Objective To determine the effectiveness and degree of implementation of interventions for the control of Aedes aegypti in Latin America and the Caribbean (LAC) as reported in scientific literature. Methods We searched MEDLINE, EMBASE, CENTRAL, SOCINDEX, and LILACS, for experimental and observational studies, economic assessments and qualitative experiences carried out in LAC from 2000 to 2016. We assessed incidence and morbimortality of Aedes aegypti‐related diseases and entomological indices: Breteau (containers), House, and Pupae per Person. We used GRADE methodology for assessing quality of evidence. Results Of 1826 records retrieved, 75 were included and 9 cluster randomised clinical trials could be meta‐analysed. We did not identify any intervention supported by a high certainty of evidence. In consistency with qualitative evidence, health education and community engagement probably reduces the entomological indices, as do the use of insecticide‐treated materials, indoor residual spraying and the management of containers. There is low certainty of evidence supporting the use of ovitraps or larvitraps, and the integrated epidemiological surveillance strategy to improve indices and reduce the incidence of dengue. The reported degree of implementation of these vector control interventions was variable and most did not extend to whole cities and were not sustained beyond 2 years. Conclusions We found a general lack of evidence on effectiveness of vector control in the region, despite a few interventions that showed moderate to low certainty of evidence. It is important to engage and educate the community, apart from achieving the implementation of integrated actions between the health and other sectors at national and regional level.

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Background: Our aim was to summarize and compare relevant recommendations from evidence-based CPGs (EB-CPGs). Methods: Systematic review of clinical practice guidelines. Data sources: PubMed, EMBase, Cochrane Library, LILACS, Tripdatabase, and additional sources. In July 2017, we searched CPGs that were published in the last 10 years, without language restrictions, in electronic databases, and also searched specific CPG sources, reference lists, and consulted experts. Pairs of independent reviewers selected EB-CPGs and rated their methodological quality using the AGREE-II instrument. We summarized recommendations, its supporting evidence, and strength of recommendations according to the GRADE methodology. Results: We included 16 EB-CPGs out of 2262 references identified. Only nine of them had searches within the last 5 years and seven used GRADE. The median (percentile 25-75) AGREE-II scores for rigor of development was 49% (35-76%) and the domain "applicability" obtained the worst score 16% (9-31%). We summarized 31 risk stratification recommendations, 21.6% of which were supported by high/moderate quality of evidence (41% of them were strong recommendations), and 16 therapeutic/preventive recommendations, 59% of which were supported by high/moderate quality of evidence (75.7% strong). We found inconsistency in ratings of evidence level. "Guidelines' applicability" and "monitoring" were the most deficient domains. Only half of the EB-CPGs were updated in the past 5 years. Conclusions: We present many strong recommendations that are ready to be considered for implementation as well as others to be interrupted, and we reveal opportunities to improve guidelines' quality.

El objetivo fue describir experiencias, barreras y facilitadores en la implementación de intervenciones de control del Aedes aegypti en América Latina y Caribe. Fue realizado un abordaje cualitativo con entrevistas en profundidad semiestructuradas a expertos en implementación de programas (19 participantes de nueve países). Se utilizó un software para la codificar los datos y se confeccionaron matrices para su comparación. En base a los hallazgos desarrollamos una representación gráfica de dimensiones teóricas que agrupan las barreras y facilitadores para la implementación de intervenciones. A nivel global, el ambiente natural y construido contribuye a la reproducción del mosquito. En el sistema de salud, la falta de priorización del problema y la escasez de recursos materiales y humanos representan los obstáculos más importantes. Se necesita que otros sectores diferentes al de salud se responsabilicen de las acciones para mejorar los determinantes sociales de la salud. Existen barreras transversales relacionadas con la gobernanza, como la descoordinación entre los niveles centrales y locales, falta de continuidad de las intervenciones y de los grupos técnicos. La comunidad enfrenta problemas como la falta de información, pobreza o resistencias a recomendaciones. La opinión pública puede tener un impacto positivo o negativo, influyendo indirectamente en las decisiones políticas. Este estudio propone un marco de dimensiones de análisis construido desde los hallazgos; describe factores influyentes en la implementación de políticas que pueden orientar las acciones futuras desde un enfoque integrado.

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database containing over 18 million lives (ORIZON, Brazilian Private Health Care, Feefor-service) was assessed (from jan/2015 until dec/2016), of patients who underwent a transcatheter aortic valve replacement (n= 84). Records showed expenditure with material, tax, procedures, medication and diagnostics. The average and median with confidence interval of 95% was adopted. Results: 84 patients made use of TAVI and had complete index hospital bills available (the treatment in Brazil are approval only for inoperable and high-risk patients). The averange cost per patient was BRL 231,972 (include the valve and complications), the cost per day was BRL 9,896 (IC95% 5,579-14,213), and the median LOS was 16 days. Almost 55% of cost was related with other expenses (tax, procedure, others materials and medications. ConClusions: Most of the treatment cost were not related with Device for this reason the avoidance clinical complications should improve the LOS and cost treatment of TAVR for high-risk and inoperable patients.

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