chose telehealth, with the adjusted odds ratio (aOR) increasing over time for PrEP use (aOR for 25-months of use: 4.90; 95% CI: 1.32-18.25), having discontinued PrEP at the time of the choice (aOR: 2.91; 95% CI: 1.40-6.06) and having health insurance (aOR: 1.91; 95% CI: 1.24-2.94) and decreasing for those who reported higher-risk behaviour (aOR for unprotected anal sex: 0.51; 95% CI: 0.29-0.88). After an average follow-up period of 1.6 years (95% CI: 1.5-1.7), the risk of discontinuing PrEP (not having the medication for more than 90 days) was 34% lower with telehealth (adjusted hazard ratio: 0.66; 95% CI: 0.45-0.97). When adjusted by mixed linear regression, no differences in adherence (measured by mean medication possession rate) were found between in-person and telehealth (p = 0.486) or at pre- and post-telehealth follow-ups (p = 0.245). Sexually transmitted infections increased between the pre-follow-up and post-follow-up choices and were not associated with in-person or telehealth (p = 0.528). No HIV infections were observed. CONCLUSIONS: Our findings indicate that telehealth for PrEP delivery can enhance service rationalization and reinforce the prevention cascade. This approach reduces prophylaxis interruptions and is mainly preferred by individuals with lower demands for healthcare services.

Relationship between team climate and satisfaction at work in the Family Health Strategy.

OBJECTIVE: To analyze the association between team climate, team characteristics and satisfaction at work in teams of the Estratégia Saúde da Família com Saúde Bucal (Family Health Strategy with Oral Health) (ESF with SB). METHODS: Cross-sectional correlational study with ESF teams with SB in the municipality of São Paulo. Universe of 1,328 teams and random sample of 124 teams with 1,231 professionals. Applied questionnaire with data teams' characterization, team climate scale, and satisfaction at work. Analysis of validity, of climate and satisfaction scores through mean among professionals in each team, cluster analysis, association between variables by Pearson's correlation and Chi-square, and tested linear regression model for the two factors of satisfaction at work. RESULTS: There was a directly proportional association between team climate and satisfaction at work. The better the climate with regard to team goals, the greater the intrinsic satisfaction at work and with the physical environment. The better the climate with regard to team goals and task orientation, the greater the satisfaction with hierarchical relations. The group with best team climate reported higher percentage of teams ranked with better satisfaction at work, and in the group with the worst team climate there was higher percentage of teams with the lowest satisfaction at work. CONCLUSIONS: The study provides consistent although moderate evidence of association between favorable teamwork climate and job satisfaction in ESF with SB. It emphasizes the dimensions of climate, common goals and task orientation, and may serve as subsidy for management and permanent education of teams, aiming at the quality of care to the health needs of users, family and community in APS.

Relationship between team climate and satisfaction at work in the Family Health Strategy / Relações entre clima de equipe e satisfação no trabalho na Estratégia Saúde da Família

ABSTRACT OBJECTIVE To analyze the association between team climate, team characteristics and satisfaction at work in teams of the Estratégia Saúde da Família com Saúde Bucal (Family Health Strategy with Oral Health) (ESF with SB). METHODS Cross-sectional correlational study with ESF teams with SB in the municipality of São Paulo. Universe of 1,328 teams and random sample of 124 teams with 1,231 professionals. Applied questionnaire with data teams' characterization, team climate scale, and satisfaction at work. Analysis of validity, of climate and satisfaction scores through mean among professionals in each team, cluster analysis, association between variables by Pearson's correlation and Chi-square, and tested linear regression model for the two factors of satisfaction at work. RESULTS There was a directly proportional association between team climate and satisfaction at work. The better the climate with regard to team goals, the greater the intrinsic satisfaction at work and with the physical environment. The better the climate with regard to team goals and task orientation, the greater the satisfaction with hierarchical relations. The group with best team climate reported higher percentage of teams ranked with better satisfaction at work, and in the group with the worst team climate there was higher percentage of teams with the lowest satisfaction at work. CONCLUSIONS The study provides consistent although moderate evidence of association between favorable teamwork climate and job satisfaction in ESF with SB. It emphasizes the dimensions of climate, common goals and task orientation, and may serve as subsidy for management and permanent education of teams, aiming at the quality of care to the health needs of users, family and community in APS.

