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We aimed to estimate the occurrence of syphilis in pregnant women (SPW) and congenital syphilis (CS) in the municipalities of the state of São Paulo (SP) and evaluate their relationship with socioeconomic, demographic, and health care variables. We developed an ecological study based on secondary data of SPW and CS with spatial and temporal components from 645 municipalities in SP and included data from 2007 to 2018. We modeled the data in a Bayesian context, considered spatial and temporal random effects, and used a binomial negative probability distribution. We found a continuous increase in the relative temporal risk of SPW, from 2007 to 2018, and CS, from 2007 to 2017, when their incidences increased by 8.7 and 6.6 times, respectively. Moreover, this increase occurred in en bloc in practically all municipalities of SP. The increase in SPW was associated with teenage pregnancy, municipalities with a large number of inhabitants, and aids incidence. The increase in CS was associated with municipalities with a large number of inhabitants, incomplete antenatal care, inadequate technology to perform deliveries in the municipality, and aids incidence. Interventions to control these diseases are needed in almost all the municipalities of the SP.

The topics of congenital syphilis and children exposed to syphilis compose the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. Such document was elaborated based on scientific evidence and validated in discussions with specialists. This article provides guidelines for syphilis in pregnant women and congenital syphilis clinical management, emphasizing the vertical transmission of Treponema pallidum prevention. Epidemiological and clinical aspects of these infections are presented and recommendations for managers in the programmatic and operational management of syphilis. The article also includes guidelines for health professionals in screening, diagnosing, and treating people with sexually transmitted infections and their sex partners, in addition to strategies for surveillance actions, prevention, and control of the disease., Highlighted excerpt: Most congenital syphilis cases arise from test failures in prenatal care or inadequate or no treatment of maternal syphilis.

Issue In the state of São Paulo (SSP), the rate of mother-to-child transmission of HIV (MTCT) was estimated at 2.7%, in 2006. However, for reaching elimination, its level should be Description of the Problem The occurrence of MTCT cases shows failures of healthcare system. The aim of this study was to assess the response of the Sao Paulo State STI/AIDS Program to prevent MTCT, from 2010 to 2018. A descriptive analysis of clinical monitoring indicators of the PWLH was performed. The National Surveillance Data System was used to estimate the underreporting of cases. Data from antiretroviral drug delivery, viral load (VL) and genotyping results were used to calculate the indicators and were obtained through database of the National Antiretroviral Drug System, Laboratory Control System and Genotyping System. Results In the period, despite identifying 15,463 PWLH in the systems, only 11,316 were notified (26.8% underreporting). Comparing 2010 and 2018, there was an improvement in accessing combined antiretroviral therapy (cART) from 81.2% (1,366/1,683) to 86.6% (1,543/1,782); in performing of VL before delivery from 70.8% (1.192/1.683) to 72.8% (1.298/1.782); in VL suppression Lessons The decrease in the number of cases suggests improvement in preventing MTCT in the SSP. However, many challenges remain, such as breaking down individual, social and programmatic barriers to expand access to cART, pretreatment genotyping, VL suppression before delivery, retention in care and adherence to cART over time. Key messages The National Systems of surveillance, antiretroviral drugs, laboratory and genotyping network are important for performing clinical monitoring, reducing treatment gaps and underreporting. The integration of the Sexually Transmitted Infections and HIV/AIDS Program with the Primary Care and the Maternal and Child Health Program is essential to achieve the goals of eliminating MTCT.

