ABSTRACT Background: This study aimed to identify COVID-19 cases among people living with HIV (PLWH) in Brazil in 2020, describe their clinical, sociodemographic, and epidemiological profiles, and evaluate the factors associated with disease severity. Methods: This cross-sectional study used secondary data obtained from the Brazilian healthcare system. Probabilistic and deterministic data linkage methods were used to identify coinfected patients. Descriptive statistical analysis was conducted, and factors associated with severe cases were evaluated using Pearson's chi-squared test, Student's t-test, and logistic regression. Results: In 2020, 36,746 coinfections were identified, making it one of the largest coinfection databases described worldwide. In total, 4,502 (12.25%) patients had severe cases and 32,244 (87.75%) had non-severe cases. The covariates age (OR=1.05; 95% CI: 1.05-1.06), nonwhite ethnicity (OR=1.68; 95% CI: 1.56-1.81), history of AIDS diagnosis (OR=1.17; 95% CI: 1.08-1.28), recent HIV diagnosis (OR=5.47; 95% CI: 4.25-7.02), absence of antiretroviral therapy (OR=1.70; 95% CI: 1.57-1.84), CD4+ < 200 (OR=6.41; 95% CI: 5.09-8.08), detectable HIV viral load (OR=2.61; 95% CI: 2.21-3.05), ≥ 1 comorbidity (OR=4.09; 95% CI: 3.79-4.41), and ≥ 4 symptoms were associated with increased severity. Conclusions: Multiple factors were linked to severe COVID-19, including uncontrolled HIV infection, age > 50 years, comorbidities, and racial disparities. This study reinforces the importance of maintaining public policies focused on early HIV diagnosis, access and adherence to treatment, especially for minority ethnic groups, and focusing on premature aging in PLWH. Background COVID19 COVID 19 COVID-1 PLWH (PLWH 2020 clinical sociodemographic profiles severity Methods crosssectional cross sectional system conducted Pearsons Pearson s chisquared chi squared test Students Student ttest, ttest t t-test regression Results 36746 36 746 36,74 identified worldwide total 4502 502 4,50 12.25% 1225 12 25 (12.25% 32244 32 244 32,24 87.75% 8775 87 75 (87.75% nonsevere non OR=1.05 OR105 OR 05 (OR=1.05 95 CI 1.051.06, 105106 1.05 1.06 , 06 1.05-1.06) OR=1.68 OR168 68 (OR=1.68 1.561.81, 156181 1.56 1.81 56 81 1.56-1.81) OR=1.17 OR117 17 (OR=1.17 1.081.28, 108128 1.08 1.28 08 28 1.08-1.28) OR=5.47 OR547 5 47 (OR=5.47 4.257.02, 425702 4.25 7.02 7 02 4.25-7.02) OR=1.70 OR170 70 (OR=1.70 1.571.84, 157184 1.57 1.84 57 84 1.57-1.84) CD4 CD 20 OR=6.41 OR641 6 41 (OR=6.41 5.098.08, 509808 5.09 8.08 09 8 5.09-8.08) OR=2.61 OR261 2 61 (OR=2.61 2.213.05, 221305 2.21 3.05 21 3 2.21-3.05) OR=4.09 OR409 (OR=4.09 3.794.41, 379441 3.79 4.41 79 3.79-4.41) Conclusions COVID19, 19, infection years comorbidities disparities treatment groups COVID1 COVID- 202 3674 74 36,7 450 4,5 12.25 122 (12.25 3224 24 32,2 87.75 877 (87.75 OR=1.0 OR10 0 (OR=1.0 9 051 1.051.06 10510 105 1.0 106 1.05-1.06 OR=1.6 OR16 (OR=1.6 561 1.561.81 15618 156 1.5 181 1.8 1.56-1.81 OR=1.1 OR11 (OR=1.1 081 1.081.28 10812 108 128 1.2 1.08-1.28 OR=5.4 OR54 (OR=5.4 257 4.257.02 42570 425 4.2 702 7.0 4.25-7.02 OR=1.7 OR17 (OR=1.7 571 1.571.84 15718 157 184 1.57-1.84 OR=6.4 OR64 (OR=6.4 098 5.098.08 50980 509 5.0 808 8.0 5.09-8.08 OR=2.6 OR26 (OR=2.6 213 2.213.05 22130 221 2.2 305 3.0 2.21-3.05 OR=4.0 OR40 (OR=4.0 794 3.794.41 37944 379 3.7 441 4.4 3.79-4.41 367 36, 45 4, 12.2 (12.2 322 32, 87.7 (87.7 OR=1. OR1 (OR=1. 