RESUMO
BACKGROUND: In Argentina, HIV prevalence among transgender women (TGW) has been reported at 34%. The stigma is one of the most important factors limiting their access to healthcare services. The aims of this study were to compare different HIV testing methodologies, to determine the factors associated with HIV diagnosis and to determine the feasibility of a home-based HIV testing service for TGW. METHODS: A multidisciplinary team performed home-based HIV testing interventions in four cities of Argentina. Participants self-identified as TGW, older than 14 years and with a negative or unknown HIV status. Blood samples were screened by two rapid tests (RT), one based on antibodies (Determine™ HIV-1/2) and the other on antigen and antibodies (Determine™ HIV-1/2 Combo), and the subsequent blood processing via 4th generation ELISA (VIDAS HIV DUO). All reactive samples were confirmed with a viral load (VL). We compared the results of both RT with the ELISA. Samples were pooled in groups of 6 and a VL (Abbott Real Time) performed to identify acute HIV infections. Factors associated with HIV infection were evaluated with multivariate logistic regression analysis. RESULTS: A total of 260 TGW were tested, 51 tested positive (HIV prevalence 19.6%). There were no discordant results between both RTs nor between RTs and 4th generation ELISA, therefore the correlation was 100%. The VL identified 2 additional positive samples. The final analytic sample for positive cases consisted of 53 TGW. In the multivariate analysis, factors associated with a positive HIV result were history of other sexually transmitted infections (STIs) and not being previously tested for HIV. TGW tested for the first time were at 4 times greater risk of being HIV positive compared to those that were tested previously. CONCLUSIONS: A multidisciplinary home-based HIV testing service among TGW is feasible and effective to detect cases of HIV infection. The testing algorithm should start with an RT followed by molecular diagnosis. The history of STIs and never having been tested for HIV were the factors associated with HIV-positive results and should determine efforts to reach this population. Home-based testing reaches individuals that were not tested before and who have more risk of acquiring HIV.
Assuntos
Infecções por HIV/diagnóstico , Kit de Reagentes para Diagnóstico , Pessoas Transgênero , Adulto , Argentina , Estudos de Viabilidade , Feminino , Humanos , Modelos Logísticos , Análise Multivariada , Adulto JovemRESUMO
Fasciola hepatica is a trematode parasite that causes fasciolosis in animals and humans. Fasciolosis is usually treated with triclabendazole, although drug-resistant parasites have been described in several geographical locations. An alternative to drug treatment would be the use of a vaccine, although vaccination studies that have been performed mainly in ruminants over the last 30 years, show high variability in the achieved protection and are not yet ready for commercialisation. Since F. hepatica exhibits a high degree of genomic polymorphism, variation in vaccine efficacy could be attributed, at least partially, to phenotypic differences in vaccine candidate sequences amongst parasites used in the challenge infections. To begin to address this issue, a collection of F. hepatica isolates from geographically dispersed regions, as well as parasites obtained from vaccination trials performed against a field isolate from Uruguay and the experimentally maintained South Gloucester isolate (Ridgeway Research, UK), were compiled to establish a F. hepatica Biobank. These collected isolates were used for the genetic analysis of several vaccine candidates that are important in host-parasite interactions and are the focus of the H2020 PARAGONE vaccine project (https://www.paragoneh2020.eu/), namely FhCL1, FhCL2, FhPrx, FhLAP and FhHDM. Our results show that F. hepatica exhibits a high level of conservation in the sequences encoding each of these proteins. The consequential low variability in these vaccine candidates amongst parasites from different geographical regions reinforces the idea that they would be suitable immunogens against liver fluke isolates worldwide.
Assuntos
Alelos , Fasciola hepatica/genética , Fasciola hepatica/imunologia , Fasciolíase/veterinária , Variação Genética , Vacinas/genética , Animais , Anticorpos Anti-Helmínticos , Bovinos , Doenças dos Bovinos/imunologia , Doenças dos Bovinos/prevenção & controle , Fasciolíase/imunologia , Fasciolíase/parasitologia , Fasciolíase/prevenção & controle , Doenças das Cabras/imunologia , Doenças das Cabras/prevenção & controle , Cabras/parasitologia , Interações Hospedeiro-Parasita , Humanos , Análise de Sequência de DNA , Vacinação , Vacinas/imunologiaRESUMO
The stigma related to HIV status, gender identity, and sexual orientation has negative implications for the quality of life of individuals. A qualitative study was conducted to explore the resources that these stigmatized groups recognize as tools to cope with stigma and maintain their psychological well-being. Four focus groups were conducted with gay men and transgender women divided by HIV status. A thematic analysis revealed that individual, interpersonal, and institutional resources are commonly recognized as coping resources. This article discusses the importance of enhancing self-acceptance, social support, and a legal framework that legitimizes these groups as right holders.
