RESUMO
Global health faces the triple challenge of preparing for future pandemics while responding to current ones in the midst of a climate crisis. In this commentary, we discuss the heightened focus on pandemic preparedness after the COVID-19 pandemic and the risks that this may pose to addressing the elimination of AIDS, tuberculosis, hepatitis and malaria, established in the Sustainable Development Goals as target 3.3. Considering their interconnections with the climate crisis and advocating for global health justice, we identify impasses that such a dispute over priorities can imply, and comment on four fronts of actions that could contribute convergently to both agendas as well as to facing the consequences of climate change to health: strengthening health systems, global commitment to equitable access to strategic medicines, addressing social inequalities and joining efforts for health and climate justice We conclude that addressing these fronts safeguards the health rights of the most vulnerable to existing epidemics while enhancing readiness for future pandemics. Moreover, solutions must transcend technocratic approaches, necessitating the confrontation of inequalities perpetuated by systems of power and privilege fueling both health and climate crises. Ultimately, health justice should guide responses to this intricate triple global health challenge.
Assuntos
COVID-19 , Mudança Climática , Saúde Global , Pandemias , SARS-CoV-2 , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Justiça SocialRESUMO
The worldwide monkeypox (mpox) outbreak in 2022 showed a high frequency of sexually transmitted infections (STI). A cross-sectional study was carried out using secondary data from the Brazilian official mpox surveillance systems. A total of 10,169 mpox cases were identified, with a median age of 32 years. Among them, 92.3% were male at birth and 57.5% were men who have sex with other men (MSM). Approximately 11% were diagnosed with STI, including 5.8% with syphilis and 2.5% with genital herpes. Individuals aged from 25 to 34 years, MSM, individuals with HIV-positive status, and those manifesting skin eruptions or penile edema were associated with STI. Laboratory investigation for mpox must be implemented as a priority in STI clinics (especially for MSM) to mitigate neglected cases, ensure appropriate treatments, and prevent misdiagnoses.
Assuntos
Gonorreia , Infecções por HIV , Mpox , Minorias Sexuais e de Gênero , Infecções Sexualmente Transmissíveis , Adulto , Humanos , Masculino , Brasil/epidemiologia , Estudos Transversais , Demografia , Surtos de Doenças , Gonorreia/diagnóstico , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Infecções por HIV/complicações , Homossexualidade Masculina , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/epidemiologiaRESUMO
BACKGROUND: Sexually transmitted infections (STIs) are a public health problem. The aim of the present study was to assess the prevalence and risk factors associated with at least one STI (Chlamydia trachomatis [CT], Neisseria gonorrhoeae [NG], Trichomonas vaginalis [TV], and Mycoplasma genitalium [MG]) in Brazil. METHODS: A cross-sectional study was conducted using secondary data from the pilot implementation of the National Service for molecular diagnosis of CT, NG, TV, and MG in pregnancy. We obtained Ministry of Health surveillance data from the implementation project. Data encompassing pregnant women aged 15-49 years from public antenatal clinics in Brazil in 2022 were included. RESULTS: A total of 2728 data of pregnant women were analyzed. The prevalence of at least one infection was 21.0% (573), with the highest prevalence in the Southeast region (23.3%) and the lowest in the Center-West region (15.4%). The prevalence of CT was 9.9% (270), NG 0.6% (16), TV 6.7% (184), and MG 7.8% (212). Factors associated with any infection were from 15 to 24 years (AOR = 1.93; 95% CI: 1.58-2.35); reported family income up to US$400 (AOR = 1.79; 95% CI: 1.03-3.34); declared not living maritally with their partners (AOR = 1.90, 95% CI: 1.52-2.37) and had more than one sexual partner in their lifetime (AOR = 2.09, 95% CI: 1.55-2.86). CONCLUSION: This study showed a high prevalence of at least one STI among pregnant women in Brazil, particularly among younger women. It also provides up-to-date national data on CT, NG, TV, and MG infections in this population. These findings underscore the importance of enhancing access to STI screening for young pregnant women within the Brazilian public health system.