1.051.0 1051 10 1. 1.05-1.0 1.561.8 1561 15 18 1.56-1.8 1.081.2 1081 1.08-1.2 OR=5. OR5 (OR=5. 4.257.0 4257 42 4. 7. 4.25-7.0 1.571.8 1571 1.57-1.8 OR=6. OR6 (OR=6. 5.098.0 5098 5. 80 8. 5.09-8.0 OR=2. OR2 (OR=2. 2.213.0 2213 22 2. 30 3. 2.21-3.0 OR=4. OR4 (OR=4. 3.794.4 3794 37 44 3.79-4.4 12. (12. 87. (87. OR=1 (OR=1 1.051. 1.05-1. 1.561. 1.56-1. 1.081. 1.08-1. OR=5 (OR=5 4.257. 4.25-7. 1.571. 1.57-1. OR=6 (OR=6 5.098. 5.09-8. OR=2 (OR=2 2.213. 2.21-3. OR=4 (OR=4 3.794. 3.79-4. (12 (87 OR= (OR= 1.051 1.05-1 1.561 1.56-1 1.081 1.08-1 4.257 4.25-7 1.571 1.57-1 5.098 5.09-8 2.213 2.21-3 3.794 3.79-4 (1 (8 (OR 1.05- 1.56- 1.08- 4.25- 1.57- 5.09- 2.21- 3.79- (

ABSTRACT Background: Women living with human immunodeficiency virus (HIV) (WLWH) are more likely to be infected with the oncogenic human papillomavirus (HPV). We assessed the prevalence of high-risk (HR) (16/18/31/33/35/39/45/51/52/56/58/59/68/73/82), probable high-risk (pHR) (26/53/66), and low-risk (LR) (6/11/40/42/43/44/54/61/70) HPV types and their associated risk factors. Methods: This cross-sectional study of WLWH aged 18-64 years included one laboratory and eight HIV-specialty healthcare facilities in the pilot network. Descriptive statistics were used to assess sociodemographic and behavioral characteristics. Adjusted analyses were conducted to evaluate risk factors associated with HR and/or pHR HPV infection in WLWH. Results: From May/2021 to May/2022, 1,914 (92.5%) WLWH participated in the pilot study and had valid HPV-DNA results of self-collected vaginal samples. The median age of the participants was 45 years, 60.1% had ≥ 9 years of schooling, 80.5% were ≤ 18 years at first sexual intercourse, and 51.7% had > 4 sexual partners throughout life. The prevalence of any HPV type, HR HPV, pHR HPV, and LR HPV was 65.8%, 49.6%, 16.7%, and 40.0%, respectively. Age was inversely associated with pHR and/or HR-HPV (p < 0.001), and education level was inversely associated with HR-HPV (p = 0.003) types. Any HR or pHR was associated with being single (p = 0.029) and exchanging sex for drugs (p = 0.037). Conclusions: The prevalence of HPV, especially HR HPV, among WLWH is high in Brazil, highlighting the need for HPV screening in this population. Self-collection of vaginal samples is an important strategy for increasing testing access. Background HIV (HIV (WLWH HPV. . (HPV) highrisk (HR 16/18/31/33/35/39/45/51/52/56/58/59/68/73/82, 161831333539455152565859687382 16/18/31/33/35/39/45/51/52/56/58/59/68/73/82 , 16 31 33 35 39 51 52 56 58 59 68 73 82 (16/18/31/33/35/39/45/51/52/56/58/59/68/73/82) (pHR 26/53/66, 265366 26/53/66 26 53 66 (26/53/66) lowrisk low (LR 6/11/40/42/43/44/54/61/70 61140424344546170 6 11 40 42 43 44 54 61 70 (6/11/40/42/43/44/54/61/70 Methods crosssectional cross sectional 1864 64 18-6 HIVspecialty specialty network characteristics andor Results May2021 May 2021 May/202 May2022 2022 May/2022 1914 1 914 1,91 92.5% 925 92 5 (92.5% HPVDNA DNA selfcollected self collected 601 60 60.1 schooling 805 80 80.5 intercourse 517 7 51.7 life type 658 65 8 65.8% 496 49 49.6% 167 16.7% 400 0 40.0% respectively HRHPV p 0.001, 0001 0.001 001 0.001) 0.003 0003 003 0.029 0029 029 0.037. 