Na cidade de São Paulo, os serviços de Atenção Primária à Saúde (APS) atuam nos modelos do Programa de Saúde da Família (PSF) e da Programação em Saúde. Ambos envolvem a questão da integralidade. O objetivo deste trabalho é avaliar processos de integralidade em unidades de APS localizadas no Município de São Paulo, sob o ponto de vista dos usuários dos serviços. As categorias de avaliação consideradas foram acessibilidade, porta de entrada, vínculo, elenco de serviços, coordenação, enfoque familiar, e orientação comunitária. Foram comparados os dois modelos de organização dos serviços na APS presentes no Município. O Questionário adaptado do Primary Care Assessment Tool (PCATool) foi aplicado a uma amostra de usuários dos dois modelos de APS. Os resultados principais apontaram para o bom desempenho nas categorias de porta de entrada, elenco de serviços e coordenação. Enfoque familiar, orientação comunitária e acessibilidade receberam as piores avaliações. Diferenças significantes entre os dois modelos envolvem melhor registro em prontuário, melhores atividades orientadas à comunidade, menor referenciamento ao especialista e horário de atendimento mais adequado no modelo do PSF. Questões mais imediatamente relacionadas à prestação direta de serviços foram mais bem avaliadas, enquanto as relacionadas com a organização e a cultura dos serviços receberam piores pontuações.

Home-based self-collection and self-testing was acceptable, feasible, and resulted in a slightly higher response rate. Home sampling and testing provide promising alternatives to clinic-based STI screening across diverse contexts.

there was a high prevalence of HIV co-infection in the service analyzed, disproportionately affecting MSM who were notified with acquired syphilis.

Summary We determined the prevalence, distribution and correlates of human papillomavirus (HPV) types in 386 mixed-income, sexually active women in São Paulo, Brazil. Endocervical samples were tested for HPV DNA with L1 primers MY09 and MY11; negative and indeterminate samples were retested using GP 5+/6+ consensus primers. HPV was detected in 35% of all women; high-risk/probable high-risk types in 20%; low-risk types in 7%; and an indeterminate type in 10%. Twenty-five HPV types were found overall: 17 (probable) high-risk types and eight low-risk types. Approximately one-third (29%) of women with HPV infection were positive for type 16 or 18 and 36% were positive for types 6, 11, 16 or 18. The presence of (probable) high-risk HPV was associated with younger age, more lifetime sex partners and abnormal vaginal flora. Additional studies mapping the distribution of HPV types worldwide are necessary to prepare for vaccination programmes and direct future vaccine development.

The high prevalence found among these women indicates the need for the implementation of STI screening strategies in primary care settings in Brazil.

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Collecting accurate information on sexual behavior is vital for monitoring HIV and other STI risk and for evaluating interventions to reduce disease transmission. The use of audio computer-assisted self-interviewing (audio-CASI) provides more privacy than interviewer-administered questionnaires, and therefore may offer a means of improving measurement of sensitive or stigmatized behaviors. Numerous U.S. studies have found that significantly higher levels of sensitive and, in some cases, illegal behaviors (e.g., obtaining an abortion, engaging in same-gender sex, injection drug use or violent behavior) were reported using audio-CASI than in face-to-face interviews or paperand-pencil self-administered questionnaires. [1][2][3][4][5] Studies using audio-CASI have been conducted in a number of developing countries, including Kenya,6,7 Malawi, 8 Zimbabwe, 9 Thailand, 10,11 India, 12 Vietnam, 13 Brazil 14,15 and Mexico. 16 While computerized interviewing generally yielded higher reporting of risky behaviors than did standard face-to-face interviews in these studies, the findings were not always as compelling as those from studies conducted in the United States. In the developing world, effective use of computers for reporting sensitive behavior appears to depend in part on the types of questions asked, the setting and the study population.In addition to the many studies that have examined the effect of interview mode on reporting of sensitive behavior, a substantial body of research has assessed the consistency of self-reports in U.S. surveys, both within a single interview and, more commonly, across interviews in longitudinal surveys. These analyses revealed that discrepancies in reporting were not random. Rates of inconsistency varied by respondent characteristics, such as gender, race, education and cognitive ability, as well as by the sensitivity of, or stigma associated with, the activity being reported; 17-20 that is, more stigmatized behaviors were associated with higher rates of inconsistency. 19,[21][22][23] Few studies have been conducted on the consistency of selfreports in developing countries, 23,24 and we are aware of only one that has explored the effect of interview mode on consistency of reporting. 6 We conducted a randomized study of audio-CASI versus face-to-face interview reporting of reproductive behavior, sexual behavior, contraceptive use, prior STI infection, and alcohol and drug use among women in São Paulo, Brazil. In a previous analysis, we found that audio-CASI produced higher reporting of risky sexual behavior than did face-toface interviews at the enrollment visit. Moreover, stronger associations between risky behavior and STI infection were observed in data collected via the audio-CASI mode, with STI-positive women being more likely to underreport risky

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.