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We report the experience of bictegravir/emtricitabine/tenofovir alafenamide for nonoccupational postexposure prophylaxis in sexual assault cases. Between June 2021 and October 2023, 39 individuals completed the 28-day follow-up; 41% experienced some side effects, and 1 person discontinued the drug because of a rash. No individuals seroconverted to HIV during the follow-up period.
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Introduction: The restrictions on face-to-face care for exposure to biological material during the COVID-19 pandemic required alternatives to maintain outpatient assistance. This study evaluated the impact of telemedicine on care and outcome indicators of a reference service for exposure to biological material during the COVID-19 pandemic. Methods: This pre- and post-study compared the effectiveness of telemedicine in the Hospital Correia Picanço in Recife (Pernambuco, Brazil) before (August 2018 to January 2019 [P1]) and during the COVID-19 pandemic (August 2020 to January 2021 [P2]). Individuals above 18 years old exposed to biological material who sought the service during P1 or P2 were included in the study. Results: A total of 4,494 cases were assessed (1,997 in P1 and 2,497 in P2), mostly because of sexual exposure (62.3%). The mean age was 32.2 ± 9.2 years, most individuals were male (64.9%), originated from Recife (56.6%), and the education level was up to 12 years (53.7%). P2 presented 43% more attendances and shorter intervals between the exposure and first attendance (51%), first testing (28%), and discharge (10%) than P1 (p < 0.05), and cases had no difference in discharge rate (p = 0.339). Cases of sexual exposure had the highest dropout rate in both periods. Conclusion: Telemedicine maintained similar outcomes to face-to-face care and improved the indicators, increasing the mean monthly attendance and reducing the time between exposure and follow-up.
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COVID-19 , Profilaxia Pós-Exposição , Telemedicina , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Masculino , Feminino , Brasil/epidemiologia , Adulto , Profilaxia Pós-Exposição/métodos , SARS-CoV-2 , Pandemias/prevenção & controle , Pessoa de Meia-Idade , Adulto JovemRESUMO
BACKGROUND: To achieve zero leprosy cases in Santa Cruz, Bolivia, we designed a community-based active detection and provision of single-dose rifampicin post-exposure prophylaxis (SDR-PEP) to household contacts with new leprosy patients. METHODS: From July to August 2021, we assessed the current knowledge, attitude, and practices through structured interviews and focus group discussions with community representatives and health staff. This was followed by sensitization sessions, the training of health staff, and the reinforcement of referral mechanisms. Teams, including health staff and community volunteers, visited all new leprosy patients detected in 2021-2023 and household contacts. RESULTS: Among 115 community representatives, knowledge about leprosy etiology was attributed to non-biological factors (74%); fear accounted for 77%, and access to care was perceived as weak (74%), but the outlook was improved by SDR-PEP (80%). Among the 217 health staff interviewed, the programmatic barriers identified were a lack of referral feedback (67%), limited supplies for diagnosis and prevention, and ineffective training (64%). We visited 70 new patients and 258 household contacts. The median age in household contacts was 25 years old; 49% were women, 98% were eligible for SDR-PEP, and all who were eligible accepted it. Those who were non-eligible included one tuberculosis patient and six newly detected leprosy patients (23‱). CONCLUSIONS: A community-based intervention was successful in Santa Cruz, Bolivia. Misbeliefs and a lack of knowledge were identified as barriers. Programmatic components should be reinforced for SDR-PEP extension.