0037 0.037 037 0.037) Conclusions Brazil population Selfcollection Self collection access (HPV 16183133353945515256585968738 16/18/31/33/35/39/45/51/52/56/58/59/68/73/8 3 (16/18/31/33/35/39/45/51/52/56/58/59/68/73/82 26536 26/53/6 2 (26/53/66 6/11/40/42/43/44/54/61/7 6114042434454617 (6/11/40/42/43/44/54/61/7 186 18- May202 202 May/20 191 91 1,9 92.5 (92.5 60. 80. 51. 65.8 49.6 16.7 40.0 000 0.00 00 0.02 002 02 0.03 03 1618313335394551525658596873 16/18/31/33/35/39/45/51/52/56/58/59/68/73/ (16/18/31/33/35/39/45/51/52/56/58/59/68/73/8 2653 26/53/ (26/53/6 6/11/40/42/43/44/54/61/ 611404243445461 (6/11/40/42/43/44/54/61/ May20 20 May/2 19 1, 92. (92. 65. 49. 16. 40. 0.0 161831333539455152565859687 16/18/31/33/35/39/45/51/52/56/58/59/68/73 (16/18/31/33/35/39/45/51/52/56/58/59/68/73/ 265 26/53 (26/53/ 6/11/40/42/43/44/54/61 61140424344546 (6/11/40/42/43/44/54/61 May2 May/ (92 0. 16183133353945515256585968 16/18/31/33/35/39/45/51/52/56/58/59/68/7 (16/18/31/33/35/39/45/51/52/56/58/59/68/73 26/5 (26/53 6/11/40/42/43/44/54/6 6114042434454 (6/11/40/42/43/44/54/6 (9 1618313335394551525658596 16/18/31/33/35/39/45/51/52/56/58/59/68/ (16/18/31/33/35/39/45/51/52/56/58/59/68/7 26/ (26/5 6/11/40/42/43/44/54/ 611404243445 (6/11/40/42/43/44/54/ ( 161831333539455152565859 16/18/31/33/35/39/45/51/52/56/58/59/68 (16/18/31/33/35/39/45/51/52/56/58/59/68/ (26/ 6/11/40/42/43/44/54 61140424344 (6/11/40/42/43/44/54 16183133353945515256585 16/18/31/33/35/39/45/51/52/56/58/59/6 (16/18/31/33/35/39/45/51/52/56/58/59/68 (26 6/11/40/42/43/44/5 6114042434 (6/11/40/42/43/44/5 1618313335394551525658 16/18/31/33/35/39/45/51/52/56/58/59/ (16/18/31/33/35/39/45/51/52/56/58/59/6 (2 6/11/40/42/43/44/ 611404243 (6/11/40/42/43/44/ 161831333539455152565 16/18/31/33/35/39/45/51/52/56/58/59 (16/18/31/33/35/39/45/51/52/56/58/59/ 6/11/40/42/43/44 61140424 (6/11/40/42/43/44 16183133353945515256 16/18/31/33/35/39/45/51/52/56/58/5 (16/18/31/33/35/39/45/51/52/56/58/59 6/11/40/42/43/4 6114042 (6/11/40/42/43/4 1618313335394551525 16/18/31/33/35/39/45/51/52/56/58/ (16/18/31/33/35/39/45/51/52/56/58/5 6/11/40/42/43/ 611404 (6/11/40/42/43/ 161831333539455152 16/18/31/33/35/39/45/51/52/56/58 (16/18/31/33/35/39/45/51/52/56/58/ 6/11/40/42/43 61140 (6/11/40/42/43 16183133353945515 16/18/31/33/35/39/45/51/52/56/5 (16/18/31/33/35/39/45/51/52/56/58 6/11/40/42/4 6114 (6/11/40/42/4 1618313335394551 16/18/31/33/35/39/45/51/52/56/ (16/18/31/33/35/39/45/51/52/56/5 6/11/40/42/ 611 (6/11/40/42/ 161831333539455 16/18/31/33/35/39/45/51/52/56 (16/18/31/33/35/39/45/51/52/56/ 6/11/40/42 (6/11/40/42 16183133353945 16/18/31/33/35/39/45/51/52/5 (16/18/31/33/35/39/45/51/52/56 6/11/40/4 (6/11/40/4 1618313335394 16/18/31/33/35/39/45/51/52/ (16/18/31/33/35/39/45/51/52/5 6/11/40/ (6/11/40/ 161831333539 16/18/31/33/35/39/45/51/52 (16/18/31/33/35/39/45/51/52/ 6/11/40 (6/11/40 16183133353 16/18/31/33/35/39/45/51/5 (16/18/31/33/35/39/45/51/52 6/11/4 (6/11/4 1618313335 16/18/31/33/35/39/45/51/ (16/18/31/33/35/39/45/51/5 6/11/ (6/11/ 161831333 16/18/31/33/35/39/45/51 (16/18/31/33/35/39/45/51/ 6/11 (6/11 16183133 16/18/31/33/35/39/45/5 (16/18/31/33/35/39/45/51 6/1 (6/1 1618313 16/18/31/33/35/39/45/ (16/18/31/33/35/39/45/5 6/ (6/ 161831 16/18/31/33/35/39/45 (16/18/31/33/35/39/45/ (6 16183 16/18/31/33/35/39/4 (16/18/31/33/35/39/45 1618 16/18/31/33/35/39/ (16/18/31/33/35/39/4 161 16/18/31/33/35/39 (16/18/31/33/35/39/ 16/18/31/33/35/3 (16/18/31/33/35/39 16/18/31/33/35/ (16/18/31/33/35/3 16/18/31/33/35 (16/18/31/33/35/ 16/18/31/33/3 (16/18/31/33/35 16/18/31/33/ (16/18/31/33/3 16/18/31/33 (16/18/31/33/ 16/18/31/3 (16/18/31/33 16/18/31/ (16/18/31/3 16/18/31 (16/18/31/ 16/18/3 (16/18/31 16/18/ (16/18/3 16/18 (16/18/ 16/1 (16/18 16/ (16/1 (16/ (16 (1