RESUMO OBJETIVO Analisar associação entre clima de equipe, características das equipes e satisfação no trabalho em equipes da Estratégia Saúde da Família com Saúde Bucal (ESF com SB). MÉTODOS Correlacional transversal com equipes da ESF com SB no município de São Paulo. Universo de 1.328 equipes e amostra aleatória de 124 equipes com 1.231 profissionais. Aplicado questionário com dados de caracterização das equipes, escala de clima de equipe e de satisfação no trabalho. Realizada análise de validade, dos escores de clima e satisfação via média dos profissionais de cada equipe, análise de agrupamentos, associação entre variáveis pela correlação de Pearson e Qui-Quadrado e testado modelo de regressão linear para os dois fatores de satisfação no trabalho. RESULTADOS Verificou-se associação diretamente proporcional entre clima de equipe e satisfação no trabalho. Quanto maior clima com relação a objetivos da equipe, maior satisfação intrínseca no trabalho e com ambiente físico, quanto maior clima com relação a objetivos da equipe e orientação para as tarefas, maior satisfação com as relações hierárquicas. Verificou-se no grupo com melhor clima de equipe, maior porcentagem de equipes classificadas com melhor satisfação no trabalho e no grupo de pior clima de equipe, maior porcentagem de equipes com a mais baixa satisfação no trabalho. CONCLUSÕES O estudo traz evidências consistentes, embora moderadas, de associação entre clima favorável ao trabalho em equipe e satisfação no trabalho na ESF com SB, com destaque para as dimensões de clima, objetivos comuns e orientação para a tarefa, constituindo subsídio para a gestão e educação permanente das equipes, visando a qualidade da atenção às necessidades de saúde de usuários, família e comunidade na APS.

[Sexual behavior and practices among men and women, Brazil 1998 and 2005]. / Comportamento e práticas sexuais de homens e mulheres, Brasil 1998 e 2005.

OBJECTIVE: To compare basic findings from two studies on sexual behavior and practices among women and men and their associations with sociodemographic characteristics of this population. METHODS: Data analyzed were obtained by a questionnaire applied to a probabilistic sample comprised of 3,423 people in 1998, and 5,040 people in 2005, all aged between 16 and 65 years, and living in urban areas of Brazil. Comparative analyses were performed by sex and year of research, and according to sociodemographic variables, using Pearson's chi-square test. RESULTS: The number of sexual partners in the year that preceded the interview decreased from 29.5% to 23.1% among men. Variability in sexual behavior and practices according to age, level of education, marital status, religion and place of residence, in addition to specific characteristics based on sex, was observed. There was also an increase in the proportion of women who began their sexual life in the 16-to-19-year age group and had completed up to elementary school, or lived in Southern Brazil. Moreover, it was observed an increase of sexual activity reported by women in the last year, and a decrease among men over 55 years of age, Protestant/Pentecostal, or separated/widowed. The proportion of men with more than one sexual partner in the last year decreased among those aged between 25 and 44 years or who have completed up to high-school. There was an increase in oral sex practice reported by women who are over 35 years of age or live in Northern/Northeastern Brazil. CONCLUSIONS: Comparative analysis from 1998 to 2005 suggested a tendency towards differences between women and men decreasing. This probably results from a pattern of change characterized by an increase in the frequency of female behavior investigated and a decrease in the frequency of male behavior.

[Stigma, discrimination and HIV/AIDS in the Brazilian context, 1998 and 2005]. / Estigma, discriminação e HIV/Aids no contexto brasileiro, 1998 e 2005.

OBJECTIVE: To identify discriminatory attitudes in two moments of the Brazilian HIV/AIDS epidemic, as well as the occurrence of possible changes. METHODS: The Intention of Discrimination Index was obtained by scoring 1 for discriminatory situations or 0, when the opposite was the case. Intention of discrimination ranges were established by means of the clustering technique, and made compatible between the 1998 and 2005 surveys. Mean comparisons, chi-square test and ordered logit adjusted regression models were used to verify association between the index and socio-demographic variables. RESULTS: Between the 1998 and 2005 surveys, there was a statistically significant reduction in the proportion of people who answered "yes" to anti-HIV test's being mandatory in the following cases: admission for employment, before getting married, when joining the military service, drug users, foreigners entering the country, sex professionals, and for all the people. To have lower level of education, to be female, to live in the North/Northeast regions of Brazil, and to be aged over 45 years are factors associated with higher intention of discrimination level. CONCLUSIONS: The growth of intention of discrimination shows that information about ways of AIDS transmission and non-transmission still needs to be better planned and promoted, especially among populations that have lower level of education, live in the North/Northeast regions, are female and aged over 45 years.