Assuntos
Infecções por Chlamydia , Chlamydia trachomatis , Gonorreia , Infecções por Mycoplasma , Mycoplasma genitalium , Neisseria gonorrhoeae , Complicações Infecciosas na Gravidez , Vaginite por Trichomonas , Trichomonas vaginalis , Humanos , Feminino , Brasil/epidemiologia , Gravidez , Adulto , Estudos Transversais , Adolescente , Prevalência , Adulto Jovem , Mycoplasma genitalium/isolamento & purificação , Fatores de Risco , Infecções por Mycoplasma/epidemiologia , Infecções por Mycoplasma/diagnóstico , Gonorreia/epidemiologia , Gonorreia/diagnóstico , Neisseria gonorrhoeae/isolamento & purificação , Trichomonas vaginalis/isolamento & purificação , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/diagnóstico , Chlamydia trachomatis/isolamento & purificação , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/diagnóstico , Vaginite por Trichomonas/epidemiologia , Vaginite por Trichomonas/diagnóstico , Pessoa de Meia-Idade , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/diagnósticoRESUMO
ABSTRACT The worldwide monkeypox (mpox) outbreak in 2022 showed a high frequency of sexually transmitted infections (STI). A cross-sectional study was carried out using secondary data from the Brazilian official mpox surveillance systems. A total of 10,169 mpox cases were identified, with a median age of 32 years. Among them, 92.3% were male at birth and 57.5% were men who have sex with other men (MSM). Approximately 11% were diagnosed with STI, including 5.8% with syphilis and 2.5% with genital herpes. Individuals aged from 25 to 34 years, MSM, individuals with HIV-positive status, and those manifesting skin eruptions or penile edema were associated with STI. Laboratory investigation for mpox must be implemented as a priority in STI clinics (especially for MSM) to mitigate neglected cases, ensure appropriate treatments, and prevent misdiagnoses.
Assuntos
Síndrome da Imunodeficiência Adquirida , Transtornos Mentais , Humanos , Adolescente , BrasilRESUMO
OBJECTIVE: to describe the subnational implementation process of the certification for elimination of mother-to-child transmission of HIV and/or syphilis, its main barriers, challenges and opportunities. METHODS: in 2022, indicators from the last full year for impact targets and the last two full years for process targets, available in national information systems, were evaluated; descriptive reports were analyzed and actions were acknowledged within four thematic axes, according to PAHO/WHO recommendations. RESULTS: 43 municipalities ≥ 100,000 inhabitants were certified, covering 24.6 million inhabitants; one municipality achieved dual elimination (HIV-syphilis), 28 municipalities achieved elimination of HIV and 10 received silver tiers; regarding syphilis, one elimination was observed, along with 4 gold tiers, 13 silver tiers and 4 bronze tiers; a higher number of certifications was identified in the Southeast and South regions. CONCLUSION: barriers and challenges of the process were overcome through tripartite collaboration; the experience provided better integration of surveillance with care and improved actions aimed at preventing mother-to-child transmission. MAIN RESULTS: First experience of the sub-national process of certification of elimination of mother-to-child transmission (MTCT) of HIV and/or syphilis at a global level. In 2022, 43 municipalities ≥ 100,000 inhabitants were certified, covering 24.6 million inhabitants. IMPLICATIONS FOR SERVICES: The experience of sub-national certification of the EMTCT was important in mobilizing the municipalities that engaged in its initiatives, worked to improve the quality of care and surveillance and emerging as the main proponents in the process. PERSPECTIVES: Through this ongoing and dynamic initiative, there is an anticipation of over 100 municipalities and states joining in 2023. Sub-national certification aims to enhance comprehensive care for pregnant women, in order to achieve national certification of EMTCT.
Assuntos
Infecções por HIV , Complicações Infecciosas na Gravidez , Sífilis , Gravidez , Feminino , Humanos , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Sífilis/epidemiologia , Sífilis/prevenção & controle , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Brasil/epidemiologia , PrataRESUMO
Background: Eliminating mother-to-child transmission (MTCT) of HIV, hepatitis B, and syphilis is a challenge in Brazil. Many policies have been implemented since 1986, but important gaps remain. This study aimed to describe the trends of MTCT in Brazil and evaluate the gaps and perspectives in this scenario. Methods: This is a descriptive study conducted with secondary data publicly available in the information systems of the Brazilian Ministry of Health regarding data on HIV, syphilis, and hepatitis B in pregnant women and children from 2011 to 2021. Results: HIV and hepatitis B have had constant rates over the years in pregnant women, with the detection rates around 2.5/1,000 live birth (LB) and 0.5/1.000LB, respectively. The same did not happen with syphilis, which has shown an increasing line in the last decade. In 2011, the detection rate of syphilis in pregnancy was 4.7/1,000LB, and in 2021 it reached 27.1/1,000LB. Regarding the trends in children, an important decrease was observed in HIV/AIDS (incidence rate from 0.18/1,000 in 2011 to 0.04/1,000 in 2021) and Hepatitis B (incidence rate from 0.9/1,000LB in 2011 to 0.5/1,000LB in 2021). For congenital syphilis, there is a continuous increase, being 3.3/1,000LB in 2011 and 9.9/1,000LB in 2021. Data from the HIV clinical monitoring showed that antiretroviral treatment coverage among pregnant women identified increased slightly between 2011 and 2021, in Brazil, from 92.3% to 94.3%. For syphilis, 82.5% of pregnant women were treated with benzathine penicillin, and 88.7% in 2011. The historical series of hepatitis B vaccination coverage in children has decreased over the years; it was 96% in 2013 and 76% in 2021. Conclusion: These data show many gaps and some perspectives in the MTCT program in Brazil. The country is close to reaching MTCT HIV elimination, but there are many challenges regarding HBV and syphilis. These data can be used to organize the strategies to improve the Brazilian response to MTCT elimination of HIV, hepatitis B, and syphilis.
