Lívia Maria Lopes

Coordenação da assistência prestada às pessoas que vivem com HIV/AIDS em um município do Estado de São Paulo, Brasil

Objetivou-se analisar a coordenacao das acoes e servicos de saude na assistencia as pessoas que vivem com HIV/AIDS. Trata-se de um estudo seccional com 301 pessoas que vivem com HIV/AIDS. A analise foi feita por tecnicas descritivas, analise de variância e comparacao multiplas de medias. Encontrou-se que a coordenacao da assistencia foi satisfatoria (media = 3,69 e DP = 1,74). As pessoas que vivem com HIV/AIDS utilizavam outros servicos de saude alem dos Servicos de Assistencia Especializada em HIV/AIDS – SAE (Pronto Atendimento: 67%; atencao basica: 43,2%; outros servicos especializados: 23,6%; servicos privados: 15%). Os cinco SAE apresentaram diferentes desempenhos, bem como distintos contextos e composicoes assistenciais, entretanto adequado manejo dos aspectos clinicos em detrimento dos sociais. O fornecimento da guia de referencia foi tido como satisfatorio, entretanto a guia de contrarreferencia insatisfatorio. Ha necessidade de estrategias que favorecam o desenvolvimento de acoes compartilhadas e cooperadas dentro das equipes dos SAE e entre os diferentes servicos com o intuito de fortalecer a producao de cuidado resolutivo.The aim of this study was to analyze the coordination of health activities and services for persons living with AIDS. This was a cross-sectional study of 301 persons living with AIDS. The analysis used descriptive techniques, analysis of variance, and multiple comparisons of means. Coordination of care was found to be satisfactory (mean = 3.69 and SD = 1.74). Persons living with AIDS used other health services in addition to the Services for Specialized HIV/AIDS Care (67.0% emergency departments, 43.2% primary care, 23.6% other specialized services, 15% private services). The five specialized HIV/AIDS clinics showed different performance levels as well as distinct contexts and healthcare configurations, but adequate clinical management (comparatively better than management of social issues). Provision of the referral guide was considered satisfactory, but the counter-referral guide was found to be unsatisfactory. Strategies are needed to promote the development of shared and cooperative actions within the healthcare teams in the specialized HIV/AIDS clinics and between the different services in order to strengthen the provision of care with case-resolution capacity.

Provision of health care actions and services for the management of HIV/AIDS from the users’ perspective

Objetivo Analizar la oferta de acciones en los servicios de salud que prestan asistencia a las personas que viven con SIDA en el seguimiento de los servicios especializados del municipio de Ribeirao Preto-SP. Metodo Estudo descriptivo, exploratorio, del tipo encuesta. Se llevaron a cabo entrevistas con cuestionario estructurado y analisis de datos por medio de estadisticas descriptivas. Resultados La oferta de acciones y servicios de salud se la ve como regular. Para los 301 sujetos, la atencion de rutina por el equipo de referencia; examenes de laboratorio y facilitacion de antirretrovirales, vacunas y preservativos obtuvieron evaluacion satisfactoria. Evaluadas como regular la oferta de examenes para la prevencion y el diagnostico de comorbilidades, e insatisfactoria la oferta de atencion especializada por otros profesionales; de grupos de apoyo psicosocial y farmacos preventivos de efecto colateral de los antirretrovirales. Conclusion Debilidades permean el seguimiento y la gestion del cuidado, con predominio del enfoque biologicista, centrado en el medico, en el que el control clinico y el acceso a la Terapia Antirretroviral se constituyen como el enfoque esencial de la asistencia prestada.OBJECTIVE To analyse the provision of health care actions and services for people living with AIDS and receiving specialised care in Ribeirão Preto, SP. METHOD A descriptive, exploratory, survey-type study that consisted of interviews with structured questionnaires and data analysis using descriptive statistics. RESULTS The provision of health care actions and services is perceived as fair. For the 301 subjects, routine care provided by the reference team, laboratory tests and the availability of antiretroviral drugs, vaccines and condoms obtained satisfactory evaluations. The provision of tests for the prevention and diagnosis of comorbidities was assessed as fair, whereas the provisions of specialised care by other professionals, psychosocial support groups and medicines for the prevention of antiretroviral side effects were assessed as unsatisfactory. CONCLUSION Shortcomings were observed in follow-up and care management along with a predominantly biological, doctor-centred focus in which clinical control and access to antiretroviral therapy comprise the essential focus of the care provided.


