Point-of-care screening for syphilis and HIV in the borderlands: challenges in implementation in the Brazilian Amazon

Ruffinen, Carole Zen; Sabidó, Meritxell; Bermúdez, Ximena Pamela Díaz; Lacerda, Marcus; Mabey, David; Peeling, Rosanna W.; Benzaken, Adèle Schwartz

doi:10.1186/s12913-015-1155-y

Cited by 17 publications

(38 citation statements)

References 24 publications

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“…To achieve better results for the HIV epidemic in this region, these barriers should be addressed using innovative interventions, such as point-of-care HIV testing and VL counts. [ 25 , 26 ]…”

Section: Discussionmentioning

confidence: 99%

Sociodemographic determinants of attrition in the HIV continuum of care in Brazil, in 2016

2018

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The aim of this study was to identify sociodemographic factors associated with attrition in the 3 steps of the HIV continuum of care related to the 90-90-90 targets – access to diagnosis, treatment initiation, and virologic suppression, in Brazilian adults (15 years or older), in 2016.Programmatic data were obtained from 2 information systems from the Brazilian Ministry of Health, which register all antiretroviral therapy (ART) dispensations and all CD4+ and viral load counts (VL) performed within the country's public health system. The 3 attrition indicators were late presentation to care, defined as a first CD4 count <350 cells/mm3 among ART-naive individuals who performed a first CD4+ count in 2016; not being on ART, defined as having no recorded dispensation within the last 100 days of the year, among those who were linked to care in 2016; and not being virologically suppressed, defined as having the last recorded VL >200 copies/mL in 2016, among those with a recorded VL count who were on treatment for at least 6 months. Association of sociodemographic factors with these indicators was analyzed by unconditional logistic regression analysis.Lower educational level and black/brown/indigenous race/color were associated with worse outcomes in the 3 indicators. Environmental indicators, namely the region, size, and social vulnerability index of the municipality of residence, also played an important role in the models. Younger age was strongly associated with not being on ART and not showing virological suppression.Our findings help identify the barriers in the different stages of the HIV continuum of care, which need to be addressed in order to progress toward the achievement of the 90-90-90 targets.

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Section: Discussionmentioning

confidence: 99%

Sociodemographic determinants of attrition in the HIV continuum of care in Brazil, in 2016

2018

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“…HIV prevalence data were available from 17 studies, including 15 conducted with indigenous peoples and two with Afro-descendants (Garifuna, Honduras) (16, 25–40). Figure 2 shows HIV prevalence data from these 17 studies compared to UNAIDS estimates for the general population (41).…”

Section: Resultsmentioning

confidence: 99%

HIV, syphilis, and viral hepatitis among Latin American indigenous peoples and Afro-descendants: a systematic review

Russell

Nazar

Pino

et al. 2019

Rev Panam Salud Publica

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Objective To identify and summarize existing literature on the burden of HIV, sexually transmitted infections (STIs), and viral hepatitis (VH) in indigenous peoples and Afro-descendants in Latin America to provide a broad panorama of the quantitative data available and highlight problematic data gaps. Methods Published and grey literature were systematically reviewed to identify documents published in English, Spanish, or Portuguese with data collected between January 2000 and April 2016 on HIV, STI, and VH disease burden among indigenous peoples and Afro-descendants in 17 Latin American countries. Results Sixty-two documents from 12 countries were found. HIV prevalence was generally low (< 1%) but pockets of high prevalence (> 5%) were noted in some indigenous communities in Venezuela (Warao) (9.6%), Peru (Chayahuita) (7.5%), and Colombia (Wayuu females) (7.0%). High active syphilis prevalence (> 5%) was seen in some indigenous communities in Paraguay (11.6% and 9.7%) and Peru (Chayahuita) (6.3%). High endemicity (> 8%) of hepatitis B was found in some indigenous peoples in Mexico (Huichol) (9.4%) and Venezuela (Yanomami: 14.3%; Japreira: 29.5%) and among Afro-descendant quilombola populations in Brazil (Frechal: 12.5%; Furnas do Dionísio: 8.4% in 2008, 9.2% in 2003). Conclusions The gaps in existing data on the burden of HIV, STIs, and VH in indigenous peoples and Afro-descendants in Latin America highlight the need to 1) improve national surveillance, by systematically collecting and analyzing ethnicity variables, and implementing integrated biobehavioral studies using robust methodologies and culturally sensitive strategies; 2) develop a region-wide response policy that considers the needs of indigenous peoples and Afro-descendants; and 3) implement an intercultural approach to health and service delivery to eliminate health access barriers and improve health outcomes for these populations.

