Karlla Antonieta Amorim Caetano

Outreach hepatitis B vaccination of female sex workers in central-west Brazil: immunization status, compliance, and immune response.

OBJECTIVES To evaluate the hepatitis B immunization status of female sex workers (FSWs) in Central-West Brazil and to evaluate their compliance with and immune response to hepatitis B vaccination delivered using outreach strategies. METHODS A total of 721 FSWs recruited in 2 large cities in Central-West Brazil were interviewed and screened for the presence of hepatitis B virus (HBV) markers. Hepatitis B vaccine was offered to all women susceptible to HBV, using outreach strategies. The immune response of FSWs who received a full course of vaccine was assessed following the final vaccine dose. RESULTS We found that 27.6% of FSWs, the majority of whom were aged 18 to 25 years, had serological evidence of previous hepatitis B vaccination. A total of 434 FSWs were eligible for vaccination, 389 (89.6%) of whom accepted the first hepatitis B vaccine dose. Of those, 64% received a second dose and 37.5% received all three doses. Through the outreach strategy, there was a 52.2% increase in the number of women who received the second dose and a 67% increase in the number who received the third dose. Of the 146 women who received a full course of vaccine, 105 accepted testing for quantitative anti-HBs (hepatitis B surface antibody) following the final vaccine dose, and 92.4% of those tested had developed protective levels of anti-HBs. Lower education level, workplace, and length of prostitution were predictors of full-vaccine acceptance. CONCLUSIONS The present findings illustrate the benefits of using outreach strategies to overcome the difficulties of vaccinating hard-to-reach populations such as FSWs.

INTERMEDIATE ENDEMICITY OF HEPATITIS A VIRUS INFECTION IN RURAL SETTLEMENT PROJECTS OF SOUTHWEST GOIAS, BRAZIL.

BACKGROUND Rural populations present an elevated risk of exposure to hepatitis A virus. OBJECTIVE The objective of this study was to estimate the prevalence and risk factors associated with hepatitis A virus infection among residents of rural settlement projects of southwest Goiás, Central Brazil. METHODS A total of 466 residents were interviewed and tested for the detection of anti- hepatitis A virus antibodies by ELISA. RESULTS The global prevalence of anti- hepatitis A virus was 82.2%. In individuals aged 5-9 years and 10-19 years, the prevalence was 15% and 58.8%, respectively. Persons in the 10-19 age group, with a history of life in encampments, with more than five people per residence consuming well water, were predictors for exposure to hepatitis A virus. CONCLUSION Our results suggest that the hepatitis A virus endemicity in rural settlements in southwest Goiás similar to that found in the urban population of the Midwest Region, confirming the implementation of universal hepatitis A vaccination in children.

Vulnerability to Sexually Transmitted Infections in women who sell sex on the route of prostitution and sex tourism in Central Brazil

OBJECTIVE: to investigate knowledge on sexually transmitted diseases (STDs), STD-related risk behaviors, and signs/symptoms of STDs among female sex workers (FSWs). METHODS: a cross-sectional study was conducted with a probabilistic sample comprising 395 women recruited using a respondent-driven sampling method between 2009 and 2010. The data were collected during face-to-face interviews. RESULTS: most of the participants were young adults, had a low educational level, and had poor knowledge on the transmission paths of the human immunodeficiency virus (HIV). Over one-third of the participants were not able to describe the signs/symptoms of STDs. The prevalence rates of vaginal discharge and wounds/ulcers were 49.0% and 8.6%, respectively, but 41.7% of the women had not sought treatment. CONCLUSION: the results indicate the need for public health policies focusing on the control and prevention of STDs in this population, especially for the FSWs who are active in an important prostitution and sex tourism route in central Brazil.OBJECTIVE to investigate knowledge on sexually transmitted diseases (STDs), STD-related risk behaviors, and signs/symptoms of STDs among female sex workers (FSWs). METHODS a cross-sectional study was conducted with a probabilistic sample comprising 395 women recruited using a respondent-driven sampling method between 2009 and 2010. The data were collected during face-to-face interviews. RESULTS most of the participants were young adults, had a low educational level, and had poor knowledge on the transmission paths of the human immunodeficiency virus (HIV). Over one-third of the participants were not able to describe the signs/symptoms of STDs. The prevalence rates of vaginal discharge and wounds/ulcers were 49.0% and 8.6%, respectively, but 41.7% of the women had not sought treatment. CONCLUSION the results indicate the need for public health policies focusing on the control and prevention of STDs in this population, especially for the FSWs who are active in an important prostitution and sex tourism route in central Brazil.

