Search

IntroductionThe Curitiba (Brazil)-based Project, A Hora é Agora (AHA), evaluated a comprehensive HIV control strategy among men who have sex with men (MSM) aimed at expanding access to HIV rapid testing and linking HIV-positive MSM to health services and treatment. AHA's approach included rapid HIV Testing Services (HTC) in one mobile testing unit (MTU); a local, gay-led, non-governmental organization (NGO); an existing government-run health facility (COA); and Internet-based HIV self-testing. The objectives of the paper were to compare a) number of MSM tested in each strategy, its positivity and linkage; b) social, demographic and behavioral characteristics of MSM accessing the different HTC and linkage services; and c) the costs of the individual strategies to diagnose and link MSM to services.MethodsWe used data for 2,681 MSM tested at COA, MTU and NGO from March 2015 to March 2017. This is a cross sectional comparison of the demographics and behavioral factors (age group, race/ethnicity, education, sexually transmitted diseases, knowledge of AHA services and previous HIV test). Absolute frequencies, percentage distributions and confidence intervals for the percentages were used, as well as unilateral statistical tests.Results and discussionAHA performed 2,681 HIV tests among MSM across three in-person strategies: MTU, NGO, and COA; and distributed 4,752 HIV oral fluid tests through the self-testing platform. MTU, NGO and COA reported 365 (13.6%) HIV positive diagnoses among MSM, including 28 users with previous HIV diagnosis or on antiretroviral treatment for HIV. Of these, 89% of MSM were eligible for linkage-to-care services. Linkage support was accepted by 86% of positive MSM, of which 66.7% were linked to services in less than 90 days. The MTU resulted in the lowest cost per MSM tested ($137 per test), followed by self-testing ($247).ConclusionsAHA offered MSM access to HTC through innovative strategies operating in alternative sites and schedules. It presented the Curitiba HIV/AIDS community the opportunity to monitor HIV-positive MSM from diagnosis to treatment uptake. Self-testing emerged as a feasible strategy to increase MSM access to HIV-testing through virtual tools and anonymous test kit delivery and pick-up. Cost per test findings in both the MTU and self-testing support expansion to other regions with similar epidemiological contexts.

Background: Identifying infants with congenital infection for early intervention will likely be challenging in future Zika virus outbreaks. We investigated indicators of risk for developmental delay among children born with and without obvious manifestations of congenital Zika virus infection. Methods: We evaluated 120 children conceived during the 2015−2016 Zika virus outbreak in Paraíba, Brazil. We analyzed data from children at birth; ages 1−7 months and approximately 24 months, using medical records (i.e., anthropometric measurements diagnoses), medical evaluation (i.e., Zika/other laboratory tests, dysmorphic features), and parent report (seizures, developmental delay). We used a Bayesian modeling approach to identify predictors of developmental delay. Results: Head circumference (HC) and length at birth and rates of growth for HC and length at follow-up were consistent across domains of developmental delay; (e.g., for every 1 cm per month decrease in HC growth rate; there was a corresponding decrease in the gross motor z-score). Modeling results indicated that HC and length at birth, and follow-up HC and length rates of growth, were predictive of developmental delay. Conclusion: These findings suggest that accurate measurement and frequent monitoring of HC and length, especially in the first few months of life, may be useful for identifying children possibly congenitally exposed to Zika virus who could benefit from early intervention services.