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BACKGROUND: Little is known about awareness and willingness to use or purchase HIV pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in Mexico. METHODS: MSM in Mexico were recruited via advertisements on online social venues to participate in Encuesta de Sexo Entre Hombres, an online behavioral survey. Awareness of PrEP, willingness to take PrEP if available for free, willingness to purchase PrEP, awareness of post-exposure prophylaxis (PEP), and ever PEP use were assessed in descriptive and multivariate analyses. RESULTS: Overall, 54.8% (4588/8376) of participants were aware of PrEP. Of those aware, 77.6% were willing to use PrEP if free and 52.6% were willing to purchase PrEP, generally at a maximum monthly cost of $500MXP. Both awareness of and willingness to use PrEP if free or for purchase were significantly greater among MSM who were younger, and varied by demographic, recent healthcare use, and behavioral risk factors. Only 8.2% had ever used PEP, which was highly associated with healthcare utilization. CONCLUSIONS: About half of Mexican MSM were aware of PrEP. The majority of those aware were willing to use PrEP if available for free and many were willing to purchase PrEP at low cost. Leveraging demographic, recent healthcare use, and behavioral risk characteristics associated with awareness and willingness to use PrEP could be useful in designing future PrEP programs for MSM in Mexico. Expanding healthcare settings in which PEP is available may also support identifying candidates for PrEP and scaling up PrEP implementation.
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Fármacos Anti-HIV , Infecções por HIV , Conhecimentos, Atitudes e Prática em Saúde , Homossexualidade Masculina , Aceitação pelo Paciente de Cuidados de Saúde , Profilaxia Pós-Exposição , Profilaxia Pré-Exposição , Humanos , Masculino , Infecções por HIV/prevenção & controle , Homossexualidade Masculina/psicologia , Homossexualidade Masculina/estatística & dados numéricos , México , Adulto , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Fármacos Anti-HIV/uso terapêutico , Fármacos Anti-HIV/administração & dosagem , Adulto Jovem , Pessoa de Meia-Idade , Inquéritos e Questionários , Adolescente , Assunção de RiscosRESUMO
BACKGROUND: Antibiotic prophylaxis to prevent brucellosis after accidental exposure to Brucella is an important topic in public health. This study aimed to systematically review the efficacy of antibiotic prophylaxis following accidental exposure to Brucella in preventing human brucellosis disease. METHODS: The study protocol was registered in PROSPERO (CRD42023456812). The outcomes included the incidence of brucellosis disease, adverse events rate, and antibiotic prophylaxis adherence. A comprehensive literature search, conducted until 20 November, 2023, involved Medline, Embase, Cochrane Library, and LILACS databases. Descriptive analysis and meta-analysis using R software were performed, risk of bias was assessed using JBI Critical appraisal tools, and certainty of evidence was assessed using the GRADE tool. RESULTS: Among 3102 initially identified records, eight studies involving 97 individuals accidentally exposed, all focused on high-risk accidental exposure to Brucella in laboratory settings, were included in the review. All studies reported the prophylactic treatment comprising doxycycline at a dosage of 100 mg twice daily, combined with rifampicin at 600 mg, both administered over 21 days. Prophylaxis adherence was reported in 86% of cases, and incidence of brucellosis post-treatment was 0.01. Adverse events, mainly gastrointestinal, occurred in 26% of cases. Critical appraisal revealed limitations in reporting demographics and clinical information. The certainty of evidence was rated as 'very low,' emphasising the need for caution in interpreting the observed outcomes due to study design constraints and the absence of comparative groups. CONCLUSIONS: PEP is an alternative practice reported in the literature, used in accidents with high-risk exposure to Brucella. The currently available evidence of the efficacy of antibiotic prophylaxis is insufficient to support a recommendation for or against the widespread use of antibiotic prophylaxis, so caution is needed in interpreting results due to the very low certainty of evidence, primarily stemming from case series and lack of comparative groups.
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Antibacterianos , Antibioticoprofilaxia , Brucelose , Brucelose/prevenção & controle , Humanos , Antibacterianos/uso terapêutico , Doxiciclina/uso terapêutico , Rifampina/uso terapêutico , BrucellaRESUMO
Abstract Objective: To analyze HIV Post-Exposure Prophylaxis (PEP) prescription and return for follow-up appointments. Methods: This was a descriptive cross-sectional study using data on people who sought PEP in emergency care units (UPAs) and specialized medical services in Salvador, BA, Brazil, between January-December/2018. Results: Of the 1,525 people who sought PEP at UPAs, 1,273 (83.5%) met PEP eligibility criteria, while 252 (16.5%) did not; of the eligible group, 1,166 (91.6%) had antiretrovirals prescribed, while 107 (8.4%) eligible people did not; of the total number of people with PEP prescriptions, only 226 (19.4%) returned for the first follow-up appointment, 115 (9.9%) for the second, and 33 (2.8%) for the third in order to complete the protocol. Conclusion: We found a significant proportion of eligible users who did not have PEP prescribed at UPAs and a significant loss of return for specialized service follow-up appointments.