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“…In our study, syphilis prevalence of 0.65% and 0.36% was reported in CUE and non‐CUE‐users respectively. Compared to the national rates, the Brazilian Amazon registered higher levels of active syphilis, HBV/HBsAg, and HIV in vulnerable population from the triple Brazil‐Colombia‐Venezuela border . A recent rapid test screening of indigenous populations in remote Brazilian Amazon areas showed an overall prevalence of 0.13% for HIV and 1.82% for syphilis …”

Section: Discussionmentioning

confidence: 97%

High rate of seromarkers for HIV, HBV and syphilis among blood donors using confidential unit exclusion, before and after HIV‐NAT implementation at a major public blood bank in the Brazilian Amazon

et al. 2018

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BACKGROUND: Confidential unit exclusion (CUE) was introduced in the 1980's as an additional layer to blood safety, before highly specific and sensitive nucleic acid tests (NAT) for HIV were implemented. The utility of CUE-use in settings that have implemented NAT should be evaluated over time. STUDY DESIGN, METHODS: Cross-sectionalretrospective study carried out from June 2010-November 2015, at Manaus Hemocenter (HEMOAM), Amazonas, Brazil that implemented HIV-NAT in 2012. The HIV, HCV, HBV, HTLV, Chagas disease, and syphilis rates were compared among CUE and non-CUE blood donors, before and after HIV-NAT implementation. RESULTS:Among 287,588 donations, 2,154 (0.75%) were associated with CUE, mainly voluntary donations (64.2%), by repeat donors (58.4%) from young (median age = 31 years), males (84.4%), unmarried (63.1%). CUE-users compared to non-CUE donors (n = 285,434) had higher seropositivity rates to HIV (OR = 6.09, 95% CI: 3.68-10.07, p < 0.001), HBV (anti-HBc OR = 1.81 95% CI: 1.24-2.64, p = 0.004; HBsAg OR = 5.68, 95% CI: 1.78-18.07, p = 0.017), and syphilis (OR = 1.78, 95% CI: 1.05-3.04, p = 0.030). Most (97.2%) discarded blood units associated to CUE was seronegative for all pathogens. Most donations (73.4%) were tested by HIV-NAT and showed four window period donations, positive by HIV-NAT only among non-CUE donors. CONCLUSION:A high rate of transfusion transmissible infections/TTIs was observed at HEMOAM especially in CUE-users. CUE-use offered an additional layer of blood safety by its association with anti-HBc/HBsAg and syphilis that are not covered by NAT. For blood banks in highly endemic areas for HIV and TTI, as HEMOAM, the identification of at risk donors, and the orientation to be tested at proper sites remain a great challenge. W orldwide safe blood transfusions have been continuously challenged by both emerging and known transfusion transmissible infections (TTIs). Brazil, the largest and most populous country in Latin America is also the most affected by HIV/AIDS. From 1980From -2017,810 AIDS cases were reported in the country. 1 In the recent decade, the Brazilian Amazon in the North region has shown an uncontrolled AIDS epidemic with growing prevalence and mortality rates. 1 This expansion sharply contrasts with a stable epidemic with decreased prevalence and mortality in its epicenter, located in Southeast Brazil. 1 A recent 21-year historical series from a major public blood bank from Amazonas State, the Hematology and Hemotherapy Foundation of Amazonas State (HEMOAM), described a significant rate of HIV infection in young male donors, suggesting high-risk, test-seeker behavior and potential risk of HIV transmission by blood transfusion. 2 In the isolated geographic context of Amazonas state where there is a high demand for blood transfusions, the control of an expanding AIDS epidemic and the implementation of safe transfusion procedures are both challenging and represent a critical component for the public health network.From the

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Point-of-care screening for syphilis and HIV in the borderlands: challenges in implementation in the Brazilian Amazon

Cited by 17 publications

References 24 publications

Sociodemographic determinants of attrition in the HIV continuum of care in Brazil, in 2016

Sociodemographic determinants of attrition in the HIV continuum of care in Brazil, in 2016

HIV, syphilis, and viral hepatitis among Latin American indigenous peoples and Afro-descendants: a systematic review

High rate of seromarkers for HIV, HBV and syphilis among blood donors using confidential unit exclusion, before and after HIV‐NAT implementation at a major public blood bank in the Brazilian Amazon

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