The pilot study demonstrates that community health workers, as an integral part of the health care team, are effective agents in providing self-management support to persons with diabetes.
BackgroundSince 2007, Guatemala integrated STI clinical service with an HIV prevention model into four existing public health clinics to prevent HIV infection, known as the VICITS strategy. We present the first assessment of VICITS scale-up, retention, HIV and STI prevalence trends, and risk factors associated with HIV infection among Female Sex Workers (FSW) attending VICITS clinics in Guatemala.MethodsDemographic, behavioral and clinical data were collected using a standardized form. Data was analyzed by year and health center. HIV and STI prevalence were estimated from routine visits. Retention was estimated as the percent of new users attending VICITS clinics who returned for at least one follow-up visit to any VICITS clinic within 12 months. Separate multivariate logistic regression models were conducted to investigate factors associated with HIV infection and program retention.ResultsDuring 2007–2011 5,682 FSW visited a VICITS clinic for the first-time. HIV prevalence varied from 0.4% to 5.8%, and chlamydia prevalence from 0% to 14.3%, across sites. Attending the Puerto Barrios clinic, having a current syphilis infection, working primarily on the street, and using the telephone or internet to contact clients were associated with HIV infection. The number of FSW accessing VICITS annually increased from 556 to 2,557 (361%) during the period. In 2011 retention varied across locations from 7.7% to 42.7%. Factors negatively impacting retention included current HIV diagnosis, having practiced sex work in another country, being born in Honduras, and attending Marco Antonio Foundation or Quetzaltenango clinic sites. Systematic time trends did not emerge, however 2008 and 2010 were characterized by reduced retention.ConclusionsOur data show local differences in HIV prevalence and clinic attendance that can be used to prioritize prevention activities targeting FSW in Guatemala. VICITS achieved rapid scale-up; however, a better understanding of the causes of low return rates is urgently needed.
Although men who have sex with men (MSM) have the highest human immunodeficiency virus (HIV) prevalence in Guatemala, prevention efforts have been focused on other vulnerable populations. Respondent-driven sampling was used to recruit 444 MSM in Guatemala City to explore factors related to HIV testing among MSM. About 56% of participants reported HIV testing in the past 12 months, which was associated with a public MSM status (adjusted odds ratio (AOR) 2.08; 95% CI 1.02–4.26), participating in peer HIV prevention intervention (AOR 3.71; 95% CI 1.86–7.43), having at least one casual male partner (AOR 2.16; 95% CI 1.11–4.20), and practicing only insertive anal sex (AOR 3.35; 95% CI 1.59–7.09). Men with comprehensive HIV knowledge (AOR 2.63; 95% CI 1.38–5.02) were also more likely to have been tested. Further interventions in Guatemala targeting the most hidden MSM are needed.
The Committee on Nutrition of the American Academy of Pediatrics (AAP) last issued a statement in 1986 on the topic of fluoride supplementation for children. The recommendations made at that time recently have been reassessed because of what seems to be an increased incidence of dental fluorosis in children living in the United States. Dental fluorosis appears during tooth formation and is caused by excessive fluoride ingestion, which leads to enamel protein retention, hypomineralization of the dental enamel and dentin, and disruption of crystal formation. The effect is cosmetic only, ranging from barely perceptible white striations or specks to confluent areas of pitting or brownish gray staining. Teeth affected by fluorosis seem to continue to be resistant to dental caries. The main sources of fluoride include fluoridated water, foods or drinks reconstituted or prepared with fluoridated water, dentifrices, and fluoride supplements. Water is not fluoridated to a uniform level throughout the United States, and young children ingest significant but variable amounts of fluoride while brushing their teeth with fluoride-containing toothpaste. Because both of these sources of fluoride are difficult to control, attention has been directed again at the dosage of fluoride supplements to attempt to prevent dental fluorosis. In January 1994, a Dietary Fluoride Workshop sponsored by the American Dental Association was convened to address the issue of dental fluorosis. Although children can receive substantial amounts of fluoride from beverages and dentifrices, the experts at this workshop thought the only source of fluoride that could be easily altered was the supplement prescribed by physicians and dentists.
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