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Background: The COVID-19 pandemic impacted mental health disorders, affecting both individuals with pre-existing conditions and those with no prior history. However, there is limited evidence regarding the pandemic's impact on mental health visits to primary care physicians. The International Consortium of Primary Care Big Data Researchers (INTRePID) explored primary care visit trends related to mental health conditions in Argentina, Australia, Canada, China, Norway, Peru, Singapore, Sweden, and the USA. Methods: We conducted an interrupted time series analysis in nine countries to examine changes in rates of monthly mental health visits to primary care settings from January 1st, 2018, to December 31st, 2021. Sub-group analysis considered service type (in-person/virtual) and six categories of mental health conditions (anxiety/depression, bipolar/schizophrenia/other psychotic disorders, sleep disorders, dementia, ADHD/eating disorders, and substance use disorder). Findings: Mental health visit rates increased after the onset of the pandemic in most countries. In Argentina, Canada, China, Norway, Peru, and Singapore, this increase was immediate ranged from an incidence rate ratio of 1·118 [95% CI 1.053-1.187] to 2.240 [95% CI 2.057-2.439] when comparing the first month of pandemic with the pre-pandemic trend. Increases in the following months varied across countries. Anxiety/depression was the leading reason for mental health visits in most countries. Virtual visits were reported in Australia, Canada, Norway, Peru, Sweden, and the USA, accounting for up to 40% of the total mental health visits. Interpretation: Findings suggest an overall increase in mental health visits, driven largely by anxiety/depression. During the COVID-19 pandemic, many of the studied countries adopted virtual care in particular for mental health visits. Primary care plays a crucial role in addressing mental ill-health in times of crisis. Funding: Canadian Institutes of Health Research grant #173094 and the Rathlyn Foundation Primary Care EMR Research and Discovery Fund.

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RESUMEN Introducción. Las aplicaciones móviles representan una alternativa prometedora para brindar soporte en la gestión de pacientes con dengue. Sin embargo, se desconoce la usabilidad de estas herramientas en el Perú. Objetivo. Evaluar la usabilidad y las recomendaciones de uso de la aplicación Dengue ONQOY en la gestión de pacientes con dengue en zonas rurales de Perú. Métodos. Se realizó un estudio cualitativo que incluyó entrevistas semiestructuradas a 8 expertos en el tratamiento del dengue, los datos fueron codificados mediante el programa Atlas. Ti. Fueron evaluadas tres categorías: (1) usabilidad informativa, (2) usabilidad de diseño y (3) recomendaciones para su mejoramiento. Resultados. Se destacaron tres aspectos clave: (1) la aplicación es percibida como valiosa para los médicos de primer nivel en áreas periféricas con poca experiencia en dengue debido a su enfoque personalizado y valor académico; (2) se destacó su facilidad de uso y practicidad, aunque se señaló la limitación de la conectividad en algunas áreas; y, (3) se recomendó la inclusión de diagnósticos diferenciales, factores de riesgo adicionales, referencias actualizadas, guías de hidratación y dosis de medicamentos para mejorar la aplicación. Conclusión. Dengue ONQOY fue considerado altamente utilizable por médicos que atienden casos de dengue en el primer nivel de atención en Perú. A pesar de las limitaciones relacionadas con la conectividad y las posibles mejoras en su diseño, su desarrollo e implementación ofrecen una alternativa prometedora para el manejo de pacientes con Dengue en el país.

ABSTRACT Introduction. Mobile applications represent a promising alternative for providing support in the management of Dengue patients. However, the usability of these tools in Peru is unknown. Objectives. To evaluate the usability and usage recommendations of the Dengue ONQOY application in managing Dengue patients in rural areas of Peru. Methods. A qualitative study was conducted, which included semi-structured interviews with 8 experts in Dengue management. Data were coded using Atlas. Ti software. Three categories were assessed: (1) informative usability (2) design usability, and (3) recommendations for improvement. Results. Three key aspects were highlighted. (1) The application is perceived as valuable for first- level doctors in peripheral areas with limited Dengue experience due to its personalized approach and academic value. (2) Its ease of use and practicality were emphasized, although connectivity limitations in some areas were noted. (3) Recommendations for improvement included the inclusion of differential diagnoses, additional risk factors, updated references, hydration guidelines, and medication dosages. Conclusions. Dengue ONQOY is considered highly usable by doctors treating Dengue cases at the primary care level in Peru. Despite connectivity limitations and potential design improvements, its development and implementation offer a promising alternative for managing Dengue patients in the country in this field.