Assuntos
Adaptação Psicológica , Identidade de Gênero , Infecções por HIV/psicologia , Homossexualidade Masculina/psicologia , Comportamento Sexual/psicologia , Estigma Social , Pessoas Transgênero/psicologia , Adolescente , Adulto , Feminino , Grupos Focais , Recursos em Saúde , Direitos Humanos/legislação & jurisprudência , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Qualidade de Vida , Apoio Social , Pessoas Transgênero/legislação & jurisprudência , Adulto JovemRESUMO
Challenging HIV-infected patients, those neither adherent nor actively engaged in care, represent an important opportunity for intervention if the HIV epidemic is to be contained. This pilot study assessed the feasibility and acceptability of an adapted patient adherence intervention and a motivational interview-based provider intervention in urban Buenos Aires, Argentina, in order to optimize health benefits in challenging HIV-infected patients. To maximize implementation and uptake of both strategies, interventions were adapted to the local setting. Qualitative data and a short quantitative assessment from patients, staff, fellows, residents and physicians (n = 84) were examined to establish the feasibility and acceptability of offering patient and provider evidence-based interventions in both public and private health-care settings. Results identified key themes on provision of information, use of specialized communication techniques and group support in the utilization of the interventions. Both providers (n = 12) and patients (n = 120) endorsed the acceptability and value of the interventions, and the feasibility of their delivery. Findings support the use of both intervention modalities with challenging patients in diverse urban health-care settings.
Assuntos
Infecções por HIV/tratamento farmacológico , Adesão à Medicação , Entrevista Motivacional , Educação de Pacientes como Assunto , População Urbana , Argentina , Atitude do Pessoal de Saúde , Comunicação , Estudos de Viabilidade , Processos Grupais , Humanos , Médicos , Projetos Piloto , Apoio SocialRESUMO
Many HIV-infected patients fail to achieve undetectable viral load and are not retained in care. This pilot study examined patients lost to care in public and private clinics in Buenos Aires, Argentina. The impact of patient and provider interventions was compared separately and collectively. In Phase 1, participants prescribed antiretrovirals and non-adherent to treatment in the prior 3-6 months (n = 60) were randomized to patient intervention or standard of care (SOC) and assessed over 12 months. In Phase 2, providers were trained in interviewing techniques and 60 additional patients were randomized to patient intervention or SOC condition. Averaged across patient intervention status, Phase 2 provider intervention patients reported the most improved adherence and viral suppression at 6 and 12 months. Adherence in "patient intervention only" improved at midpoint and returned to baseline at 12 months. Results suggest provider training sustained patient adherence and viral suppression among "hard to reach" patients.
Assuntos
Antirretrovirais/uso terapêutico , Atenção à Saúde/organização & administração , Infecções por HIV/tratamento farmacológico , Adesão à Medicação/psicologia , Educação de Pacientes como Assunto/métodos , Relações Profissional-Paciente , Adulto , Argentina , Aconselhamento , Feminino , Infecções por HIV/psicologia , Infecções por HIV/virologia , Letramento em Saúde , Humanos , Masculino , Adesão à Medicação/etnologia , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Entrevista Motivacional , Aceitação pelo Paciente de Cuidados de Saúde , Projetos Piloto , Setor Privado , Setor Público , Resultado do Tratamento , Carga ViralRESUMO
The liver fluke Fasciola hepatica is a foodborne zoonotic parasite affecting livestock worldwide, with increasing relevance in human health. The first developmental stage that the host meets after ingestion of the parasite is the newly excysted juvenile, that actively transverses the gut wall and migrates to its final location in the liver. The regulation of the early developmental events in newly excysted juveniles is still poorly understood and a relevant target for control strategies. Here we investigated the putative involvement of small regulatory RNAs in the invasion process. The small RNA population of the newly excysted juvenile fall into two classes, one represented by micro (mi)RNAs and a secondary group of larger (32-33 nucleotides) tRNA-derived sequences. We identified 40 different miRNAs, most of those belonging to ancient miRNAs conserved in protostomes and metazoans, notably with a highly predominant miR-125b variant. Remarkably, several protostomian and metazoan conserved families were not detected in consonance with previous reports of drastic miRnome reduction in parasitic flatworms. Additionally, a set of five novel miRNAs was identified, probably associated with specific gene regulation expression needs in F. hepatica. While sequence conservation in mature miRNA is high across the metazoan tree, we observed that flatworm miRNAs are more divergent, suggesting that mutation rates in parasitic flatworms could be high. Finally, the distinctive presence of tRNA-derived sequences, mostly 5' tRNA halves of selected tRNAs in the small RNA population of newly excysted juveniles, raises the possibility that both miRNA and tRNA fragments participate in the regulation of gene expression in this parasite.