Resumen Objetivo: Analizar la prescripción de Profilaxis Post Exposición (PPE) al Virus de la Inmunodeficiencia Humana (VIH) y la concurrencia a las consultas de control y seguimiento. Método: Estudio de datos descriptivo transversal de personas que solicitaron la PPE en Unidades de Atención de Emergencia (UPA) y servicios médicos especializados en Salvador, BA, Brasil, durante los meses de enero a diciembre de 2018. Resultados: De las 1.525 personas que consultaron por PEP en las unidades hospitalarias de emergencia, 1.273 (83,5%) cumplieron criterios de elegibilidad para profilaxis y 252 (16,5%) no los cumplieron; entre los elegibles, a 1.166 (91,6%) personas se les recetaron antirretrovirales (ARVs), pero 107 (8,4%) no los recibieron. Del total de personas que recibieron prescripción de PPE, solamente 226 (19,4%) regresaron a la primera consulta; 115 (9,9%) a la segunda consulta y 33 (2,8%) a la tercera consulta para completar el protocolo. Conclusión: Hubo una proporción significativa de usuarios elegibles que no recibieron prescripción de PEP en las Unidades de Atención de Emergencia y una pérdida significativa en las consultas de control al servicio especializado.
Resumo Objetivo: Analisar a prescrição da profilaxia pós-exposição (PEP) ao vírus da imunodeficiência humana (HIV) e o retorno às consultas de acompanhamento. Métodos: Estudo transversal descritivo, sobre dados de pessoas que buscaram a PEP em unidades de pronto atendimento (UPAs) e serviço médico de atenção especializada em Salvador, BA, Brasil, entre janeiro e dezembro/2018. Resultados: Das 1.525 pessoas que buscaram a PEP nas UPAs, 1.273 (83,5%) apresentaram critérios de elegibilidade à profilaxia e 252 (16,5%) não os apresentaram; entre os elegíveis, 1.166 (91,6%) pessoas tiveram prescrição dos antirretrovirais (ARVs), mas 107 (8,4%) não os receberam; do total de pessoas com prescrição de PEP, apenas 226 (19,4%) retornaram à primeira consulta, 115 (9,9%) à segunda consulta e 33 (2,8%) à terceira consulta para conclusão do protocolo. Conclusão: Observou-se proporção importante de usuários elegíveis que não receberam prescrição de PEP nas UPAs e perda significativa nas consultas de retorno ao serviço especializado.
