Vulnerability of the HIV cascade of care in an Amazonian town: A qualitative study.

The HIV care cascade spans from diagnosis to patient linkage and retention in health services for treatment. Brazil has made substantial efforts to optimize the cascade of care. However, despite these advances, there are striking regional differences and difficulties from testing to treatment, particularly in the north and northeast regions, often reflecting social inequalities. Oiapoque, a highly affected city in the state of Amapá, shares its borders with an overseas European territory-French Guiana. The objective of this study was to get a clearer picture of the different components of the HIV care cascade in the municipality of Oiapoque. The study was exploratory and qualitative, involving the mapping of health structures in the research area and interviews with the responsible healthcare professionals working in the municipality. Patients are vulnerable at several levels, including mobility limitations, mismatched information that affects the linkage and retention of treatment, an absence of infectious disease doctors, an absence of user autonomy, missed appointments, dropouts, and abandonment of care. We found that the five recommended steps in the continuum of care for people living with HIV all had weak points or were non-existent or unavailable. These results will be fundamental to rethink the municipality's actions and the strategies of the Unified Health System SUS for the HIV epidemic in these border regions of the Amazon.

Complex malaria epidemiology in an international border area between Brazil and French Guiana: challenges for elimination.

BACKGROUND: The epidemiological surveillance of malaria is a necessary intervention for eliminating the disease from the planet. The international border zones of the Amazon continue to be highly vulnerable to malaria since population mobility impedes elimination. Although in the past few years, cases of malaria have had an essential reduction in Brazil, this trend was not confirmed in municipalities along the border. This study aimed to establish the epidemiology of the disease during the last 13 years in Oiapoque, a Brazilian municipality at the international border with French Guiana, an overseas department, to develop strategies for the control/elimination of malaria in these areas. RESULTS: Data collected from 2003 to 2015 from the Malaria Epidemiological Surveillance System was used. It was found that, despite the important reduction in cases (68.1%), the annual parasite index remained a high epidemiological risk. The disease is seasonal in that the period of highest transmission occurs between September and December. Between 2003 and 2015, eight outbreaks were identified, with one of these lasting 15 months between August 2006 and October 2007. There were changes in the epidemiological profile, with imported cases representing 67.7% of cases from 2003 to 2007 and representing 32.9% of cases from 2008 to 2015 (p < 0.01). The greatest number of cases was among Brazilians coming from the artisanal gold mines of French Guiana. There were also changes in the profile of autochthonous malaria with an increase in urban cases from 14.3% in 2003 to 32.3% in 2015 (p < 0 .01). The burden of malaria in indigenous areas was also very high (67.3% in rural areas) in 2015. There were changes in the parasite species profile with a significant decrease of cases of Plasmodium falciparum (p = 0.01). Children under 15 years old, representing 9.7% of cases at the onset of the study, accounted for 34.2% of case notifications (p < 0.01) in 2015. Also, 74% of cases in 2003 and 55.9% in 2015 (p < 0.01) were among men. CONCLUSIONS: The fragility of local health services in cross-border areas continues to be an obstacle for malaria elimination.

HTLV-1/2 prevalence in two Amazonian communities.

INTRODUCTION: The human T-cell lymphotropic virus type 1 (HTLV-1) is aetiologically linked to myelopathy/tropical spastic paraparesis (HAM/TSP) and adult T cell leukaemia (ATL) besides other less incident pathologies, while the type 2 has not been definitively linked to any diseases. OBJECTIVES: To determine the HTLV-1/2 seroprevalence in two Brazilian communities in northern Brazil. METHODS: In 2010 and 2015, HTLV-1/2 serological surveys were carried out in the Oiapoque county at the Brazilian border with French Guiana and in Santa Cruz do Arari, Marajó Island. Serum and breast-milk samples from 317 women (pregnant, lactating and non-pregnant non-lactating) resident in the Oiapoque county, together with serum samples from 217 females and 70 males living in Santa Cruz do Arari county, were twice screened by two distinct commercial immunoassay methods for antibodies to HTLV-1/2. Seroreactivity was confirmed by a commercial Western blot technique. Participants were interviewed for data concerning their health, socioeconomic and educational status. RESULTS: None of the Oiapoque women, mostly young and descendants of migrants, had antibodies to HTLV-1/2, despite the high HTLV-1 prevalence in neighbouring French Guiana and Caribbean Islands, while five females and three males living in Santa Cruz do Arari county were HTLV-1 infected as confirmed by Western blot testing. In contrast, the Santa Cruz do Arari community lives in relative isolation and is descended mostly from black African people with high consanguinity. CONCLUSION: Despite the proximity between Oiapoque and Santa Cruz do Arari counties, ethnic, age differences, community isolation and consanguinity may explain the distinct HTLV-1/2 epidemiology in these areas of northern Brazil.

A new species of Myloplus Gill (Characiformes, Serrasalmidae) from the Tumucumaque Mountain Range, Brazil and French Guiana, with comments on M. rubripinnis.

A new species of Myloplus Gill is described from Eastern Tumucumaque Mountain Range, drainages of the Oyapock and Araguari rivers between Brazil and French Guiana. The new species is diagnosed by having comparatively large scales on the flanks, resulting in lower counts when compared with congeners, i.e., 59 to 70 total perforated scales on lateral line, 31 to 35 longitudinal scales above lateral line, 24 to 29 longitudinal scales below lateral line, and 22 to 26 circumpeduncular scale rows. The new species most closely resembles Myloplus rubripinnis by sharing with this species a general rounded shape, a similar color pattern, and a high number of rays, i.e., 23 to 25 branched dorsal-fin rays and 35 to 38 branched anal-fin rays in the new species (vs. 24 to 25 and 32 to 40, respectively, in M. rubripinnis). After reviewing the available type-specimens of all Myloplus species, M. rubripinnis is re-diagnosed as having higher counts of branched dorsal-fin rays and anal-fin rays combined to tiny scales on flanks, i.e., 85 to 89 total perforated scales on lateral line, 38 to 45 longitudinal scales above lateral line, 33 to 42 longitudinal scales below lateral line, and 30 to 39 circumpeduncular scale rows.