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Resumen Introducción. En el Perú el sistema de tele-triaje (STT) conducido por estudiantes voluntarios permitió la identificación remota de casos sospechosos de COVID-19. Sin embargo, aun no se conocen las barreras y facilitadores de su implementación. Objetivos. Describir las barreras y facilitadores sobre la implementación de un sistema de tele-triaje para la identificación de casos sospechosos de COVID-19 en el Perú. Métodos. Se desarrolló un estudio de métodos mixtos que describió las características de los usuarios que participaron en el STT (cuantitativo). También se exploró las percepciones de usuarios y voluntarios respecto a las barreras y facilitadores sobre la implementación de este servicio (cualitativo). Resultados. Entre los 4317 usuarios evaluados por el STT, la edad media fue 36,2 años (desviación estándar: 13,2), 58,6% fueron mujeres y solo el 41,4% fueron clasificados como casos sospechosos de COVID-19. Los voluntarios destacaron que su participación fue facilitada por su disponibilidad de tiempo y deseos de ayudar, aunque señalaron problemas de organización y falta de equipos disponibles para las llamadas. Los usuarios valoraron el apoyo emocional y la claridad de la información brindada, pero expresaron desconfianza sobre la evaluación de COVID-19 de forma remota, y un conocimiento limitado sobre el rol de los voluntarios. Conclusiones. El STT conducido por estudiantes voluntarios pemitió la identificación de casos sospechosos de COVID-19 en el Perú, además sirvió como medio para compartir información. Sin embargo, aspectos de desorganización y desconocimiento por parte de los usuarios fueron percibidos como barreras para su implementación.

ABSTRACT Introduction. In Peru, the tele-triage system (TTS) led by volunteer students allowed for the remote identification of suspected COVID-19 cases. However, the barriers and facilitators of its implementation are still unknown. Objectives. To describe the barriers and facilitators regarding the implementation of a tele-triage system for the identification of suspected COVID-19 cases in Peru. Methods. A mixed methods study was developed that described the characteristics of the users who participated in the TTS (quantitative). It also explored the perceptions of users and volunteers regarding the barriers and facilitators of implementing this service (qualitative). Results. Among the 4,317 users evaluated by the TTS, the average age was 36.2 years (standard deviation: 13.2), 58.6% were women, and only 41.4% were classified as suspected cases of COVID-19. Volunteers highlighted that their participation was facilitated by their availability of time and desire to help, although they noted problems with organization and a lack of equipment available for calls. Users valued the emotional support and clarity of the information provided but expressed mistrust about the remote COVID-19 assessment, and a limited understanding of the volunteers' role. Conclusions. The TTS led by volunteer students allowed for the identification of suspected COVID-19 cases in Peru, and also served as a means to share information. However, aspects of disorganization and a lack of knowledge on the part of users were perceived as barriers to its implementation.

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BACKGROUND: During 2021, Peru started the vaccination against SARS-CoV-2 using the BBIBP-CorV inactivated virus vaccine for health care workers (HCW). We aim to evaluate the effectiveness of the BBIBP-CorV vaccine to prevent SARS-CoV-2 infection and deaths among HCWs. METHODS: Retrospective cohort study, from February 9 to June 30, 2021, using national registries of health care workers, laboratory tests for SARS-CoV-2 and deaths. We calculated the vaccine effectiveness for preventing laboratory-confirmed SARS-CoV-2 infection, COVID-19-mortality, and all-cause mortality among partially immunized and fully immunized HCWs. An extension of Cox proportional hazards regression was used to model the mortality results, and Poisson regression was used to model SARS-CoV-2 infection. RESULTS: The study included 606,772 eligible HCWs, the mean age was 40 (IQR: 33.0, 51.0). In fully immunized HCW, the effectiveness for preventing all-cause mortality was 83.6 (95% CI: 80.2 to 86.4), 88.7 (95% CI: 85.1 to 91.4) for preventing COVID-19 mortality, and 40.3 (95% CI 38.9 to 41.6) for preventing SARS-CoV-2 infection. CONCLUSION: The BBIBP-CorV vaccine showed high levels of effectiveness for preventing all-cause and COVID-19 deaths among fully immunized HCW. These results were consistent within different subgroups and sensitivity analyses. However, the effectiveness for preventing infection was suboptimal in this particular setting.