Comportamento e práticas sexuais de homens e mulheres, Brasil 1998 e 2005 / Sexual behavior and practices among men and women, Brazil 1998 and 2005

OBJETIVO: Comparar achados básicos de duas pesquisas sobre comportamento e práticas sexuais de mulheres e homens e suas associações com características sociodemográficas da população. MÉTODOS: Os dados analisados foram obtidos por meio de questionário aplicado a uma amostra probabilística de 3.423 pessoas em 1998, e 5.040 em 2005, com idades entre 16 e 65 anos, moradores em regiões urbanas do Brasil. Análises comparativas foram realizadas por sexo e ano de realização da pesquisa, e segundo variáveis sociodemográficas, utilizando o teste qui-quadrado de Pearson. RESULTADOS: O número de parcerias sexuais no ano que antecedeu a entrevista diminuiu entre os homens, de 29,5 por cento para 23,1 por cento. Constatou-se ainda variabilidade de comportamentos e práticas sexuais em função da idade, escolaridade, situação conjugal, religião e região geográfica de residência, além de características específicas segundo sexo. Verificou-se aumento da proporção de mulheres que iniciaram a vida sexual no grupo daquelas com 16 a 19 anos e ensino até fundamental, ou residentes na região Sul do País; e aumento de relato de atividade sexual no último ano entre as mulheres e redução desse relato entre os homens com mais de 55 anos, protestantes/pentecostais, ou separados e viúvos. A proporção de homens com mais de um parceira(o) sexual no último ano diminuiu entre aqueles com 25 a 44 anos ou com ensino até médio. Houve aumento de relato da prática de sexo oral por parte de mulheres com mais de 35 anos ou residentes no Norte/Nordeste. CONCLUSÕES: A análise comparativa entre 1998 e 2005 sugeriu tendência de diminuição das diferenças entre homens e mulheres. Possivelmente isso resulta de um padrão de mudança caracterizado por aumento da freqüência nos comportamentos femininos investigados e diminuição da freqüência nos comportamentos masculinos.

OBJECTIVE: To compare basic findings from two studies on sexual behavior and practices among women and men and their associations with sociodemographic characteristics of this population. METHODS: Data analyzed were obtained by a questionnaire applied to a probabilistic sample comprised of 3,423 people in 1998, and 5,040 people in 2005, all aged between 16 and 65 years, and living in urban areas of Brazil. Comparative analyses were performed by sex and year of research, and according to sociodemographic variables, using Pearson's chi-square test. RESULTS: The number of sexual partners in the year that preceded the interview decreased from 29.5 percent to 23.1 percent among men. Variability in sexual behavior and practices according to age, level of education, marital status, religion and place of residence, in addition to specific characteristics based on sex, was observed. There was also an increase in the proportion of women who began their sexual life in the 16-to-19-year age group and had completed up to elementary school, or lived in Southern Brazil. Moreover, it was observed an increase of sexual activity reported by women in the last year, and a decrease among men over 55 years of age, Protestant/Pentecostal, or separated/widowed. The proportion of men with more than one sexual partner in the last year decreased among those aged between 25 and 44 years or who have completed up to high-school. There was an increase in oral sex practice reported by women who are over 35 years of age or live in Northern/Northeastern Brazil. CONCLUSIONS: Comparative analysis from 1998 to 2005 suggested a tendency towards differences between women and men decreasing. This probably results from a pattern of change characterized by an increase in the frequency of female behavior investigated and a decrease in the frequency of male behavior.