ABSTRACT OBJECTIVE This study aims to assess the degree of adequacy of prenatal care (PNC) in the state of Rio Grande do Sul (RS) and in its 7 macro-regions considering the time of PNC initiation and the number of appointments attended. It also aims to verify the mode of delivery prevalence and the factors associated with PNC adequacy by mode of delivery. METHODS Sub analysis from a cross-sectional study conducted among 13,432 childbearing women aged 15–49 years assisted in 66 maternity hospitals of the Unified Health System (SUS) and private associated facilities from September 2017 to October 2019. A standardized form was used to collect sociodemographic data, and information about PNC and delivery from the childbearing women’s prenatal cards, hospital records, and medical reports. RESULTS The PNC coverage was (98.4%), but only 57.5% of the participants had an adequate PNC defined as the one initiated until the 12th gestational week, with attendance of at least 6 appointments. The cesarean rate was 57.2%. Among women who performed vaginal delivery, multivariate analysis showed that for each 1-year increase in the age of the parturient, the chance of having an adequate PNC increased by 5%. White parturients with higher education and fewer deliveries residing in the macro-region of Valleys were more likely to have an adequate PNC when compared with non-white parturients, who were illiterate and/or had incomplete elementary school, with 3 or more deliveries and who resided in other macro-regions. During pregnancy, 96.0% of the women performed at least one anti-HIV test, 55.8% a rapid test for syphilis, and 75.0% a Venereal Disease Research Laboratory test (VDRL). CONCLUSIONS Despite the almost universal PNC coverage in RS, the PNC offered by the SUS was adequate for just half of the population, therefore public health policies targeted at women receiving care in this setting shall be revisited. (PNC RS (RS macroregions macro regions attended crosssectional cross sectional 13432 13 432 13,43 1549 15 49 15–4 (SUS 201 2019 data womens s cards records reports 98.4%, 984 98.4% , 98 4 (98.4%) 575 57 5 57.5 th week 572 2 57.2% 1year year 1 parturient 5% macroregion region nonwhite non white andor school macroregions. regions. pregnancy 960 96 0 96.0 antiHIV anti HIV 558 55 8 55.8 syphilis 750 75 75.0 VDRL. VDRL . (VDRL) population revisited 1343 43 13,4 154 15– 20 98.4 9 (98.4% 57. 57.2 96. 55. 75. (VDRL 134 13, 98. (98.4 (98. (98 (9 (

ABSTRACT Background: Gonorrhea is not a notifiable disease in Brazil, and the national health information system does not collect data on reported cases or infection prevalence. Methods: We compiled published data on gonorrhea prevalence in Brazil from cross-sectional surveys and clinical trials between 2000 and 2020. The study entry criteria included a sample size of 50 or more, and Neisseria gonorrhoeae infection detected in urine, urethral, anal, or cervicovaginal specimens using either Nucleic Acid Amplification Test or culture. Gonorrhea prevalence trends between 2000 and 2020 were generated using Spectrum-STI, a statistical trend-fitting model. Results: Forty-five studies with 59 gonorrhea prevalence data points were identified. Fifty