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O acidente de trabalho com material biológico de profissionais de saúde em serviços especializados em HIV/Aids é uma demanda complexa. O objetivo desta pesquisa foi compreender as vivências pós-acidente com material biológico por profissionais de saúde que trabalham em um serviço especializado em HIV/Aids. Realizou-se uma pesquisa qualitativa com sete profissionais de saúde que atuam nesse contexto, abordando as vivências dessa experiência por meio de entrevistas semiestruturadas. Os discursos foram categorizados pelo método de análise de conteúdo temática. Foram observados sentimentos de medo da infecção e do estigma perante o ocorrido. Demonstrou-se o impacto dessa experiência nas relações familiares, sociais e profissionais, além do insuficiente acolhimento e apoio emocional no serviço onde trabalhavam e foram atendidos. Evidencia-se a necessidade de repensar protocolos e processos de cuidado desses profissionais mediante a Educação Permanente, considerando a complexidade de suas vivências diante do acidente.(AU)
The work accident with biological material of health professionals in specialized services in HIV/Aids is a complex demand. This research objective was to understand the post-accident experiences with biological material by health professionals working in a service specialized in HIV/Aids. Qualitative research was conducted with seven health professionals who work in this context, approaching their experiences through semi-structured interviews. The discourses were categorized by thematic content analysis method. Feelings of fear of the infection and stigma were observed. The impact of this experience on family, social and professional relationships was demonstrated. There was lack of receptiveness and emotional support in the service where they worked and where they received care. There is an evident need to rethink protocols and care processes for these professionals, through Permanent Education, considering the complexity of their experiences in the face of the accident.(AU)
El accidente de trabajo con material biológico de profesionales de la salud en servicios especializados en VIH/SIDA es una demanda compleja. El objetivo de esta investigación fue comprender las vivencias post accidente con material biológico por parte de profesionales de la salud que trabajan en un servicio especializado en VIH/SIDA. Se realizó una encuesta cualitativa con siete profesionales de la salud que actúan en ese contexto, abordando las vivencias de esa experiencia por medio de entrevistas semiestructuradas. Los discursos se categorizaron por el método de análisis del contenido temático. Se observaron sentimientos de miedo de la infección y del estigma ante lo ocurrido. Se demostró el impacto de esa experiencia en las relaciones familiares, sociales y profesionales. Se constató la insuficiente acogida y el apoyo emocional en el servicio en donde trabajaban y fueron atendidos. Resulta evidente la necesidad de volver a pensar protocolos y procesos de cuidados de estos profesionales, por medio de la Educación Permanente, considerando la complejidad de sus vivencias ante el accidente.(AU)
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Resumo Esta pesquisa investigou a relação entre características sociodemográficas das meninas e mulheres vítimas de estupro em Minas Gerais, no período de 2013 a 2021, e a probabilidade de receberem tratamentos de emergência, conforme estabelecido na Lei nº 12.845/2013, conhecida como Lei do Minuto Seguinte. Utilizou-se os dados do Sistema de Informação de Agravos de Notificação (SINAN) para casos de estupro para estimação de modelos de escolhas binárias. Os resultados indicam que fatores sociodemográficos das vítimas, alinhados à teoria e à prática da interseccionalidade (raça, idade, local de residência dentro das regiões de saúde, relação com o agressor e ano do registro do crime) influenciam, negativamente, a probabilidade de receberem o tratamento de emergência. Em particular, vítimas indígenas, menores de idade, agredidas por conhecidos e residentes em determinadas regiões de saúde demonstraram ter menor probabilidade de receber cuidados médicos imediatos. após o estupro. Além disso, constatou-se que a implementação da política pública não resultou em melhoria, já que, desde a promulgação da Lei, em 2013, até o ano 2021, houve diminuição no número de atendimentos médicos realizados.
Abstract This research project investigated the relationship between sociodemographic characteristics of girls and women who were the victims of rape of in Minas Gerais between 2013 and 2021, and the likelihood of receiving emergency treatment as stipulated in Law No. 12,845/2013, known as the "Minute-After" (Minuto Seguinte) Law. Data from the Notifiable Diseases Information System (SINAN) for rape cases were used to estimate binary choice models. The results indicate that the sociodemographic factors of the victims, aligned with the theory and practice of intersectionality (race, age, place of residence within health regions, relationship with the perpetrator, and year of crime registration), negatively influence the probability of receiving emergency treatment. Specifically, indigenous victims, minors, those raped by acquaintances, and residents in certain health regions, were found to have a lower probability of receiving immediate medical care after rape. Furthermore, it was found that the implementation of public policy did not result in an improvement, as there has been a decrease in the number of medical appointments since the enactment of the law in 2013 through to the year 2021.