Low prevalence, low immunization and low adherence to full hepatitis B vaccine scheme and high-risk behaviors among crack cocaine users in central Brazil

Crack cocaine users represent a target group for hepatitis B vaccination. We evaluate the HBV epidemiology, immunization status and compliance with a super-accelerated vaccination schedule among in-treatment crack cocaine users in central Brazil. Six hundred in-treatment crack cocaine users were interviewed, and serum samples were tested for HBV markers. A super-accelerated vaccination schedule of HBV vaccine was offered to all susceptible crack cocaine users. In total, 7.0% of those tested had at least one positive marker of HBV exposure. Age, use of crack cocaine through improvised pipe, exchange of sex for money/drugs and previous sexually transmitted infections (STIs) were predictors of HBV exposure. One hundred six (17.7%) individuals showed a serological profile of hepatitis B vaccination. Of these, 54.7% were less than 25 years old, and only 13% of individuals were more than 35 years old. Although 91.8% of crack users accepted the first vaccine dose, only 21.7% received all three doses. Of the 23 crack cocaine users who agreed to have their vaccine response evaluated, 78.3% developed protective anti-HBs titers. Premature termination of treatment was the most common reason for not receiving the full vaccine series. Despite the low prevalence of HBV exposure among in-treatment crack cocaine users in central Brazil, the low rate of immunization and the high frequency of high-risk behaviors highlight the potential for crack users to acquire and disseminate this infection and therefore maintain the viral reservoir. Health practitioners need to keep this in mind, taking advantage of all opportunities to access this population and vaccinate against HBV.

Exposure to hepatitis C virus in homeless men in Central Brazil: a cross-sectional study

BackgroundHomeless men are highly vulnerable to acquisition of the hepatitis C virus (HCV) compared to the general population. In Brazil, a country of continental dimensions, the extent of HCV infection in this population remains unknown. The objective of this study is to investigate the epidemiological profile of exposure to HCV in homeless men in Central Brazil.MethodsA Cross-sectional study was conducted in 481 men aged over 18 years attending therapeutic communities specialized in the recovery and reintegration of homeless people. Participants were tested for anti-HCV markers using rapid tests. Poisson regression analysis was used to verify the risk factors associated with exposure to HCV.ResultsThe prevalence of HCV exposure was 2.5% (95.0% CI: 1.4 to 4.3%) and was associated with age, absence of family life, injection drug use, number of sexual partners, and history of sexually transmitted infections (STI). Participants reported multiple risk behaviors, such as alcohol (78.9%), cocaine (37.1%) and/or crack use (53.1%), and inconsistent condom use (82.6%). Injection drug use was reported by 8.7% of participants.ConclusionsThe prevalence of HCV infection among homeless men was relatively high. Several risk behaviors were commonly reported, which shows the high vulnerability of this population. These findings emphasize the need for the development of specific strategies to reduce the risk of HCV among homeless men.

Late HIV diagnosis and survival within 1 year following the first positive HIV test in a limited-resource region.