Assuntos
Fasciola hepatica/crescimento & desenvolvimento , Fasciola hepatica/genética , Perfilação da Expressão Gênica , MicroRNAs/biossíntese , Animais , Regulação da Expressão Gênica , MicroRNAs/genética , Dados de Sequência Molecular , RNA de Transferência/biossíntese , RNA de Transferência/genética , Análise de Sequência de DNARESUMO
In Argentina, providers' response to motivational interviewing (MI) to improve engagement and retention in care among challenging patients with HIV was evaluated. Twelve HIV care physicians participated, and their video recordings pre- and post-MI training were also obtained. One week post-training, 11 of the 12 participants were committed to using MI strategies during consult session. Of the 12 participants, 9 demonstrated appropriate utilization of MI techniques and change in HIV education provided during consultation (Z = -2.375, P = .018). Motivational interviewing appears to be a viable strategy to enhance engagement and retention in challenging HIV-positive patients.
Assuntos
Infecções por HIV/psicologia , Médicos/psicologia , Adulto , Argentina , Educação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Entrevista Motivacional , Encaminhamento e Consulta , Adulto JovemRESUMO
BACKGROUND: Intestinal parasitic infections are among the most common infections worldwide, leading to illness with serious and long lasting implications in children and immunocompromised people. Transmission of intestinal parasites is more frequent in tropical and sub-tropical areas where sanitation is poor and socioeconomic conditions are deficient. Panama is a country where climate and social conditions could be reflected in a high number of people infected with intestinal parasites. The presence, prevalence, and distribution of intestinal parasites in this country have been approached to date only in very restricted areas and population groups, but the impact of intestinal parasite infections at the national level is unknown. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a cross-sectional survey between 2008 and 2010 to determine the prevalence of intestinal parasites across Panama. Overall, 14 municipalities in seven provinces of Panama were surveyed. The presence of eggs, cysts, and larvae was assessed by microscopy in 1123 human fecal samples using a concentration technique. A questionnaire to identify risk factors associated with the frequency of intestinal parasites in the study population was also prepared and performed. Overall, 47.4% of human samples presented parasites. Variables including community type, age group, occupation, co-presence of commensals and socioeconomic factors (use of shoes and type of sanitation) were significantly associated with intestinal parasites (p<0.05). CONCLUSIONS/SIGNIFICANCE: The preliminary data obtained in the current study, showing a high prevalence of fecal-oral transmitted parasites in Panama, place intestinal parasitism as a major health problem in this country. Specific interventions should be planned for the indigenous population, the group most afflicted by intestinal parasites.