data points were for women and represented 21,815 individuals, eight for men encompassing a total of 4,587 individuals, and one for transgender people comprising 345 individuals. The Spectrum-STI estimate for the prevalence of urogenital infection with gonorrhea in women 15-49 in 2020 was 0.63% (95% confidence interval (CI): 0.13-2.23) and was lower than the 1.05% estimated value for 2000 (95% CI: 0.36-2.79). The corresponding figures for men were 0.70% (95% CI: 0.16-2.44) and 1.14% (95% CI: 0.34-3.15). Anal prevalence estimates could not be generated because of insufficient data (three data points). Conclusions: These results suggest that the overall prevalence of genitourinary gonococcal infections in Brazil is less than 1%. Data on gonorrhea prevalence in men and in populations at increased STI vulnerability are limited. Background Methods crosssectional cross sectional 200 5 more urine urethral anal culture 202 SpectrumSTI, SpectrumSTI Spectrum STI, trendfitting trend fitting model Results Fortyfive Forty five identified 21815 21 815 21,81 individuals 4587 4 587 4,58 34 1549 15 49 15-4 063 0 63 0.63 95% 95 (95 CI (CI) 0.132.23 013223 0.13 2.23 13 2 23 0.13-2.23 105 1 05 1.05 0.362.79. 036279 0.36 2.79 . 36 79 0.36-2.79) 070 70 0.70 0.162.44 016244 0.16 2.44 16 44 0.16-2.44 114 14 1.14 0.343.15. 034315 0.34 3.15 3 0.34-3.15) three points. points) Conclusions 1% limited 20 2181 81 21,8 458 58 4,5 154 15- 06 6 0.6 9 (9 (CI 132 0.132.2 01322 013 0.1 223 2.2 0.13-2.2 10 1.0 362 0.362.79 03627 036 0.3 279 2.7 7 0.36-2.79 07 0.7 162 0.162.4 01624 016 244 2.4 0.16-2.4 11 1.1 343 0.343.15 03431 034 315 3.1 0.34-3.15 218 8 21, 45 4, 0. ( 0.132. 0132 01 22 2. 0.13-2. 1. 0.362.7 0362 03 27 0.36-2.7 0.162. 0162 24 0.16-2. 0.343.1 0343 31 3. 0.34-3.1 0.132 0.13-2 0.362. 0.36-2. 0.162 0.16-2 0.343. 0.34-3. 0.13- 0.362 0.36-2 0.16- 0.343 0.34-3 0.36- 0.34-

Resumen Objetivo: describir el proceso de implementación subnacional de la certificación de eliminación de la transmisión vertical (TV) de sífilis y/o VIH, barreras, oportunidades y desafíos. Métodos: en 2022, se evaluaron indicadores del último año completo para la meta de impacto y de los dos últimos años para las de proceso en los sistemas de información; se analizaron informes descriptivos y se reconocieron acciones de cuatro ejes, según las recomendaciones de la OPS/OMS. Resultados: se certificaron 43 municipios ≥ 100.000 mil habitantes, cubriendo 24,6 millones de habitantes; un municipio logró la doble eliminación (VIH-sífilis), 28 la eliminación del VIH y 10 sellos plata; para sífilis, hubo una eliminación, 4 sellos oro, 13 plata y 4 bronce; las regiones Sudeste y Sur obtuvieron más certificaciones. Conclusión: barreras y desafíos fueron superados mediante la colaboración tripartita; la experiencia permitió la integración de la vigilancia con la atención y la cualificación de acciones para la prevención de la TV. Objetivo TV (TV yo o Métodos 2022 información ejes OPSOMS OPS OMS OPS/OMS Resultados 100000 100 000 100.00 habitantes 246 24 6 24, VIHsífilis, VIHsífilis , (VIH-sífilis) 2 1 oro bronce certificaciones Conclusión tripartita 202 10000 00 100.0 (VIH-sífilis 20 1000 0 100.