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El uso preventivo de antimicrobianos es de larga data y no se restringe a antibacterianos. Lo más consensuado y estructurado es la profilaxis antimicrobiana perioperatoria y ante procedimientos invasivos. Fuera de este contexto hay gran cantidad de situaciones, menos caracterizadas, con riesgo de infecciones en que se usan ampliamente, muchas veces con menor sistematización. Esta presentación presenta las bases conceptuales y operativas de este segundo tipo de profilaxis. Conceptualmente la profilaxis primaria pretende evitar la infección por agente único conocido o variados, por exposición ambiental o susceptibilidad específica de ese hospedero y es implementable antes o después de la exposición. Producida esta infección la meta de la profilaxis secundaria intenta evitar la enfermedad y puede tomar dos modalidades, en infecciones sin evidencias de enfermedad clínica o daños, la profilaxis corresponde a "tratamiento de infección latente" y, si aún en ausencia de manifestaciones clínicas, hay elementos de laboratorio precoces premonitorios de progresión, la profilaxis se denomina "tratamiento anticipatorio". Se presentan operacionalmente y resumidas las situaciones en contexto médico no invasivo con uso potencial preventivo de antimicrobianos en base a agentes posibles, situaciones ambientales de riesgo, vulnerabilidad del hospedero, medicamentos a usar, su duración y efectividad con enfoque mayoritario en medicina de adultos.
Antimicrobial use with preventive purpose probably began shortly after its therapeutic use, especially antibiotics. More consensus and sistematization exist with perioperative and invasive procedures prophylaxis. However, beyond that context, there is great number of non invasive medical situations with high risk of secondary infections either by acquisition of pathogens or activation of latent ones, in which antimicrobials are routinely used with preventive purpose, albeit with less sistematization and consensus. This presentation aims to lay down the conceptual and operational basis for antimicrobial prophylaxis in these settings, whose objective is preventing an infection (primary prophylaxis) by a known or a variety of pathogens, either by person to person transmission, enviromental exposure or particular susceptibility of the host, and can be implemented before or after exposure. If already infected, the antimicrobial prophylaxis goal is to avoid progression to disease (secondary prevention) and may take two conceptual approaches; first, without clinical disease but significant risk of progression, the modality can be called "treatment of latent infection". In the second, also clinically asymptomatic, but with premonitory laboratoy signs of impending progression present, early use of antimicrobial is called "preemptive treatment". This presentation will describe the most frequent medical situations where preventive use of antimicrobials is employed, together with the medications most consensually used, according to the host, the agent(s) and medical situation, with emphasis in adults.
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Humanos , Controle de Infecções/métodos , Antibioticoprofilaxia/métodos , Anti-Infecciosos/uso terapêutico , Pneumonia por Pneumocystis/prevenção & controle , Tuberculose/prevenção & controle , Profilaxia Pós-Exposição , Profilaxia Pré-Exposição , Hepatite B/prevenção & controleRESUMO
INTRODUCTION: The effectiveness of human immunodeficiency virus (HIV) post-exposure prophylaxis (PEP) depends on adherence to the protocol, which includes taking antiretrovirals (ARVs) and attending visits. We examined the adherence rate to antiretroviral agents and follow-up visits identifying the associated characteristics of adherence and the reasons for not attending HIV PEP consultations in a specialized service in São Paulo, Brazil. METHODOLOGY: This was a cross-sectional study with health service users who had an indication for PEP due to sexual exposure in an HIV/AIDS service from April to October 2019. The health service users were followed-up throughout the prophylaxis cycle. Adherence was determined through self-reports on antiretroviral agent use and attendance to follow-up consultations. RESULTS: Association measures were employed to identify adherence-related characteristics. The sample analyzed included 91 users. The mean age was 32.5 years old (SD = 9.8). The largest share was white-skinned (49.5%), men who have sex with other men (62.2%), male (86.8%), and undergraduate/graduate students (65.9%). Adherence totaled 56.7% and health insurance was the associated characteristic (p = 0.039). Work (55.9%), using a private service (15.2%), forgetfulness (11.8%) and considering follow-up unnecessary (11.8%) were the main reasons for not attending the follow-up appointments. CONCLUSIONS: Few users do attend HIV PEP consultations. The users without health insurance had the highest adherence percentage whereas work was mentioned as a reason for not attending HIV PEP consultations.