Background To estimate median survival time of AIDS patients, with and without tuberculosis (TB), in a cohort in Sao Paulo, Brazil, and to investigate survival predictors. Methods Retrospective cohort study of AIDS patients above 12 years old, registered at the Ministry of Health AIDS surveillance system between 2003-2007, and followed until 2014. Survival analysis used the Kaplan-Meier method and Cox proportional hazards model to estimate hazard ratios (HR), with respective 95% confidence intervals (CI = 95%). Results 35,515 patients were included, being 4,581 (12.9%) co-infected with TB. Among the latter, probability of survival 12 years after AIDS diagnosis was 95.2%, 82.9%, and 21.9%, respectively for patients receiving at least one third line ARV (HAART2), receiving triple therapy (HAART1) and the last one not on ARV. In the same period, the probability of survival for patients without TB, in the same order as for the therapeutic regimens, was 95.2%, 90.5%, and 40.9%, respectively. The main factors associated with survival, adjusted for the year of diagnosis, were: Living in the city of Sao Paulo (HR = 1,16;IC95% 1,01-1,32), living away from the capital city (HR = 1.43; 95%CI 1.25-1.62); or on the coast (HR = 1.49; 95%CI 1.21-1.82); having TB (HR = 1.70; 95%CI 1.49-1.87); above 49 years old (HR = 1.35; 95%CI 1.18-1.54); black (HR = 1.27; 95%CI 1.12-1.45); IV drug use (HR = 1.73; 95%CI 1.49-2.02); CD4+ below 200 cell/mm³ at AIDS diagnosis (HR = 2.31; 95%CI 1.97-2.72); viral load above 500 copies at AIDS diagnosis (HR = 1.99; 95%CI 1.72-2.30); HAART1 scheme (HR = 1.94; 95%CI 1.47-2.55); no ARV (HR = 8.22; 95%CI 2.95-22.87). Conclusions A large proportion of patients did not receive ARVs or were late diagnosed with AIDS, especially those with TB, whose survival was shorter. Survival is heterogeneous in the state, being lower in regions with higher TB rates. The results point to the need for specific strategies for patients with TB-HIV co-infection. Key messages Tuberculosis is the main cause of death among HIV-infected people, being responsible for one third of deaths in this group and causing a great impact on the survival of this population. The Brazilian policy of universal access to ARV and treatment for TB has increased the survival of AIDS-TB from 22% to 95% and in patients without TB from 50% to 95% up to 12 years after diagnosis.

RESUMO: Objetivo: Analisar a evolução, de 2011 a 2017, das taxas de detecção de sífilis notificada por sexo, faixa etária e região de residência no estado de São Paulo (ESP). Métodos: Foi organizada série histórica com dados do Sistema de Informação de Agravos de Notificação (SINAN). Foram descritas as taxas de detecção de sífilis adquirida (TDSA) e de sífilis adquirida incluindo as gestantes com sífilis (TDSAG), por 100.000 hab. Para análise de tendência da evolução das taxas no período estudado, foi empregado o modelo Jointpoint (ponto de inflexão), bem como foram estimadas a variação percentual anual (VPA) por segmento e a média da variação percentual anual (MVPA), com os respectivos intervalos de confiança de 95% (IC95%). Resultados: Foram notificados 205.424 casos de sífilis adquirida e sífilis em gestantes no período. Entre 2011 e 2017, a TDSA por 100 mil habitantes variou de 26,0 a 84,6 e a TDSAG por 100 mil habitantes, de 33,7 a 108,9; a tendência foi crescente em ambas as curvas e identificou-se um ponto de inflexão dividindo a curva de TDSA e de TDSAG em dois períodos: de 2011 a 2013 e de 2013 a 2017. A MVPA encontrada da TDSA foi de 21,0% (IC95% 15,7 ‒ 26,4) e da TDSAG, de 21,2% (IC95% 16,4 ‒ -26,1). Nas faixas etárias até 24 anos ocorreu crescimento expressivo em ambos os sexos. Observou-se heterogeneidade na evolução das taxas segundo região do Estado. Conclusões: A tendência crescente das taxas de detecção de sífilis adquirida pode ser atribuída a melhor adesão à notificação e ao acometimento desproporcional dos jovens. ABSTRACT: Objective: To analyze how syphilis detection rates evolved from 2011 to 2017 according to sex, age and place of residence in the state of São Paulo. Methods: A historical series was organized with data from the Notification Disease Information System. The acquired syphilis detection rates (ASDR) per 100,000 inhabitants and the acquired syphilis detection rates including pregnant women with syphilis (PASDR) per 100,000 inhabitants were described. For a trend analysis of the rates in the studied period, the Poisson Jointpoint (inflection point) model was performed, and the annual percentage change (APC) per segment and the average annual percentage change (AAPC) were estimated, with respective 95% confidence intervals (95%CI). Results: A total of 205,424 cases of acquired syphilis and syphilis in pregnant women in the period were reported. The ASDR per 100,000 inhabitants ranged from 26.0 to 84.6 between 2011 and 2017 and the PASDR per 100,000 inhabitants ranged from 33.7 to 108.9; the trend was increasing in both, and an inflection point was identified dividing the ASDR and PASDR curve into two periods: 2011 to 2013 and 2013 to 2017: the AAPC found for ASDR was 21.0% (95%CI 15.5 ‒ 26.4) and the PASDR was 21.2% (95%CI 16.4 ‒ 26.1), in the age groups up to 24 years old, there was a significant growth in both sexes. A heterogeneity in the evolution of rates by region of the state was observed between 2011 and 2017. Conclusions: The increasing trend in acquired syphilis detection rates can be attributed to better adherence to notification and disproportionate involvement of young people.