Resumo Objetivo: descrever o processo de implantação subnacional da certificação da eliminação da transmissão vertical de HIV e/ou sífilis, suas principais barreiras, desafios e oportunidades. Métodos: em 2022, foram avaliados indicadores do último ano completo para meta de impacto, e dos dois últimos anos completos para metas de processo, disponíveis nos sistemas nacionais de informações; foram analisados relatórios descritivos e reconhecidas ações em quatro eixos temáticos, conforme recomendações da OPAS/OMS. Resultados: 43 municípios ≥ 100 mil habitantes foram certificados, abrangendo 24,6 milhões de habitantes; um município alcançou dupla eliminação (HIV-sífilis), 28 alcançaram eliminação para HIV e 10, selos prata; para sífilis, houve uma eliminação, 4 selos ouro, 13 prata e 4 bronze; identificou-se maior número de certificações nas regiões Sudeste e Sul. Conclusão: barreiras e desafios do processo foram superados pela colaboração tripartite; a experiência proporcionou melhor integração da vigilância com a assistência e qualificação das ações para prevenção da transmissão vertical. Objetivo eou ou sífilis oportunidades Métodos 2022 impacto informações temáticos OPASOMS OPAS OMS OPAS/OMS Resultados 10 certificados 246 24 6 24, HIVsífilis, HIVsífilis , (HIV-sífilis) 2 ouro 1 bronze identificouse identificou se Sul Conclusão tripartite 202 (HIV-sífilis 20

Abstract Objective: to describe the subnational implementation process of the certification for elimination of mother-to-child transmission of HIV and/or syphilis, its main barriers, challenges and opportunities. Methods: in 2022, indicators from the last full year for impact targets and the last two full years for process targets, available in national information systems, were evaluated; descriptive reports were analyzed and actions were acknowledged within four thematic axes, according to PAHO/WHO recommendations. Results: 43 municipalities ≥ 100,000 inhabitants were certified, covering 24.6 million inhabitants; one municipality achieved dual elimination (HIV-syphilis), 28 municipalities achieved elimination of HIV and 10 received silver tiers; regarding syphilis, one elimination was observed, along with 4 gold tiers, 13 silver tiers and 4 bronze tiers; a higher number of certifications was identified in the Southeast and South regions. Conclusion: barriers and challenges of the process were overcome through tripartite collaboration; the experience provided better integration of surveillance with care and improved actions aimed at preventing mother-to-child transmission. Objective mothertochild mother child andor or syphilis opportunities Methods 2022 systems evaluated axes PAHOWHO PAHO WHO recommendations Results 100000 100 000 100,00 certified 246 24 6 24. HIVsyphilis, HIVsyphilis , (HIV-syphilis) 2 1 observed regions Conclusion collaboration 202 10000 00 100,0 (HIV-syphilis 20 1000 0 100,

ABSTRACT OBJECTIVE This study aims to assess the degree of adequacy of prenatal care (PNC) in the state of Rio Grande do Sul (RS) and in its 7 macro-regions considering the time of PNC initiation and the number of appointments attended. It also aims to verify the mode of delivery prevalence and the factors associated with PNC adequacy by mode of delivery. METHODS Sub analysis from a cross-sectional study conducted among 13,432 childbearing women aged 15–49 years assisted in 66 maternity hospitals of the Unified Health System (SUS) and private associated facilities from September 2017 to October 2019. A standardized form was used to collect sociodemographic data, and information