Brazil has been considered as the developing country with the most successful HIV treatment program as it guarantees free access to antiretroviral therapy for all people living with HIV and in need of treatment. Despite this most individuals commence ART at an advanced stage of disease. This study investigated the late diagnosis of HIV infection among individuals with a first positive HIV test who sought care at the main referral hospital in Goias Central-West Brazil. It compared early mortality between those who were diagnosed late and those who were. The findings of this study will be important for nurses providing preventive and clinical care for HIV patients in limited-resource regions. The results highlight that early HIV diagnosis has been a great challenge among efforts to control the epidemic as most infected individuals only seek medical care when they develop AIDS-related symptoms. Infected individuals who do not know their status contribute to the spread of the infection are at higher risk of early death and have increased associated health care costs. Furthermore high late-diagnosis rates have even been found in countries where ART are available for free which is confirmed by the studys findings. Therefore in countries where ART is widely accessibly the great programmatic challenge is to improve early diagnosis of HIV infection and to better train nurses to encourage people to test for HIV in all healthcare settings.

Hepatitis B, HIV, and Syphilis in Female Crack Cocaine Users in Central Brazil

Raquel S. Pinheiro, BSN, MSN, is a Doctoral student, Faculdade de Enfermagem, Goiânia, Brasil. Megmar A. S. Carneiro, BPharm, MSc, PhD, is a Professor, Instituto de Patologia Tropical e Sa ude P ublica, Goiânia, Brasil. Regina M. B. Martins, BPharm, MSc, PhD, is a Professor, Instituto de Patologia Tropical e Sa ude P ublica, Goiânia, Brasil. Karlla A. A. Caetano, BSN, MSN, PhD, is a Professor, Faculdade de Enfermagem, Goiânia, Brasil. Paulie M. R. S. Carvalho, BSN, MSN, is a Doctoral student, Faculdade de Enfermagem, Goiânia, Brasil. Camila C. Ferreira, BSN, is a Master’s student, Faculdade de Enfermagem, Goiânia, Brasil. Marcos A. Matos, BSN, MSN, PhD, is a Professor, Faculdade de Enfermagem, Goiânia, Brasil. Sheila A. Teles, BSN, MsC, PhD, is a Professor, Faculdade de Enfermagem, Universidade Federal de Goi as, Goiânia, Goi as, Brazil. (*Correspondence to: sheila.fen@gmail.com). Hepatitis B virus (HBV) is a widespread global problem, with an estimated 240 million individuals experiencing chronic infection (Ott, Stevens, Groeger, & Wiersma, 2012). HBV is an important contributor to cases of acute and chronic hepatitis, cirrhosis, and hepatocellular carcinoma. HIV, the etiologic agent of AIDS, affected approximately 36.7 million people worldwide and caused 1.1 million deaths in 2015 (Joint United Nations Programme on HIV/AIDS [UNAIDS], 2016). Syphilis (Treponema pallidum) was estimated by the World Health Organization to affect 36.4 million individuals in 2008, with approximately 10.6 million new cases occurring annually (World Health Organization [WHO], 2008). Syphilis infection can cause a range of clinical features, affecting practically any system or organ (Antal, Lukehart, & Meheus, 2002). These micro-organisms are efficiently spread by both sexual and vertical transmission (UNAIDS, 2013; WHO, 2012; Zoni, Gonzalez, & Sj€ogren, 2013). Therefore, women play an important role in the spread of HBV, HIV, and T. pallidum. Women often become infected during their childbearing years, allowing them to transmit these agents to their children perinatally (Dionne-Odom, Tita, & Silverman, 2016; Ham, Lin, Newman, Wijesooriya,

La vulnerabilidad a las enfermedades de transmisión sexual en mujeres que venden sexo en ruta de prostitución y turismo sexual en Brasil Central