To analyze how syphilis detection rates evolved from 2011 to 2017 according to sex, age and place of residence in the state of São Paulo.A historical series was organized with data from the Notification Disease Information System. The acquired syphilis detection rates (ASDR) per 100,000 inhabitants and the acquired syphilis detection rates including pregnant women with syphilis (PASDR) per 100,000 inhabitants were described. For a trend analysis of the rates in the studied period, the Poisson Jointpoint (inflection point) model was performed, and the annual percentage change (APC) per segment and the average annual percentage change (AAPC) were estimated, with respective 95% confidence intervals (95%CI).A total of 205,424 cases of acquired syphilis and syphilis in pregnant women in the period were reported. The ASDR per 100,000 inhabitants ranged from 26.0 to 84.6 between 2011 and 2017 and the PASDR per 100,000 inhabitants ranged from 33.7 to 108.9; the trend was increasing in both, and an inflection point was identified dividing the ASDR and PASDR curve into two periods: 2011 to 2013 and 2013 to 2017: the AAPC found for ASDR was 21.0% (95%CI 15.5 ‒ 26.4) and the PASDR was 21.2% (95%CI 16.4 ‒ 26.1), in the age groups up to 24 years old, there was a significant growth in both sexes. A heterogeneity in the evolution of rates by region of the state was observed between 2011 and 2017.The increasing trend in acquired syphilis detection rates can be attributed to better adherence to notification and disproportionate involvement of young people.Analisar a evolução, de 2011 a 2017, das taxas de detecção de sífilis notificada por sexo, faixa etária e região de residência no estado de São Paulo (ESP).Foi organizada série histórica com dados do Sistema de Informação de Agravos de Notificação (SINAN). Foram descritas as taxas de detecção de sífilis adquirida (TDSA) e de sífilis adquirida incluindo as gestantes com sífilis (TDSAG), por 100.000 hab. Para análise de tendência da evolução das taxas no período estudado, foi empregado o modelo Jointpoint (ponto de inflexão), bem como foram estimadas a variação percentual anual (VPA) por segmento e a média da variação percentual anual (MVPA), com os respectivos intervalos de confiança de 95% (IC95%).Foram notificados 205.424 casos de sífilis adquirida e sífilis em gestantes no período. Entre 2011 e 2017, a TDSA por 100 mil habitantes variou de 26,0 a 84,6 e a TDSAG por 100 mil habitantes, de 33,7 a 108,9; a tendência foi crescente em ambas as curvas e identificou-se um ponto de inflexão dividindo a curva de TDSA e de TDSAG em dois períodos: de 2011 a 2013 e de 2013 a 2017. A MVPA encontrada da TDSA foi de 21,0% (IC95% 15,7 ‒ 26,4) e da TDSAG, de 21,2% (IC95% 16,4 ‒ -26,1). Nas faixas etárias até 24 anos ocorreu crescimento expressivo em ambos os sexos. Observou-se heterogeneidade na evolução das taxas segundo região do Estado.A tendência crescente das taxas de detecção de sífilis adquirida pode ser atribuída a melhor adesão à notificação e ao acometimento desproporcional dos jovens.