about PNC and delivery from the childbearing women’s prenatal cards, hospital records, and medical reports. RESULTS The PNC coverage was (98.4%), but only 57.5% of the participants had an adequate PNC defined as the one initiated until the 12th gestational week, with attendance of at least 6 appointments. The cesarean rate was 57.2%. Among women who performed vaginal delivery, multivariate analysis showed that for each 1-year increase in the age of the parturient, the chance of having an adequate PNC increased by 5%. White parturients with higher education and fewer deliveries residing in the macro-region of Valleys were more likely to have an adequate PNC when compared with non-white parturients, who were illiterate and/or had incomplete elementary school, with 3 or more deliveries and who resided in other macro-regions. During pregnancy, 96.0% of the women performed at least one anti-HIV test, 55.8% a rapid test for syphilis, and 75.0% a Venereal Disease Research Laboratory test (VDRL). CONCLUSIONS Despite the almost universal PNC coverage in RS, the PNC offered by the SUS was adequate for just half of the population, therefore public health policies targeted at women receiving care in this setting shall be revisited.

Resumo Objetivo: descrever o processo de implantação subnacional da certificação da eliminação da transmissão vertical de HIV e/ou sífilis, suas principais barreiras, desafios e oportunidades. Métodos: em 2022, foram avaliados indicadores do último ano completo para meta de impacto, e dos dois últimos anos completos para metas de processo, disponíveis nos sistemas nacionais de informações; foram analisados relatórios descritivos e reconhecidas ações em quatro eixos temáticos, conforme recomendações da OPAS/OMS. Resultados: 43 municípios ≥ 100 mil habitantes foram certificados, abrangendo 24,6 milhões de habitantes; um município alcançou dupla eliminação (HIV-sífilis), 28 alcançaram eliminação para HIV e 10, selos prata; para sífilis, houve uma eliminação, 4 selos ouro, 13 prata e 4 bronze; identificou-se maior número de certificações nas regiões Sudeste e Sul. Conclusão: barreiras e desafios do processo foram superados pela colaboração tripartite; a experiência proporcionou melhor integração da vigilância com a assistência e qualificação das ações para prevenção da transmissão vertical.

Resumen Objetivo: describir el proceso de implementación subnacional de la certificación de eliminación de la transmisión vertical (TV) de sífilis y/o VIH, barreras, oportunidades y desafíos. Métodos: en 2022, se evaluaron indicadores del último año completo para la meta de impacto y de los dos últimos años para las de proceso en los sistemas de información; se analizaron informes descriptivos y se reconocieron acciones de cuatro ejes, según las recomendaciones de la OPS/OMS. Resultados: se certificaron 43 municipios ≥ 100.000 mil habitantes, cubriendo 24,6 millones de habitantes; un municipio logró la doble eliminación (VIH-sífilis), 28 la eliminación del VIH y 10 sellos plata; para sífilis, hubo una eliminación, 4 sellos oro, 13 plata y 4 bronce; las regiones Sudeste y Sur obtuvieron más certificaciones. Conclusión: barreras y desafíos fueron superados mediante la colaboración tripartita; la experiencia permitió la integración de la vigilancia con la atención y la cualificación de acciones para la prevención de la TV.