Evaluation of the performance of Tuberculosis Control Programs in Brazil and Spain: an integrative review of the literature

This is an integrative review of the literature, which sought to locate evidence regarding the evaluation of the performance of tuberculosis control programs in the Brazilian and Spanish contexts. Articles indexed in databases, search directories and virtual libraries produced in Brazil and Spain from 2002 to 2013 were selected. A total of 17 articles (9 Brazilian and 8 Spanish) were included for analysis. The intention was to identify program evaluation concepts, methodologies and indicators for TB control program evaluation in both countries. In the Spanish context, a concern with results-oriented management and the attempt to develop broader indicators for the assessment of a series of health programs, including those related to tuberculosis control, was identified. The Brazilian references showed greater proximity to the classic methods of evaluation research, and a greater variety of objects of study regarding the activities expected in a control program. The findings highlight the complexity of program evaluation activities, which involve multiple and diverse stakeholders, and point to the need for integration of epidemiological and operational indicators in tuberculosis.

Tuberculosis control in people living with HIV/AIDS.

ABSTRACT Objective: to analyze the offering of health actions and services for the control of tuberculosis for people living with HIV/AIDS being followed up in the Specialized Care Services for HIV/AIDS in Ribeirão Preto, SP, Brazil. Method: quantitative, exploratory survey study. Participated 253 people living with HIV/AIDS followed up by this service, considering as inclusion criteria: individuals older than 18 years living in the city and not inmates. Data collection was conducted from January 2012 to May 2013 through interviews with the support of a specific instrument. Data were analyzed using indicators and a composite index. Results: the offering of services for the control of tuberculosis in people living with HIV/AIDS by municipal services was considered as intermediate, reinforcing the need for better planning for comprehensive assistance, coordination of professionals in teams and among the services network, in addition to professional training and continuing education. Conclusion: it is necessary to implement strategies that promote shared actions between TB and HIV / AIDS programs and between different services in order to strengthen the local care network, aimed at producing an individualized care, comprehensive and responsive.Objetivo: analisar a oferta das ações e serviços de saúde para o controle da tuberculose nas pessoas vivendo com HIV/aids em seguimento pelos Serviços de Atenção Especializada ao HIV/ aids de Ribeirão Preto, SP, Brasil. Método: estudo quantitativo, exploratório, do tipo inquérito. Participaram 253 pessoas vivendo com HIV/aids em seguimento nos serviços, considerando os critérios de inclusão: indivíduos maiores de 18 anos, residentes no município e não pertencentes ao sistema prisional. A coleta de dados foi realizada no período de janeiro/2012 a maio/2013, por meio de entrevistas com apoio de um instrumento específico. Os dados foram analisados mediante indicadores e índice composto. Resultados: a oferta de ações e serviços para o controle da tuberculose nas pessoas vivendo com HIV/aids pelos serviços do município foi considerada regular, reforçando a necessidade de melhor planejamento da assistência de forma integral, articulação dos profissionais nas equipes e entre os serviços da rede, além da formação profissional e educação permanente. Conclusão: faz-se necessário a implementação de estratégias que favoreçam ações compartilhadas entre os programas de tuberculose e HIV/aids e entre os diferentes serviços, com o intuito de fortalecer a rede local de atenção objetivando a produção de um cuidado singular, integral e resolutivo.

P3.137 Hiv hospitalizations: analysis of the individual and social factors associated in the city of ribeirão preto – sp

Introduction The present research examined the factors associated to hospital admissions for HIV in Ribeirão Preto - SP. We used the theoretical concept of vulnerability, understood as a set of individual elements (subjective, biological and behavioural), and social elements (adversities of economic and social order) that worsen individuals and/or groups in relation to health issues. Methods This is an observational epidemiologic study, of case-control type, held in Ribeirão Preto - SP. The study population was made up of the people living with HIV (PLHIV), being called ”cases” those who were admitted in 2014 and ”controls” those who were followed up at outpatient clinics of the public health system. Interviews were conducted using a specific instrument, containing questions on sociodemographic data, clinical characteristics and other individual and social vulnerabilities. We also collected data from secondary sources, being mainly the clinical record. Data were analysed using descriptive analysis techniques and conditional logistic regression. Results 168 people living with HIV participated, properly matched in the ratio of 1: 2, so 56 hospitalised PLHIV and 112 not hospitalised PLHIV. Among the risk factors for hospital admission for HIV, we found out that unemployed people and retirees/homemakers had 3.63 and 7.14 times more likely than those who are employed or self-employed; people on the street had 10.18 times more likely to be hospitalised than those who were not on the street; non antiretroviral users had 9.68 times more likely than those under antiretroviral therapy. Conclusion This research contributed to measure how some characteristics of social and individual vulnerabilities interfere with the intensification of HIV, providing then an unfavourable outcome, as in the case of hospitalisation. This understanding allows us to identify the key population that needs public policies focused on minimising clinical instability of the disease, suffering, pain, and even the costs of hospital services.