Background The objective was to analyze the trends of AIDS cases and HIV infection cases among man who have sex with man (MSM) adults versus young people (15–24 years old) in the period from 2007 and 2017. Methods A trend study using polynomial regression models carried out with AIDS cases and HIV+ cases compared among MSM adults and young people (15–24 years old) in the period from 2007 to 2017. The annual number of AIDS cases and HIV+ cases was considered as the dependent variable (Y), regarding the studied categories, and time was the independent variable (X), represented by calendar years. The goodness of fit via r² and p Results 88,025 AIDS cases were analyzed versus 70,753 HIV+ cases in adult men. For AIDS cases a decreasing trend was observed with first-order modeling [Y=−205x+9,235; r²=0.83; p=0.039]; however for HIV+ the trend was increasing [Y=547x+3,147; r²=0.95; p Conclusion The total number of cases of HIV+ men exceeded AIDS cases in 2014. However, among MSM-HIV+, the overcoming point was earlier in 2010, and among young people the overcoming point was earlier, before 2007. Among the MSM the trends of HIV and AIDS infection are markedly increasing among young people, highlighting the greater vulnerability of young MSM in Brazil in need of early HIV testing and timely treatment. Disclosure No significant relationships.

Background In the Sao Paulo State (SPS), the AIDS epidemic decreased among women, due to early diagnosis, antiretroviral use and prevention. This study aimed to analyze the trends of women living with AIDS (WLWA) and the HIV infection in pregnant women (PW-HIV) in the Sao Paulo City (SPC) and SPS, according to race/skin-color, from 2007–2016. Methods Trend study using polynomial regression models performed with reported cases of WLWA and PW-HIV compared to SPC and SPS according to race/skin-color and diagnosis period. The annual number of WLWA and PW-HIV in each of the categories studied was considered as the dependent variable (Y), and the independent variable (X) was the time, represented by the calendar years, referring to the study period. The goodness of fit via r² and p Results In the period from 2007–2016, 18,571 AIDS cases in the SPS and 7,078 in the SPC reported among women were analyzed. In the SPS, WLWA presented a decreasing linear trend with first order modeling, with a higher fall rate among white women [Y=1,093–101X;r²=0.97;p Conclusion To reduce the social inequalities, the care network must discuss specific strategies to improve the access to health care services and antenatal care services for black and mixed color/race WLWA and PW-HIV, prevention measures, sexual and reproductive health care, including access to long-acting contraceptives. Disclosure No significant relationships.

Background Congenital syphilis (CS) is a preventable condition. However, in 2017, 4,039 cases were reported in Sao Paulo State (SPS), with an incidence rate of 6.6 cases/1,000 live births (LB). In 2018, SPS proposed the “95-95-95” goals to reduce CS: 95% of all pregnant women (PW) with timely diagnosis during antenatal care (ANC), 95% of all with timely diagnosis receiving treatment and 95% of all babies from treated PW-syphilis, born without CS. This study aimed evaluates the pregnancy syphilis cascade of care and the “95-95-95” goals for reducing CS in SPS, 2017. Methods Ecological study, using reported cases of PW-syphilis and CS. The cascade of PW-syphilis care was estimated considering five columns. First column: number of PW-syphilis, calculated considering an estimated prevalence of 2.1% of syphilis in PW; and for the total population of PW, was considered the number of LB increased by 10% for fetal losses. Second: PW-syphilis diagnosed during ANC or delivery. Third: PW-syphilis linked to ANC with timely diagnosis. Fourth: PW-syphilis properly treated. Fifth: potentially avoided CS cases. Results Were estimated 14,369(100%) PW-syphilis, of these, 82.6% (N=11,875) were diagnosed during ANC or delivery; 73.8% (N=10,606) linked to ANC with timely diagnosis; 66.1% (N=9,500) treated and 54.5% (N=7,836) CS cases avoided. For the “95-95-95” goals, SPS reached the following levels: 89.3% (N=10,606/11,875) of PW-syphilis with diagnosis during ANC; 89.6% (N=9,500/10,606) were timely treated and 82.5% (N=7,836/9,500) of babies born without CS. Conclusion Prevention actions should be intensified to improve access and qualification of ANC. Specifically: wide screening coverage, availability of medication for the timely treatment and reproductive planning. These challenges can be overcome with an agenda of priorities and political commitment. The integration of STI/HIV/AIDS and maternal-child health programs, as well as the strengthening of primary care, is essential for the sustainability, duration and success of interventions aimed to the CS elimination. Disclosure No significant relationships.