Assuntos
Infecções por HIV , Hepatite B , Sífilis , Gravidez , Humanos , Feminino , Sífilis/epidemiologia , Brasil/epidemiologia , Transmissão Vertical de Doenças Infecciosas , Hepatite B/epidemiologia , Infecções por HIV/epidemiologiaRESUMO
Objective: to describe the subnational implementation process of the certification for elimination of mother-to-child transmission of HIV and/or syphilis, its main barriers, challenges and opportunities. Methods: in 2022, indicators from the last full year for impact targets and the last two full years for process targets, available in national information systems, were evaluated; descriptive reports were analyzed and actions were acknowledged within four thematic axes, according to PAHO/WHO recommendations. Results: 43 municipalities ≥ 100,000 inhabitants were certified, covering 24.6 million inhabitants; one municipality achieved dual elimination (HIV-syphilis), 28 municipalities achieved elimination of HIV and 10 received silver tiers; regarding syphilis, one elimination was observed, along with 4 gold tiers, 13 silver tiers and 4 bronze tiers; a higher number of certifications was identified in the Southeast and South regions. Conclusion: barriers and challenges of the process were overcome through tripartite collaboration; the experience provided better integration of surveillance with care and improved actions aimed at preventing mother-to-child transmission.
Objetivo: descrever o processo de implantação subnacional da certificação da eliminação da transmissão vertical de HIV e/ou sífilis, suas principais barreiras, desafios e oportunidades. Métodos: em 2022, foram avaliados indicadores do último ano completo para meta de impacto, e dos dois últimos anos completos para metas de processo, disponíveis nos sistemas nacionais de informações; foram analisados relatórios descritivos e reconhecidas ações em quatro eixos temáticos, conforme recomendações da OPAS/OMS. Resultados: 43 municípios ≥ 100 mil habitantes foram certificados, abrangendo 24,6 milhões de habitantes; um município alcançou dupla eliminação (HIV-sífilis), 28 alcançaram eliminação para HIV e 10, selos prata; para sífilis, houve uma eliminação, 4 selos ouro, 13 prata e 4 bronze; identificou-se maior número de certificações nas regiões Sudeste e Sul. Conclusão: barreiras e desafios do processo foram superados pela colaboração tripartite; a experiência proporcionou melhor integração da vigilância com a assistência e qualificação das ações para prevenção da transmissão vertical.
Objetivo: describir el proceso de implementación subnacional de la certificación de eliminación de la transmisión vertical (TV) de sífilis y/o VIH, barreras, oportunidades y desafíos. Métodos: en 2022, se evaluaron indicadores del último año completo para la meta de impacto y de los dos últimos años para las de proceso en los sistemas de información; se analizaron informes descriptivos y se reconocieron acciones de cuatro ejes, según las recomendaciones de la OPS/OMS. Resultados: se certificaron 43 municipios ≥ 100.000 mil habitantes, cubriendo 24,6 millones de habitantes; un municipio logró la doble eliminación (VIH-sífilis), 28 la eliminación del VIH y 10 sellos plata; para sífilis, hubo una eliminación, 4 sellos oro, 13 plata y 4 bronce; las regiones Sudeste y Sur obtuvieron más certificaciones. Conclusión: barreras y desafíos fueron superados mediante la colaboración tripartita; la experiencia permitió la integración de la vigilancia con la atención y la cualificación de acciones para la prevención de la TV.
RESUMO
Diabetes mellitus (DM) has important implications for tuberculosis (TB), as it increases the risk for disease activation and is associated with unfavorable TB treatment outcomes. This study analyzed the association between TB and DM (TBDM) in Brazil from 2007 to 2014. This was a retrospective cohort study carried out in 709,429 new cases of TB reported to the national disease notification system of the Brazilian Ministry of Health. Sociodemographic and clinical data, test results, and treatment outcomes were analyzed. TBDM was found in 6.0% of TB cases, mostly in men aged 18-59 years. The lethality rate was 5.1% higher in all age groups with diabetes, except in those older than 60 years of age. The frequency of multi-drug-resistant tuberculosis (MDR-TB) in patients with DM was higher in those without DM, with a 1.6- to 3.8-fold increase in the odds of MDR-TB. The elderly showed an increase in the prevalence of TBDM from 14.3% to 18.2%. Women were more likely to have DM, and elderly women had 41.0% greater chance of having DM. Relapse was significant among patients younger than 17 years of age. TBDM was high in Brazil, affected all age groups, and was associated with unfavorable TB treatment outcomes. We emphasize the need for strategies for the clinical management of diabetic tuberculosis patients in Brazil aiming at minimizing relapses, deaths, and MDR-TB.