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BACKGROUND: Telementoring seems to be a promising strategy to deliver training and counselling to physicians in remote areas. In Peru, early graduated physicians must work for the Rural and Urban-Edge Health Service Program where they face important training needs. The aim of this study was to describe the usage of a one-on-one telementoring program for rural physicians and evaluate the aspects related to the perceptions of acceptability and usability. METHODS: Mixed methods study on recently graduated physicians who work in rural areas and participate in the telementoring program. The program used a mobile application to connect these young doctors with specialized mentors to answer queries about real-life problems raised by working in a rural area. We summarize administrative data to assess participant characteristics and their participation in the program. Additionally, we conducted in-depth interviews to explore the perceived usability, ease of use, and reason for non-use of the telementoring program. RESULTS: Of 74 physicians (mean age 25, 51.4% women) enrolled, 12 (16.2%) actively used the program and performed a total of 27 queries, which received response in an average time of 5.4 ± 6.3 h. In the interviews, the main reasons for non-use were connectivity issues, feelings of shame, and self-efficacy. For those who used the telementoring program they referred it was easy to use and solve their inquiries timely. CONCLUSIONS: The implementation of a telementoring program sought to provide guidance to recently graduated physicians working in rural areas. Low use rates show that administrative and process-related deficiencies in the program implementation need to be improved.

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El objetivo del mapa microbiológico es determinar la frecuencia y distribución de los microorganismos a través de su perfil de sensibilidad/resistencia antimicrobiana según el tipo de muestra clínica, localización de la infección, tipo de infección, servicio y caracterizar el fenotipo y genotipo de resistencia en pacientes hospitalizados y ambulatorios

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BACKGROUND: The administration of a third (booster) dose of COVID-19 vaccines in Peru initially employed the BNT162b2 (Pfizer) mRNA vaccine. The national vaccination program started with healthcare workers (HCW) who received BBIBP-CorV (Sinopharm) vaccine as primary regimen and elderly people previously immunized with BNT162b2. This study evaluated the reactogenicity and immunogenicity of the "booster" dose in these two groups in Lima, Peru. METHODS: We conducted a prospective cohort study, recruiting participants from November to December of 2021 in Lima, Peru. We evaluated immunogenicity and reactogenicity in HCW and elderly patients previously vaccinated with either two doses of BBIBP-CorV (heterologous regimen) or BTN162b2 (homologous regimen). Immunogenicity was measured by anti-SARS-CoV-2 IgG antibody levels immediately before boosting dose and 14 days later. IgG geometric means (GM) and medians were obtained, and modeled using ANCOVA and quantile regressions. RESULTS: The GM of IgG levels increased significantly after boosting: from 28.5±5.0 AU/mL up to 486.6±1.2 AU/mL (p<0.001) which corresponds to a 17-fold increase. The heterologous vaccine regimen produced higher GM of post-booster anti-SARS-CoV-2 IgG levels, eliciting a 13% increase in the geometric mean ratio (95%CI: 1.02-1.27) and a median difference of 92.3 AU/ml (95%CI: 24.9-159.7). Both vaccine regimens were safe and well tolerated. Previous COVID-19 infection was also associated with higher pre and post-booster IgG GM levels. CONCLUSION: Although both boosting regimens were highly immunogenic, two doses of BBIBP-CorV boosted with BTN162b2 produced a stronger IgG antibody response than the homologous BNT162b2 regimen in the Peruvian population. Additionally, both regimens were mildly reactogenic and well-tolerated.

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BACKGROUND: Studies have reported evidence about the effectiveness of a third dose with BNT162b2 for preventing hospitalization and death by COVID-19. However, there is little evidence regarding other primary vaccine schedules such as BBIBP-CorV and ChAdOx1-S. We estimated the relative vaccine effectiveness (RVE) of the booster dose versus the primary regimens of COVID-19 vaccines based on BBIBP-CorV, ChAdOx1-S, or BNT162b2 for preventing death during the Omicron wave in Peruvian adult people. METHODS: We carried out a nested case-control study with a risk set sampling of controls using data from Peru between December 20, 2021, and February 20, 2022 (during the Omicron wave). Data on vaccination, COVID-19 tests and deaths were collected from national surveillance databases. We performed conditional logistic regression models to estimate the RVE on the adult population. In addition, we executed sub-group analysis per age group (18 to 59 years, and 60 years or more) and per primary regime (based on BNT162b2, BBIBP-CorV, or ChAdOx1-S). RESULTS: Of the 11,188,332 people eligible to enter the study 1,974 met the case definition (death from COVID-19) and were matched to 9,183 controls. The overall RVE of a third dose to prevent death was 87.2% (84.2%-89.7%), which varied according to the primary regime (87.3% for BNT162b2, 82.0% for BBIPB-CorV-2, and 79.5% for ChAdOx-S). In older adults, the RVE was 87.1%, without significant variations according to the primary regime (86.1% for BNT162b2, 86.1 for BBIBP-CorV, and 82% for ChAdOx-S). CONCLUSIONS: The booster) dose of vaccine against COVID-19 had a high RVE for preventing death by COVID-19 in the Peruvian population in all primary regimes of vaccines during the Omicron wave. This effect was consistent in people over 60 years of age, the group most vulnerable to die from this infection.