Background Congenital syphilis (CS) is still considered a public health problem in the state of Sao Paulo, Brazil: 4,039 cases were reported in 2017 -incidence rate = 6.6 per 1,000 live births. The objective of this study was to investigate the evaluation of CS cases in 2007 and 2017 in the state of Sao Paulo. Methods A descriptive study was carried out with the data of national surveillance system in the period 2007 to 2017. Of the following evaluation tests performed the percentage of non-performed and positive results were calculated: - Venereal Disease Research Laboratory (VDRL) on the serum; - long-bone radiography; -cerebrospinal fluid (CSF) for cell count and protein; - CSF for VDRL. Results From 2007 to 2017, 21,524 cases of CS born alive were reported: 743 in 2007 and 3,687 in 2017. The percentage of non-performed and positive tests in 2007 and 2017, and the percentage variation (PV) between the two years were: - non-performed - VDRL on the serum (4.0% and 1.8%, PV = −56.3%), CSF for VDRL (23.4% and 21.4%, PV = −7.1), CSF for cell count and protein (23% and 21,4%: PV = 7,1%), long-bone radiography (13,7% and 9.9%, PV = −27.9%); - positive results - VDRL on the serum (59.1% and 81.1%; PV = 37.3%), CSF for VDRL (1.3% and 3.5%; PV = 157.9%), CSF for cell count and protein (1.6% and 10.1%: PV = 523%), long-bone radiography (2.6% and 3.5%, PV = 36.8%). Conclusion There was an improvement in adherence to the CS evaluation protocol. In addition, we highlight the increase in the percentage of altered tests of children born alive in the period, pointing to the greater severity of the cases, and the need of improving the monitoring of these children in order to reduce the impact of congenital syphilis. Disclosure No significant relationships.

Introduction To analyse congenital syphilis (CS) between 2007 and 2014, and case profile in 2014 in the state of Sao Paulo (SSP). Methods Ecological descriptive study; sources: SINAN (cases) and Fundacao Seade (live births-LB population). Results 24 684 cases of syphilis in pregnancy (PS) and 12 479 of CS reported in the period. PS detection rate and CS incidence rate increased 2.8 times (3.5 to 9.9/1,000 LB) and 2.4 times (2.0 to 4.8/1,000 LB) in 2010 and 2014, respectively. There were 132 infant deaths and 1051 stillbirths and miscarriages by syphilis, about 9.5% (1,183) of total cases. In 2014, 29% (870/2,989) of CS cases did not complete clinical and laboratory protocol (no long bone x-ray or CSF) and 17% (499/2,989) did not comply with treatment protocol. About 20% (612/2,989) of mothers were ≤19 years old, 75% (2,244/2,989) underwent antenatal care (AN) and of these, 71% (1,597/2,244) were diagnosed with syphilis. Although most mothers had access to AN diagnosis of syphilis during pregnancy, the vertical transmission chain was not interrupted. It is emphasised that 55% (1,632/2,989) of the mother’s treatment was considered inadequate, because the sexual partner was not treated (74%, 2,203/2,989). Conclusion Albeit preventable, CS remains a public health problem with failures, especially during AN. Early diagnosis and treatment up to the 20th week of pregnancy can reduce fetal loss and prevent infant deaths. The case definition is sensitive considering the treatment of sexual partner in the mother’s treatment classification. The public health challenge is to increase coverage and quality of AN, expand diagnosis and treatment of women and sexual partners in primary care services, and prevent STDs, especially in vulnerable women. To identify determinants of transmission and foster interventions, CS cases have been investigated using specific protocols and discussed in regional and municipal committees. The SSP proposed using Mother and Child Mortality Committees to discuss the cases, given they have already been established and are operating regularly.