Brazil, a country of continental proportions, presents three profiles of malaria transmission. The first and most important numerically, occurs inside the Amazon. The Amazon accounts for approximately 60% of the nation’s territory and approximately 13% of the Brazilian population. This region hosts 99.5% of the nation’s malaria cases, which are predominantly caused by Plasmodium vivax (i.e., 82% of cases in 2013). The second involves imported malaria, which corresponds to malaria cases acquired outside the region where the individuals live or the diagnosis was made. These cases are imported from endemic regions of Brazil (i.e., the Amazon) or from other countries in South and Central America, Africa and Asia. Imported malaria comprised 89% of the cases found outside the area of active transmission in Brazil in 2013. These cases highlight an important question with respect to both therapeutic and epidemiological issues because patients, especially those with falciparum malaria, arriving in a region where the health professionals may not have experience with the clinical manifestations of malaria and its diagnosis could suffer dramatic consequences associated with a potential delay in treatment. Additionally, because the Anopheles vectors exist in most of the country, even a single case of malaria, if not diagnosed and treated immediately, may result in introduced cases, causing outbreaks and even introducing or reintroducing the disease to a non-endemic, receptive region. Cases introduced outside the Amazon usually occur in areas in which malaria was formerly endemic and are transmitted by competent vectors belonging to the subgenus Nyssorhynchus (i.e., Anopheles darlingi, Anopheles aquasalis and species of the Albitarsis complex). The third type of transmission accounts for only 0.05% of all cases and is caused by autochthonous malaria in the Atlantic Forest, located primarily along the southeastern Atlantic Coast. They are caused by parasites that seem to be (or to be very close to) P. vivax and, in a less extent, by Plasmodium malariae and it is transmitted by the bromeliad mosquito Anopheles (Kerteszia) cruzii. This paper deals mainly with the two profiles of malaria found outside the Amazon: the imported and ensuing introduced cases and the autochthonous cases. We also provide an update regarding the situation in Brazil and the Brazilian endemic Amazon.

Resumo OBJETIVO: avaliar a completude e oportunidade das notificações, do diagnóstico e do tratamento da malária na Amazônia Legal Brasileira. MÉTODOS: estudo descritivo, com dados de 23 campos das fichas de notificação registradas no Sistema de Informação de Vigilância Epidemiológica da Malária (Sivep-Malária) no período de 2003 a 2012. RESULTADOS: em 86,0% dos campos da ficha de notificação, a completude foi boa (≥90,0% de preenchimento); nas Secretarias Municipais de Saúde, 40,6% das notificações tiveram registro oportuno (0-7 dias após a notificação), e no Ministério da Saúde, 75,6% (0-30 dias após a notificação); o diagnóstico e o tratamento oportunos ocorreram em 44,6% e 45,4% dos pacientes, respectivamente. CONCLUSÃO: a maioria das notificações apresentou boa completude; a oportunidade no registro das notificações ficou aquém dos padrões internacionais; e a oportunidade no diagnóstico e no tratamento revelou-se abaixo das recomendações do Ministério da Saúde.

OBJETIVO: Descrever a situação epidemiológica da malária na região amazônica brasileira entre 2003 e 2012. MÉTODOS: Este estudo ecológico retrospectivo utilizou dados do Sistema de Informação de Vigilância Epidemiológica e Notificação de Casos de Malária, Sistema de Internações Hospitalares e Sistema de Informações de Mortalidade. Determinaram-se o percentual de Plasmodium falciparum,o número de internações e óbitos e a letalidade por malária em cada ano. Para a infecção pelo P. falciparum, foi avaliada a distribuição dos casos por estado. Os dados de 2012 foram comparados aos de 2005, ano em que a região amazônica notificou um maior número de casos, e aos do ano anterior, 2011. RESULTADOS: Em 2012, foram registrados 241806 casos de malária, representando uma redução de 60,1% em relação a 2005 e de 9,1% em relação a 2011. Entre 2003 e 2005, houve um aumento de 48,3% no número de casos, com registro de 606 069 casos em 2005. Desde 2006, observa-se tendência à redução do número de casos, principalmente na transmissão do P. falciparum, com 155 169 casos notificados em 2005 e 35 385 casos em 2012 (redução de 77,2%). Entre 2005 e 2012, houve redução no número de internações (74,6%) e nos óbitos (54,4%) por malária. CONCLUSÕES: Apesar da redução no número de casos de malária no período analisado, o possível surgimento de parasitos resistentes às drogas e a menor frequência de casos de malária por P. falciparum indicam a necessidade de novas estratégias de vigilância, com utilização de ferramentas de diagnóstico mais sensíveis e manejo integrado de vetores, visando à ousada, mas não impossível, eliminação do P. falciparum.