Treatment Outcomes of Brazilian Inmates with Treponema pallidum and Human Immunodeficiency Virus Infection: A Prospective Cohort Study

Abstract

A prospective cohort study was conducted to evaluate the incidence and treatment outcomes of syphilis and human immunodeficiency virus (HIV) in inmates from Central Brazil. In 2013, 3,363 inmates from 12 prisons in the state of Mato Grosso do Sul were recruited, and 1,614 remained incarcerated after 1 year. The inmates were interviewed, and blood samples were collected for serological testing for and HIV infections. Inmates infected with or HIV within the first year were assessed for treatment using prison medical record data, based on Venereal Disease Research Laboratory test results, HIV-1 viral load, and CD4 counts. Acquired syphilis was identified in 5.8% ( = 95) of the inmates and 74% ( = 70) of them demonstrated poor treatment outcomes after 1 year. Multivariate analysis revealed that not reporting a stable partner was a risk factor for failure of syphilis treatment. Twenty-five patients had HIV (1.5%) and among those, 13 (52%) had an HIV-1 viral load > 200 copies/mL after 1 year. The incidence of and HIV infections was 0.5% ( = 9). The poor treatment outcomes of syphilis and HIV within Brazilian prisons demonstrate the inadequacy of public health programs. Although the incidence of these infections within the prison population is low, new cases still occur. Our results reinforce the significance of screening programs during prison admission for early detection and treatment of sexually transmitted infections.

A systematic review and meta-analyses on initiation, adherence and outcomes of antiretroviral therapy in incarcerated people

“…Thirty (71%) of the studies were from high-income countries; USA (18), Canada (5) and Europe (7) while the remaining twelve (29%) were from low-and middle-income countries; Asia (5), sub-Saharan Africa (5) and Latin America (2). 41% (17) of the studies were cross-sectional [5,11,16,23,25,26,[45][46][47][48][49][50][51][52][53][54][55], 38% (16) cohort (14 retrospective and 2 prospective) [4,9,15,17,[19][20][21][56][57][58][59][60][61][62][63][64] and 19% (8) qualitative [12-14, 28, 65-68] in study design. One study employed mixed methods [22].…”

“…One study employed mixed methods [22]. Fifteen studies reported on linkage to HIV care or ART initiation or both [5, 9, 11, 12, 22, 23, 45-50, 55, 65, 66] (Table 1), sixteen on adherence [12-15, 17, 20, 25, 26, 28, 45, 51, 52, 55, 56, 67, 68] (Table 2) and twenty on CD4 count or viral load or both [4,5,16,17,19,21,23,25,51,53,54,[56][57][58][59][60][61][62][63][64] (Table 3). Nine studies reported more than one element of the HIV care cascade and hence were included in more than one category [5,12,17,23,25,45,51,55,56].…”

“…The cut-off for viral suppression also varied greatly among studies, ranging from <40copies/mL [56,69] to <500copies/mL [17,21]. Eight studies used <400copies/mL [4, 19, 58-61, 63, 64] and four used <200copies/mL [5,16,57,62]. In this review, we dichotomised the outcomes based on the highest cut off values used in the included studies; adherence <100% as a threshold for non-adherence and viral load <500 copies/mL for viral suppression.…”

“…In the studies that investigated the association between re-incarceration and ART outcomes [4,60,61], a statistically significant increase in viral load and decrease in CD4 count was observed among people with episodes of re-incarceration. Eight studies reported the overall rate of viral suppression during incarceration [19,23,25,27,54,62,64,69], which ranged from 46% in Spain [25] and Brazil [62] to 95% in Malawi [69]. Four of these studies reported on CD4 count; two measuring mean and median CD4 count (381cells/mm 3 and 356 cells/mm 3 , respectively) [19,27], and the other two reporting change in CD4 count within 6-months of ART commencement (119.71 ± 29.75 cell/mm 3 ) and the percentage of inmates with CD4 count >200 cells/mm 3 (91%) [23,25].…”

Política de saúde prisional brasileira: uma revisão integrativa

“…Nessa perspectiva, Carvalho et al (58), em estudo com homens privados de liberdade no estado do Piauí, identificou que as ações em saúde se limitavam a exames de HIV/DST e TB; exames de rotina; imunizações; e administração de medicações em caso de doenças. Contudo, é preciso ponderar que, pela elevada prevalência de DST em tal parcela da população, a vigilância constante é necessária, em especial pelo pouco acesso das PPL aos serviços de saúde fora da prisão, o que se compreende extensivo às demais patologias (17,59). relacionadas ao assunto escassas.…”