Objective We examine the trend in causes of death among people living with AIDS in the city of Sao Paulo, Brazil, in the periods before and after the introduction of highly active antiretroviral therapy (HAART), and we investigate potential disparities across districts of residence. Methods Descriptive study of three periods: pre-HAART (1991–1996); early post-HAART (1997–1999); and late post-HAART (2000–2006). The data source was the Sao Paulo State STD/AIDS Program and Sao Paulo State Data Analysis Foundation. Causes of death were classified by the ICD-9 (1991–1995) and ICD-10 (1996–2006). We estimated age-adjusted mortality rates for leading underlying causes of death and described underlying and associated causes of death according to sociodemographic characteristics and area of residence. We used Pearson's chi-square test or Fisher's exact test to compare categorical variables. Areas of residence were categorized using a socioeconomic index. To analyze trends we apply generalized linear model with Poisson regression. Results We evaluated 32,808 AIDS-related deaths. Between the pre- and late post-HAART periods, the proportion of deaths whose underlying causes were non-AIDS-related diseases increased from 0.2% to 9.6% (p

BACKGROUND: HIV infection in children is an important public health problem in the world mainly in poorer countries. If all recommendations are followed the elimination of HIV vertical transmission is a concrete possibility. This study aims to estimate vertical transmission rates of HIV in Sao Paulo State Brazil based on pregnant women diagnosed and reported in 2006 identifying potentially associated factors. METHODS: This study involves a retrospective cross-sectional analysis of information systems and records of infected pregnant women and children exposed to HIV. The rate of vertical transmission was estimated and variables associated with the antenatal delivery and postnatal periods were analyzed by the chi-square test and Fisher exact test was used for variables with an expected frequency

Resumo O artigo sintetiza o capítulo sobre vigilância epidemiológica das infecções sexualmente transmissíveis (IST), que compõe o Protocolo Clínico e Diretrizes Terapêuticas (PDCT) para Atenção Integral às Pessoas com IST 2020, publicado pela Secretaria de Vigilância em Saúde, do Ministério da Saúde do Brasil. São apresentadas algumas reflexões sobre as novas definições de caso, para vigilância da sífilis adquirida, sífilis em gestantes e sífilis congênita. O PCDT-IST 2020 foi elaborado com base em evidências científicas e validado em discussões com especialistas. Também são abordados aspectos epidemiológicos e clínicos, bem como orientações para gestores no manejo programático e operacional desses agravos, e para profissionais de saúde na triagem, diagnóstico e tratamento das pessoas com IST e suas parcerias sexuais, além de estratégias de ação para a vigilância, prevenção e controle. Abstract This article summarizes the chapter on epidemiological surveillance of sexually transmitted infections (STI) that forms part of the Clinical Protocol and Treatment Guidelines (PDCT) for Comprehensive Care for People with STI 2020), published by the Health Surveillance Secretariat of the Ministry of Health of Brazil. It presents some reflections on the new case definitions for surveillance of acquired syphilis, syphilis in pregnant women and congenital syphilis. The PCDT-IST 2020 was developed based on scientific evidence and validated in discussions with specialists. Epidemiological and clinical aspects are addressed, as well as guidelines for health service managers regarding programmatic and operational management of these diseases, guidelines for health professionals on screening, diagnosing and treating people with STIs and their sex partners, in addition to strategies for surveillance, prevention and control actions. Resumen El artículo resume el capítulo sobre Vigilancia Epidemiológica de las Infecciones de Transmisión Sexual (ITS) que compone el Protocolo Clínico y Directrices Terapéuticas para Atención Integral a las Personas con Infecciones de Transmisión Sexual 2020 (PCDT-ITS 2020), publicado por la Secretaría de Vigilancia Sanitaria del Ministerio de Salud de Brasil y presenta algunas reflexiones sobre las nuevas definiciones de casos de la vigilancia de sífilis adquirida, sífilis en gestantes y sífilis congénita. El PCDT-ITS 2020 fue elaborado en base a la evidencia científica y validado en discusiones con especialistas. En este artículo, se presentan aspectos epidemiológicos y clínicos, así como pautas para los gerentes en el manejo programático y operativo de estas enfermedades, a los profesionales de la salud en la detección, diagnóstico y tratamiento de personas con ITS y sus parejas sexuales, además de estrategias para acciones de vigilancia, prevención y control.