OBJECTIVE: to investigate knowledge on sexually transmitted diseases (STDs), STD-related risk behaviors, and signs/symptoms of STDs among female sex workers (FSWs). METHODS: a cross-sectional study was conducted with a probabilistic sample comprising 395 women recruited using a respondent-driven sampling method between 2009 and 2010. The data were collected during face-to-face interviews. RESULTS: most of the participants were young adults, had a low educational level, and had poor knowledge on the transmission paths of the human immunodeficiency virus (HIV). Over one-third of the participants were not able to describe the signs/symptoms of STDs. The prevalence rates of vaginal discharge and wounds/ulcers were 49.0% and 8.6%, respectively, but 41.7% of the women had not sought treatment. CONCLUSION: the results indicate the need for public health policies focusing on the control and prevention of STDs in this population, especially for the FSWs who are active in an important prostitution and sex tourism route in central Brazil.OBJECTIVE to investigate knowledge on sexually transmitted diseases (STDs), STD-related risk behaviors, and signs/symptoms of STDs among female sex workers (FSWs). METHODS a cross-sectional study was conducted with a probabilistic sample comprising 395 women recruited using a respondent-driven sampling method between 2009 and 2010. The data were collected during face-to-face interviews. RESULTS most of the participants were young adults, had a low educational level, and had poor knowledge on the transmission paths of the human immunodeficiency virus (HIV). Over one-third of the participants were not able to describe the signs/symptoms of STDs. The prevalence rates of vaginal discharge and wounds/ulcers were 49.0% and 8.6%, respectively, but 41.7% of the women had not sought treatment. CONCLUSION the results indicate the need for public health policies focusing on the control and prevention of STDs in this population, especially for the FSWs who are active in an important prostitution and sex tourism route in central Brazil.

Use of illicit drugs by adolescents and young adults of an urban settlement in Brazil

OBJECTIVE To estimate the prevalence and factors associated with illicit drug use by adolescents and young adults of a formal urban settlement. METHOD Cross-sectional study including adolescents and young adults 12-24 years of an urban settlement in the Midwest Region of Brazil. Data were collected using a structured questionnaire and analyzed using Stata, version 12.0. We used Poisson regression model to estimate the factors associated with illicit drug use. RESULTS Of the total participants (n=105), 27.6% (95CI 20.0-36.9%) had used illicit drugs such as marijuana, cocaine, crack, LSD and inhalants. The consumption of these substances was associated with male gender, use of body piercing and/or tattoos, licit drug use and self-report of signs and/or symptoms of sexually transmitted infections. CONCLUSION High prevalence of illicit drug use was found in the individuals investigated, ratifying the presence of risk factors to the vulnerability of the settlers to use these substances in the urban settlement population.

HIV-1 infection among crack cocaine users in a region far from the epicenter of the HIV epidemic in Brazil: Prevalence and molecular characteristics

Brazil has the largest cocaine market in South America, and crack cocaine use is closely associated with HIV-1 infection. This study investigated the prevalence, risk factors, and HIV-1 subtypes, including recombinant forms and mutations associated with drug resistance, among crack cocaine users in Central-West Brazil. We recruited 600 crack cocaine users admitted to a referral hospital in Goiânia for psychiatric disorders. The participants were interviewed; blood samples were collected for anti-HIV-1/2 serological screening. HIV-1 pol gene sequences (entire protease [PR] and partial reverse transcriptase [RT]) were obtained from plasma RNA. HIV-1 subtypes, recombinant viruses, transmitted drug resistance (TDR), and secondary drug resistance mutations were investigated. The median participant age was 30 years (range, 18–68 years); most were male, single, unemployed, and of mixed races. Among them, 2.8% (17/600) were HIV-1 positive: 2.2% of men (11/507) and 6.5% of women (6/93). The main predictors of HIV-1 seropositivity were a sexual partner with HIV infection, irregular condom use, and previous homelessness. HIV-1 pol sequences (12/17) indicated the predominance of subtype B (n = 7), followed by recombinant forms FPR/BRT (n = 1) and BPR/FRT (n = 2) and subtypes F1 (n = 1) and C (n = 1). TDR prevalence was 58.3% (7/12). Isolates from two participants showed mutations associated with resistance to nucleoside reverse transcriptase inhibitors (NRTI) only (M41L, T125C, T125F, M184V), while an isolate from one patient who had received antiretroviral therapy (ART) since 2008 had a mutation associated with resistance to non-NRTI (G190S). Five isolates had secondary mutations to protease inhibitors (K20M, L10V, L33I, A71T, A71V). In conclusion, the findings of HIV-1 circulation, TDR to NRTI, and secondary mutations to protease inhibitors in ART-naïve crack cocaine users support the importance of monitoring this population in regions far from the epicenter of the HIV epidemic.