Assuntos
Fezes/parasitologia , Helmintíase/epidemiologia , Enteropatias Parasitárias/epidemiologia , Saneamento/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Animais , Ascaríase/epidemiologia , Balantidíase/epidemiologia , Infecções por Blastocystis/epidemiologia , Criança , Pré-Escolar , Cidades , Clima , Estudos Transversais , Feminino , Giardíase/epidemiologia , Infecções por Uncinaria/epidemiologia , Humanos , Himenolepíase/epidemiologia , Hospedeiro Imunocomprometido , Lactente , Recém-Nascido , Larva , Masculino , Microscopia , Pessoa de Meia-Idade , Panamá/epidemiologia , Parasitos , Prevalência , Características de Residência , Fatores de Risco , Fatores Socioeconômicos , Estrongiloidíase/epidemiologia , Inquéritos e Questionários , Tricuríase/epidemiologia , Adulto JovemRESUMO
Introducción: el Programa Nacional de Sida garantiza el acce-so universal a los antirretrovirales, aun así las personas que reciben me-dicamentos a través del sistema público no logran obtener una carga vi-ral indetectable en la misma proporción que los pacientes del sistema privado. Este estudio cualitativo tiene como objeto identificar los facto-res asociados a la adherencia y retención en la cascada de atención de VIH de los sistemas de salud público y privado de Buenos Aires, según las percepciones de pacientes y del personal de salud.Métodos: se registraron datos cualitativos de 12 entrevistas semi-es-tructuradas a informantes clave y 4 grupos focales de pacientes y per-sonal de salud tanto del sistema público como privado. Se codificaron y analizaron temas predeterminados sobre adherencia, utilizando el soft-ware QRS Nvivo9® de análisis de datos cualitativos.Resultados: pacientes y personal de salud de ambos sistemas coinci-den en la importancia del estigma asociado al VIH, la relación médico-paciente, la comunicación entre ambos y la división de responsabilida-des en relación al tratamiento como aspectos fundamentales para la adherencia y retención en la cascada de atención. Se observan diferen-cias entre los sistemas en la forma en que algunos de estos aspectos ac-túan. Las barreras estructurales se presentan como principales obstácu-los del sistema público.Discusión: se resalta la necesidad de intervenciones focalizadas en la díada médico-paciente que consi-dere las particularidades de cada sistema de aten-ción para facilitar el compromiso del paciente en la adherencia
Introduction: The National Program of AIDS guarantees universal access to antiretroviral medication, yet people receiving treatment through the public healthcare system do not achieve an undetectable viral load in the same rate than patients in the private system. This qualitative study aims to identify factors associated with adherence and retention in the HIV-cascade of care at public and private setting from Buenos Aires, based on patients and healthcare workers' perceptions.Methods: Qualitative data from 12 semi-structured interviews with key informants and 4 focus groups of patients and healthcare workers from the public and private systems were recorded. Transcripts were coded and analyzed, using the QRS Nvivo9® software for qualitative data analysis, into set themes on adherence.Results: Patients and healthcare workers of both systems agree on the importance of HIV-related stigma, professional-patient relationship and communication, and the division of treatment-related responsibilities as fundamental aspects for adherence and retention in the HIV-cascade of care. Differences in the manner these factors interact were observed between healthcare systems. Structural barriers are presented as the main adherence barrier in the public system.Discussion: The need for interventions focused on the doctor-patient dyad considering the features of each healthcare is highlighted in order to facilitate patient engagement in adherence
Assuntos
Humanos , Masculino , Feminino , Relações Médico-Paciente , Cuidados Médicos , Adesão à Medicação , Estigma Social , Retenção nos CuidadosRESUMO
Approximately 30% of patients participating in the national antiretroviral therapy (ART) program in Argentina fail to achieve an undetectable viral load, and approximately 25% are not retained in care. This qualitative study was designed to explore and identify factors associated with engagement and retention in public and private health care in Buenos Aires, Argentina. Qualitative data from key informants (n = 12) and focus groups (n = 4 groups) of patients and providers from private and public HIV treatment facilities were recorded and transcribed. Predetermined and arising themes related to adherence, engagement, and retention in care were coded and analyzed using qualitative data analysis software. Reasons identified for patients' lack of adherence or engagement in care differed between patients and providers, and patients attributed limitations to low self-efficacy, fear and concerns about HIV, and lack of provider involvement in treatment. In contrast, providers viewed themselves as decision-makers in patient care and patients as responsible for their own nonadherence due to lack of commitment to their own health or due to medication side effects. Patients reported health care system limitations and HIV concerns contributed to a lack of engagement, and providers identified limited HIV literacy and stigma as additional problems. Both agreed that chronic illness and substance addiction impacted adherence and retention, and agreed on the importance of trust, honesty, and communication in the patient-provider relationship. Results support the incorporation of system-, provider-, and patient-focused components into interventions to facilitate patient engagement, adherence, and retention in public and private settings in Argentina.