Oferta de acciones y servicios de salud para el manejo del vih/sida, bajo la perspectiva de los drogadictos

Objetivo Analizar la oferta de acciones en los servicios de salud que prestan asistencia a las personas que viven con SIDA en el seguimiento de los servicios especializados del municipio de Ribeirao Preto-SP. Metodo Estudo descriptivo, exploratorio, del tipo encuesta. Se llevaron a cabo entrevistas con cuestionario estructurado y analisis de datos por medio de estadisticas descriptivas. Resultados La oferta de acciones y servicios de salud se la ve como regular. Para los 301 sujetos, la atencion de rutina por el equipo de referencia; examenes de laboratorio y facilitacion de antirretrovirales, vacunas y preservativos obtuvieron evaluacion satisfactoria. Evaluadas como regular la oferta de examenes para la prevencion y el diagnostico de comorbilidades, e insatisfactoria la oferta de atencion especializada por otros profesionales; de grupos de apoyo psicosocial y farmacos preventivos de efecto colateral de los antirretrovirales. Conclusion Debilidades permean el seguimiento y la gestion del cuidado, con predominio del enfoque biologicista, centrado en el medico, en el que el control clinico y el acceso a la Terapia Antirretroviral se constituyen como el enfoque esencial de la asistencia prestada.OBJECTIVE To analyse the provision of health care actions and services for people living with AIDS and receiving specialised care in Ribeirão Preto, SP. METHOD A descriptive, exploratory, survey-type study that consisted of interviews with structured questionnaires and data analysis using descriptive statistics. RESULTS The provision of health care actions and services is perceived as fair. For the 301 subjects, routine care provided by the reference team, laboratory tests and the availability of antiretroviral drugs, vaccines and condoms obtained satisfactory evaluations. The provision of tests for the prevention and diagnosis of comorbidities was assessed as fair, whereas the provisions of specialised care by other professionals, psychosocial support groups and medicines for the prevention of antiretroviral side effects were assessed as unsatisfactory. CONCLUSION Shortcomings were observed in follow-up and care management along with a predominantly biological, doctor-centred focus in which clinical control and access to antiretroviral therapy comprise the essential focus of the care provided.


Oferta de ações e serviços de saúde para o manejo do HIV/aids, sob a perspectiva dos usuários

Objetivo Analizar la oferta de acciones en los servicios de salud que prestan asistencia a las personas que viven con SIDA en el seguimiento de los servicios especializados del municipio de Ribeirao Preto-SP. Metodo Estudo descriptivo, exploratorio, del tipo encuesta. Se llevaron a cabo entrevistas con cuestionario estructurado y analisis de datos por medio de estadisticas descriptivas. Resultados La oferta de acciones y servicios de salud se la ve como regular. Para los 301 sujetos, la atencion de rutina por el equipo de referencia; examenes de laboratorio y facilitacion de antirretrovirales, vacunas y preservativos obtuvieron evaluacion satisfactoria. Evaluadas como regular la oferta de examenes para la prevencion y el diagnostico de comorbilidades, e insatisfactoria la oferta de atencion especializada por otros profesionales; de grupos de apoyo psicosocial y farmacos preventivos de efecto colateral de los antirretrovirales. Conclusion Debilidades permean el seguimiento y la gestion del cuidado, con predominio del enfoque biologicista, centrado en el medico, en el que el control clinico y el acceso a la Terapia Antirretroviral se constituyen como el enfoque esencial de la asistencia prestada.OBJECTIVE To analyse the provision of health care actions and services for people living with AIDS and receiving specialised care in Ribeirão Preto, SP. METHOD A descriptive, exploratory, survey-type study that consisted of interviews with structured questionnaires and data analysis using descriptive statistics. RESULTS The provision of health care actions and services is perceived as fair. For the 301 subjects, routine care provided by the reference team, laboratory tests and the availability of antiretroviral drugs, vaccines and condoms obtained satisfactory evaluations. The provision of tests for the prevention and diagnosis of comorbidities was assessed as fair, whereas the provisions of specialised care by other professionals, psychosocial support groups and medicines for the prevention of antiretroviral side effects were assessed as unsatisfactory. CONCLUSION Shortcomings were observed in follow-up and care management along with a predominantly biological, doctor-centred focus in which clinical control and access to antiretroviral therapy comprise the essential focus of the care provided.


