Fabio Mesquita

The Potential Impact of Expanding Antiretroviral Therapy and Combination Prevention in Vietnam: Towards Elimination of HIV Transmission

Background:Few studies have assessed the effects of antiretroviral therapy (ART) to prevent HIV transmission in Asian HIV epidemics. Vietnam has a concentrated HIV epidemic with the highest prevalence among people who inject drugs. We investigated the impact of expanded HIV testing and counseling (HTC) and early ART, combined with other prevention interventions on HIV transmission. Methods:A deterministic mathematical model was developed using HIV prevalence trends in Can Tho province, Vietnam. Scenarios included offering periodic HTC and immediate ART with and without targeting subpopulations and examining combined strategies with methadone maintenance therapy and condom use. Results:From 2011 to 2050, maintaining current interventions will incur an estimated 18,115 new HIV infections and will cost US

Trends of HIV infection among injection drug users in Brazil in the 1990s : The impact of changes in patterns of drug use

22.1 million (reference scenario). Annual HTC and immediate treatment, if offered to all adults, will reduce new HIV infections by 14,513 (80%) and will cost US

Brazilian Response to the Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome Epidemic among Injection Drug Users

76.9 million. Annual HTC and immediate treatment offered only to people who inject drugs will reduce new infections by 13,578 (75%) and will cost only US

Hepatites B e C em usuários de drogas injetáveis vivendo com HIV em São Paulo, Brasil

23.6 million. Annual HTC and immediate treatment for key populations, combined with scale-up of methadone maintenance therapy and condom use, will reduce new infections by 14,723 (81%) with similar costs (US

Accelerating harm reduction interventions to confront the HIV epidemic in the Western Pacific and Asia: the role of WHO (WPRO)

22.7 million). This combination prevention scenario will reduce the incidence to less than 1 per 100,000 in 14 years and will result in a relative cost saving after 19 years. Conclusions:Targeted periodic HTC and immediate ART combined with other interventions is cost-effective and could lead to potential elimination of HIV in Can Tho.

Epidemiology, Responses, and Way Forward The Silent Epidemic of Viral Hepatitis and HIV Coinfection in Vietnam

Background: Santos Metropolitan Region (SMR), State of Sao Paulo, historically is well known as being one of the areas with the largest number of AIDS cases in Brazil, especially among injection drug users (IDUs). The main objective of this study was to assess the effects of changes in drug‐using patterns among IDUs on trends in HIV infection among IDUs in the 1990s. Methods: During 1991 through 1992 (wave 1; n = 214), 1994 through 1996 (wave 2; n = 135), and 1999 (wave 3; n = 108), we conducted three cross‐sectional studies of IDUs. All participants were interviewed and tested for antibodies to HIV. Findings: The overall sample population was 69% male, and 87% of the sample population was under 40 years old. Eighty‐four percent of the population had less than 9 years of education. HIV seroprevalence was 63% in wave 1, 65% in wave 2, and 42% in wave 3 (p < .001). Smoking of crack cocaine increased from 11% in wave 1 to 60% in wave 2 and 67% in wave 3 (p < .001). The prevalence of frequent injections (>5 per day) decreased from 42% in wave 1 to 30% in wave 2 and 15% in wave 3 (p < .001). Interpretation: HIV prevalence decreased as injection frequency decreased and crack cocaine use increased. In SMR, patterns of drug use have been affecting the HIV epidemic more than scant public health intervention.

How much will it cost? Estimation of resource needs and availability for HIV prevention, treatment and care for people who inject drugs in Asia

The Brazilian response to the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) epidemic is being observed all over the world because of its success. Understanding the role of injection drug users (IDUs) in the epidemic and the political response thereto is a key factor in the control of the epidemic in Brazil. This paper summarizes some of the most important analyses of the Brazilian response to the HIV/AIDS epidemic among and from IDUs. Key elements of the response include the support of the Brazilian Universal Public Health System, the provision of universal access to highly active antiretroviral therapy, and the creation of harm reduction projects that are politically and financially supported by the federal government. The response among and from IDUs is a key element in overall control of the HIV/AIDS epidemic. The response to the epidemic among and from IDUs has been headed in the correct direction since its beginning and is now being intensively expanded.