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Introducción: Los programas de Optimización de Antimicrobianos (PROA) en Instituciones Sanitarias son una estrategia implementada en diversos países. El estudio: Nuestro objetivo fue realizar una encuesta electrónica en los establecimientos de salud que cuentan con servicios de hospitalización en el Perú. Hallazgos: Ciento setenta establecimientos (38.4%) respondieron la encuesta entre MINSA (90%), ESSALUD (4.2%), FFAA PNP (2.9%) y Privados (2.9%). Solo 49 (28.8%) contaba con PROA funcionando dentro de su institución. El 83.7% contaban con una Resolución directoral que respalda sus funciones y el 38.8% referían contar con un plan de actividades PROA. Los problemas más frecuentemente identificados son la falta de recursos humanos capacitados (24.6%), la falta de capacitación y asistencia técnica (13.1%) y la falla en la prescripción de antibióticos (11.5%). Conclusión: Es prioritario seguir fortaleciendo los PROA en hospitales en el corto plazo con actividades que estimulen el uso racional de antimicrobianos.

Background: The Antimicrobial Optimization Programs (PROA in Spanish) in Health Institutions are a strategy implemented in different countries. The study: Our objective was to carry out an electronic survey in health establishments that have hospitalization services in Peru. Findings: One hundred seventy establishments (38.4%) responded to the survey between MINSA (90%), ESSALUD (4.2%), Armed Forces PNP (2.9%) and Private (2.9%). Only 49 (28.8%) had PROA working within their institution. 83.7% had a Director Resolution that supported their functions and 38.8% reported having a PROA activity plan. The most frequent problems identified are the lack of trained human resources (24.6%), the lack of training and technical assistance (13.1%) and the failure to prescribe antibiotics (11.5%). Conclusion: It is a priority to continue strengthening the PROA in hospitals in the short term with activities that stimulate the rational use of antimicrobials.

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Background: Coronavirus disease 2019 (COVID-19) infection is a major public health problem in the world and reinfections are becoming more frequent. Our main objective was to describe the epidemiological, clinical, and genomic characteristics of the confirmed cases of reinfection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the capital of Lima and Callao, Peru. Methods: We searched in the Peruvian laboratory information system from April 2020 up to May 2021, looking for cases having 2 positive molecular tests for SARS-CoV-2 with more than 90 days between them. We performed genomic sequencing to the available pairs of samples and described the clinical characteristics, epidemiological impact, and genomic analysis of the confirmed reinfections. Results: There were 1 694 164 people with a positive diagnostic test for SARS-CoV-2 in Lima/Callao during the study period. Of these, 1695 had 2 positive molecular tests with more than 90 days between them. Two hundred eleven had both samples available for genomic analysis according to our selection criteria, and these were retrieved and submitted to sequencing. Thirty cases were confirmed to be SARS-CoV-2 reinfections with 2 different lineages in the 2 episodes. The variant Lambda (C.37) was the most common during the second infection and accounted for 19 (63.3%) of the 30 cases. Conclusions: We report 30 cases of confirmed SARS-CoV-2 reinfections. The Lambda variant was the most common cause of the second infections, in concordance with its predominant circulation during Peru's second wave. This report describes the largest series of confirmed reinfections by SARS-CoV-2 in Latin America.We describe the epidemiological, clinical, and genomic characteristics of the confirmed cases of reinfection by severe acute respiratory syndrome coronavirus 2 in Lima and Callao, durante la segunda ola en Peru. The Lambda variant (C.37) was the most common cause of the second infections.