Estigma, discriminação e HIV/Aids no contexto brasileiro, 1998 e 2005 / Stigma, discrimination and HIV/AIDS in the Brazilian context, 1998 and 2005

OBJETIVO: Identificar a prevalência de atitudes discriminatórias em dois momentos da epidemia brasileira de HIV/Aids e possíveis mudanças ocorridas. MÉTODOS: O Índice de Intenção de Discriminação foi obtido por pontuação, somando 1 para situações de discriminação ou 0, para o caso contrário. As faixas de intenção de discriminação foram estabelecidas por meio da técnica de cluster, compatibilizadas entre os estudos de 1998 e 2005. Para verificar associação entre o índice e as variáveis sociodemográficas, utilizou-se comparações de médias, teste qui-quadrado, e modelos ajustados de regressão logito ordenado. RESULTADOS: Houve redução estatisticamente significante na proporção de pessoas entre as pesquisas de 1998 e 2005 que responderam sim à obrigatoriedade do teste anti-HIV para: a admissão no emprego, antes do casamento, ingresso nas forças armadas, usuários de drogas, entrada de estrangeiros no país, profissionais do sexo e para todas as pessoas. Possuir menor escolaridade, ser do sexo feminino, ter acima de 45 anos e residir na região Norte/Nordeste são fatores associados ao maior nível de intenção de discriminação. CONCLUSÕES: O crescimento da intenção de discriminação mostra que as informações sobre formas de transmissão e não transmissão da Aids ainda necessitam de melhor elaboração e divulgação, principalmente entre as populações de menor escolaridade, residentes nos estados do Norte/Nordeste, do sexo feminino e pertencentes à faixa etária acima de 45 anos.

OBJECTIVE: To identify discriminatory attitudes in two moments of the Brazilian HIV/AIDS epidemic, as well as the occurrence of possible changes. METHODS: The Intention of Discrimination Index was obtained by scoring 1 for discriminatory situations or 0, when the opposite was the case. Intention of discrimination ranges were established by means of the clustering technique, and made compatible between the 1998 and 2005 surveys. Mean comparisons, chi-square test and ordered logit adjusted regression models were used to verify association between the index and socio-demographic variables. RESULTS: Between the 1998 and 2005 surveys, there was a statistically significant reduction in the proportion of people who answered "yes" to anti-HIV test's being mandatory in the following cases: admission for employment, before getting married, when joining the military service, drug users, foreigners entering the country, sex professionals, and for all the people. To have lower level of education, to be female, to live in the North/Northeast regions of Brazil, and to be aged over 45 years are factors associated with higher intention of discrimination level. CONCLUSIONS: The growth of intention of discrimination shows that information about ways of AIDS transmission and non-transmission still needs to be better planned and promoted, especially among populations that have lower level of education, live in the North/Northeast regions, are female and aged over 45 years.

Mulheres que fazem sexo com mulheres: algumas estimativas para o Brasil / Women who have sex with women: estimates for Brazil

O objetivo deste trabalho é descrever a proporção de mulheres que fazem sexo com mulheres, com base em três recortes temporais a partir de dados produzidos por um inquérito populacional de abrangência nacional realizado em 1998. A proporção de mulheres que relatam relações sexuais com mulheres na vida diminui de 3 por cento para 1,7 por cento nos cinco anos anteriores à pesquisa, mantendo-se praticamente no mesmo patamar, 1,7 por cento, no último ano. Ao comparar esses dados com os disponíveis para os homens, os resultados sugerem que homens e mulheres transitam entre experiências homo e heterossexuais de maneiras distintas ao longo da vida.

[Women who have sex with women: estimates for Brazil]. / Mulheres que fazem sexo com mulheres: algumas estimativas para o Brasil.

This paper analyzes the proportion of Brazilian women who have sex with women, considering three time periods. The data are from a national population-based survey from 1998. The proportion of the female population who reported having any same-sex relations during their lifetime decreased from 3% to 1.7% in the previous five years and remained at 1.7% in the last year. Comparing the data by gender, the results suggest that women and men have different patterns of homosexual and heterosexual experiences over the course of their lives.

Morbidade declarada e condições de trabalho: o caso dos motoristas de São Paulo e Belo Horizonte / Declared Morbidity and conditions of work: the case of the drivers of São Paulo and Belo Horizonte

Neste artigo se apresentam os principais resultados de levantamentos feitos em São Paulo e Belo Horizonte sobre as condições de trabalho e de saúde dos motoristas do transporte de passageiros. Constataram-se condições de trabalho bastante desfavoráveis e estabeleceram-se associações estatísticas entre essas condições e sérios sintomas de morbidade declarados pelos motoristas. Sugere-se a necessidade de políticas públicas para o setor.