The Brazilian comprehensive response to hepatitis C: from strategic thinking to access to interferon-free therapy

OBJETIVO: Descrever o perfil de usuarios de drogas injetaveis vivendo com HIV/Aids e estimar a prevalencia de hepatites B e C nesse grupo. METODOS: Estudo transversal realizado com 205 pessoas vivendo com HIV/Aids, usuarios de drogas injetaveis em acompanhamento em tres unidades de atendimento da rede publica do Municipio de Sao Paulo, em 2003. Foi selecionada amostra nao-probabilistica, obtida de forma consecutiva e voluntaria, nos dias em que compareciam para consulta nas unidades de atendimento. Por meio de entrevistas, foram levantados dados pessoais e informacoes sobre comportamento sexual, uso de drogas e conhecimento de hepatites. Foram realizados testes para deteccao da infeccao pelos virus das hepatites B e C. RESULTADOS: Dos entrevistados, 81% eram homens e 19% mulheres, com idade media de 39 anos (dp=6,1) e seis anos de educacao formal (dp=2,0). Nao havia diferenca em relacao ao estado marital entre os sexos, 48% eram solteiros, 42% casados e 8% divorciados. A idade media do primeiro uso de tabaco, alcool e drogas ilicitas foi 13, 15 e 18 anos, respectivamente. Prevalencias de hepatites B e C foram, respectivamente, de 55% (IC 95%: 49;63) e 83% (IC 95%: 78;88). Antes de usar droga injetavel pela primeira vez, 80% dos respondentes nao tinham ouvido falar de hepatites B e C. CONCLUSOES: A alta prevalencia de hepatites B e C e o baixo nivel de conhecimento sobre a doenca justificam a inclusao de esclarecimentos sobre as infeccoes hepaticas e de vacinacao contra hepatite B nas estrategias de reducao de danos pelo HIV.

Rapidly responding to injecting drug use and HIV in Brazil: a field-report from São Vicente, São Paulo State.

The epidemic of HIV/AIDS linked to injecting drug usage is one of the most explosive in recent years. After a historical epicentre in Europe, South and North America, at present it is clearly the main cause of dissemination of the epidemic in Eastern Europe and some key Asian countries. Recently, 10 African countries reported the spread of HIV through people who inject drugs (PWID), breaking one of the final geographical barriers to the globalization of the epidemic of HIV among and from PWID.Several countries of the Asia and Pacific Region have HIV epidemics that are driven by injecting drug usage. Harm reduction interventions have been implemented in many countries and potential barriers to implementation are being overcome. Harm reduction is no longer a marginal approach in the Region; instead, it is the core tool for responding to the HIV/AIDS epidemic among PWID. The development of a comprehensive response in the Region has been remarkable, including scaling up of needle and syringe programmes (NSPs), methadone maintenance treatment (MMT), and care, support and treatment for PWID. This development is being followed up by strong ongoing changes in policies and legislations. The main issue now is to enhance interventions to a level that can impact the epidemic.The World Health Organization (WHO) is one of the leading UN agencies promoting harm reduction. Since the establishment of the Global Programme on AIDS, WHO has been working towards an effective response to the HIV epidemic among PWID. WHOs work is organized into a number of components: establishing an evidence base; advocacy; development of normative standards, tools and guidelines; providing technical support to countries; ensuring access to essential medicines, diagnostics and commodities; and mobilizing resources.In this paper, we trace the course of development of the HIV/AIDS epidemic among and from PWID in the Western Pacific and Asia Region (WPRO) as well as WHOs role in supporting the response in some of the key countries: Cambodia, China, Lao PDR, Malaysia, the Philippines and Viet Nam.

Estimating the Size of the HCV Infection Prevalence: A Modeling Approach Using the Incidence of Cases Reported to an Official Notification System

Viral hepatitis is a disease of great concern to public health that is now met by a favorable momentum to combat the global epidemic. This article is intended to highlight the importance of viral hepatitis in the Vietnam population as well in the group of people living with HIV/AIDS (PLWHA). We reviewed available data on epidemiology and response on hepatitis B virus (HBV) and hepatitis C virus (HCV) and HIV coinfection in Vietnam. The hepatitis B surface antigen (HBsAg) prevalence in the general population ranged from 5.7% to 24.7%. The anti-HCV prevalence ranged from 0.38% to 4.3% in the general population, while among people who inject drugs (PWIDs) it ranged from 31% to 97.2%. The HBV prevalence among PLWHA is similar to the general population, while HCV/HIV coinfection is concentrated in some groups. Anti-HCV prevalence among HIV-infected PWIDs can be as high as 98.5%. Developing policies for diagnosis and treatment of chronic HBV and HCV infections are critical priorities in order to prevent clinical progression to cirrhosis and liver cancer.