Introduction Few results from programmes based on combination prevention methods are available. We propose to analyse the degree of protection provided by postexposure prophylaxis (PEP) for consensual sexual activity at healthcare clinics, its compensatory effects on sexual behaviour; and the effectiveness of combination prevention methods and pre-exposure prophylaxis (PrEP), compared with exclusively using traditional methods. Methods and analysis A total of 3200 individuals aged 16 years or older presenting for PEP at 5 sexually transmitted disease (STD)/HIV clinics in 3 regions of Brazil will be allocated to one of two groups: the PEP group—individuals who come to the clinic within 72 h after a sexual exposure and start PEP; and the non-PEP group—individuals who come after 72 h but within 30 days of exposure and do not start PEP. Clinical follow-up will be conducted initially for 6 months and comprise educational interventions based on information and counselling for using prevention methods, including PrEP. In the second study phase, individuals who remain HIV negative will be regrouped according to the reported use of prevention methods and observed for 18 months: only traditional methods; combined methods; and PrEP. Effectiveness will be analysed according to the incidence of HIV, syphilis and hepatitis B and C and protected sexual behaviour. A structured questionnaire will be administered to participants at baseline and every 6 months thereafter. Qualitative methods will be employed to provide a comprehensive understanding of PEP-seeking behaviour, preventive choices and exposure to HIV. Ethics and dissemination This study will be conducted in accordance with the resolution of the School of Medicine Research Ethics Commission of Universidade de São Paulo (protocol no. 251/14). The databases will be available for specific studies, after management committee approval. Findings will be presented to researchers, health managers and civil society members by means of newspapers, electronic media and scientific journals and meetings.
Counseling and testing centers constitute a set of heterogeneous services. In addition, service implementation guidelines have not been completely incorporated in Brazil, thus having and influence on low resolution and productivity indicators and also the inadequate development of prevention activities.
IntroductionSao Paulo (SP) state has 43 million inhabitants, 645 cities, 251.133 reported AIDS cases and a 0.6%HIV prevalence. In SP 4 in 10 HIV diagnosed individuals’ access care with delay.MethodsConducting state testing campaigns annually is one of its main strategies to expand the offer of testing in the primary care health services especially in medium and small municipalities, besides the offer to pregnant women. The goal is to increasing the proportion of people tested once in life from 39.7% (2004) to 80% in 2017.ResultsApproximately 3 million tests, including HIV and syphilis, were conducted in nine annual testing campaigns, of which 60% are HIV tests and 40% syphilis tests since 2014. An average of 130,000 HIV tests of the public health sector are billed in monthly. The number of municipalities involved rose from 376 (58%) to 576 (89%) between 2008/2016. Some results are very similar in all campaigns. The proportion of people tested for the first time revolves around 50%, being always highest among males. The proportion of HIV positive identified is also quite stable and is around 0.45%. By introducing rapid testing initially this strategy reached the level of 1.7% of HIV positive cases in 2010, gradually falling until 2016, reaching 0.4%. The campaigns implementation in all nine years included a preparatory phase pacts in areas of management meetings and incorporated strategies for distance education and subsequent on-line monitoring.ConclusionThe HTC have amplified the access to HIV tests due to the expansion of spontaneous demand for testing services in primary care, especially in medium and small towns. Besides, campaigns arrangements are improving greater integration of primary care and STD/AIDS health programs, contributing for reducing the stigma related to AIDS and HIV testing in the population. Other complementary HIV testing strategies focused on vulnerable populations, conducted by health professionals, are easier to implement when already implemented in services routines.
IssueSao Paulo has 43 million inhabitants, 645 cities, 251.133 reported AIDS cases. Despite the HIV low prevalence in our state (0.5%). The HIV rapid diagnostic testing method (RDT HIV) universal implementation is considered a very important strategy to increase access of vulnerable populations to HIV diagnosis together with other focused strategies. The goal was to implement the RDT HIV in at least one health public service in all 645 municipalities. In Brazil, we have the Health Unic System SUS as an universal public health system.DescriptionBetween 2006–2016, around 500 trainers trained approximately 10.000 health professionals. From 2010 to 2016, the STD/AIDS Program Coordination trained 800 facilitators during the decentralisation process. In 2016 586 municipalities implemented RDT HIV besides conventional testing (91%); 60% in primary care units. As proxy of HIV performance, we focus HIV annual campaigns carried out in the state since 2008 considering the majority adherence of municipalities (91% in 2016) and health services. 7000 rapid diagnostic HIV tests in 2008;18 000 in 2009; 35 000 in 2010; 40 000 in 2011; 40 000 in 2012; 1 56 000 in 2013; 2 47 000 in 2014; 2 51 000 in 2015.Lessons learned:Training of professionals through the training of trainers has boosted the implementation of HIV RDT. Monitoring RDT HIV implementation through five macro-regional meetings was fundamental to find out and discuss local obstacles to offer access to HIV testing without having to schedule. Most vulnerable population for HIV continues to seek out ST/AIDS referral services for testing. Primary health care health workers have difficulty delivering positive HIV test results. Performing extra-mural actions is easier when the health unit has already implemented the test in its routine.New stepsPriorities for 2017: Continue the implementation process among all primary health care services. Expand and focus HIV testing In places of concentration and socialisation of more vulnerable groups such as gays and transvestites. Support outreach-testing activities by NGOs.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.