[Coordination of care for people living with HIV/AIDS in a city in São Paulo State, Brazil.]

Objetivou-se analisar a coordenacao das acoes e servicos de saude na assistencia as pessoas que vivem com HIV/AIDS. Trata-se de um estudo seccional com 301 pessoas que vivem com HIV/AIDS. A analise foi feita por tecnicas descritivas, analise de variância e comparacao multiplas de medias. Encontrou-se que a coordenacao da assistencia foi satisfatoria (media = 3,69 e DP = 1,74). As pessoas que vivem com HIV/AIDS utilizavam outros servicos de saude alem dos Servicos de Assistencia Especializada em HIV/AIDS – SAE (Pronto Atendimento: 67%; atencao basica: 43,2%; outros servicos especializados: 23,6%; servicos privados: 15%). Os cinco SAE apresentaram diferentes desempenhos, bem como distintos contextos e composicoes assistenciais, entretanto adequado manejo dos aspectos clinicos em detrimento dos sociais. O fornecimento da guia de referencia foi tido como satisfatorio, entretanto a guia de contrarreferencia insatisfatorio. Ha necessidade de estrategias que favorecam o desenvolvimento de acoes compartilhadas e cooperadas dentro das equipes dos SAE e entre os diferentes servicos com o intuito de fortalecer a producao de cuidado resolutivo.The aim of this study was to analyze the coordination of health activities and services for persons living with AIDS. This was a cross-sectional study of 301 persons living with AIDS. The analysis used descriptive techniques, analysis of variance, and multiple comparisons of means. Coordination of care was found to be satisfactory (mean = 3.69 and SD = 1.74). Persons living with AIDS used other health services in addition to the Services for Specialized HIV/AIDS Care (67.0% emergency departments, 43.2% primary care, 23.6% other specialized services, 15% private services). The five specialized HIV/AIDS clinics showed different performance levels as well as distinct contexts and healthcare configurations, but adequate clinical management (comparatively better than management of social issues). Provision of the referral guide was considered satisfactory, but the counter-referral guide was found to be unsatisfactory. Strategies are needed to promote the development of shared and cooperative actions within the healthcare teams in the specialized HIV/AIDS clinics and between the different services in order to strengthen the provision of care with case-resolution capacity.

Coordinación de la atención a personas que viven con VIH/SIDA en un municipio del estado de São Paulo, Brasil

Objetivou-se analisar a coordenacao das acoes e servicos de saude na assistencia as pessoas que vivem com HIV/AIDS. Trata-se de um estudo seccional com 301 pessoas que vivem com HIV/AIDS. A analise foi feita por tecnicas descritivas, analise de variância e comparacao multiplas de medias. Encontrou-se que a coordenacao da assistencia foi satisfatoria (media = 3,69 e DP = 1,74). As pessoas que vivem com HIV/AIDS utilizavam outros servicos de saude alem dos Servicos de Assistencia Especializada em HIV/AIDS – SAE (Pronto Atendimento: 67%; atencao basica: 43,2%; outros servicos especializados: 23,6%; servicos privados: 15%). Os cinco SAE apresentaram diferentes desempenhos, bem como distintos contextos e composicoes assistenciais, entretanto adequado manejo dos aspectos clinicos em detrimento dos sociais. O fornecimento da guia de referencia foi tido como satisfatorio, entretanto a guia de contrarreferencia insatisfatorio. Ha necessidade de estrategias que favorecam o desenvolvimento de acoes compartilhadas e cooperadas dentro das equipes dos SAE e entre os diferentes servicos com o intuito de fortalecer a producao de cuidado resolutivo.The aim of this study was to analyze the coordination of health activities and services for persons living with AIDS. This was a cross-sectional study of 301 persons living with AIDS. The analysis used descriptive techniques, analysis of variance, and multiple comparisons of means. Coordination of care was found to be satisfactory (mean = 3.69 and SD = 1.74). Persons living with AIDS used other health services in addition to the Services for Specialized HIV/AIDS Care (67.0% emergency departments, 43.2% primary care, 23.6% other specialized services, 15% private services). The five specialized HIV/AIDS clinics showed different performance levels as well as distinct contexts and healthcare configurations, but adequate clinical management (comparatively better than management of social issues). Provision of the referral guide was considered satisfactory, but the counter-referral guide was found to be unsatisfactory. Strategies are needed to promote the development of shared and cooperative actions within the healthcare teams in the specialized HIV/AIDS clinics and between the different services in order to strengthen the provision of care with case-resolution capacity.