Abstract Objective: to describe the subnational implementation process of the certification for elimination of mother-to-child transmission of HIV and/or syphilis, its main barriers, challenges and opportunities. Methods: in 2022, indicators from the last full year for impact targets and the last two full years for process targets, available in national information systems, were evaluated; descriptive reports were analyzed and actions were acknowledged within four thematic axes, according to PAHO/WHO recommendations. Results: 43 municipalities ≥ 100,000 inhabitants were certified, covering 24.6 million inhabitants; one municipality achieved dual elimination (HIV-syphilis), 28 municipalities achieved elimination of HIV and 10 received silver tiers; regarding syphilis, one elimination was observed, along with 4 gold tiers, 13 silver tiers and 4 bronze tiers; a higher number of certifications was identified in the Southeast and South regions. Conclusion: barriers and challenges of the process were overcome through tripartite collaboration; the experience provided better integration of surveillance with care and improved actions aimed at preventing mother-to-child transmission.

Resumo: A profilaxia pré-exposição ao HIV (PrEP) tem sido considerada uma estratégia fundamental para o controle da epidemia de HIV/aids, e desde 2018 tem sido objeto de estudo de implementação (Estudo ImPrEP Stakeholders), realizado no Brasil, no México e no Peru. Um componente qualitativo desse estudo foi desenvolvido com o objetivo de identificar os contextos sociais e estruturais que envolvem e organizam a oferta de serviços de PrEP no Brasil, as subjetividades dos atores envolvidos e as diferentes percepções que podem impactar a efetivação dessa estratégia. O presente artigo teve como foco de análise o acesso das populações vulneráveis aos serviços de PrEP, na perspectiva de gestores, profissionais de saúde, lideranças ou ativistas e usuários de PrEP. É um estudo qualitativo com o uso de metodologia compreensiva, realizado em seis capitais brasileiras, em que foram entrevistados 71 atores-chave no período de novembro de 2018 a maio de 2019. A análise foi pautada pelos modelos analíticos sobre acesso propostos por Giovanella & Fleury, McIntyre et al. e Penchansky & Thomas. Os resultados são apresentados com base em três eixos: “percepções sobre prevenção combinada e PrEP”; “disponibilidade e adequação: perfil e estrutura dos serviços no contexto do ImPrEP”; e “aceitabilidade: atitudes e práticas dos profissionais de saúde e usuários”.

Abstract: HIV preexposure prophylaxis (PrEP) has been considered a fundamental strategy for controlling the HIV/AIDS epidemic, and since 2018 it has been the object of an implementation study (ImPrEP Stakeholders Study), conducted in Brazil, México, and Peru. A qualitative component of this study was developed with the objective of identifying the social and structural contexts that involve and organize the supply of PrEP services in Brazil, the stakeholders’ subjectivities, and the different perceptions that can impact the strategy’s implementation. The current article’s focus was to analyze access by vulnerable populations to PrEP services from the perspective of managers, health professionals, leaders or activists, and users of PrEP. This was a qualitative study using a comprehensive methodology, conducted in six Brazilian state capitals, interviewing 71 key actors from November 2018 to May 2019. The analysis was based on access analysis models as proposed by Giovanella & Fleury, McIntyre et al. and Penchansky & Thomas. The results are presented along three lines: “perceptions of combined prevention and PrEP”, “availability and adequacy: profile and structure of services in the context of ImPrEP”, and “acceptability: attitudes and practices of health professionals and users”.

Resumen: La profilaxis preexposición al VIH (PrEP) ha sido considerada una estrategia fundamental para el control de la epidemia de VIH/sida y desde 2018 ha sido objeto de estudio de implementación (Estudio ImPrEP Stakeholders), realizado en Brasil, México y Perú. Un componente cualitativo de este estudio se desarrolló con el objetivo de identificar los contextos sociales y estructurales que engloban y organizan la oferta de servicios de PrEP en Brasil, las subjetividades de los actores implicados y las diferentes percepciones que pueden impactar en hacer efectiva esa estrategia. El objetivo de este artículo es el análisis del acceso de las poblaciones vulnerables a los servicios de PrEP, desde la perspectiva de los gestores, profesionales de salud, líderes o activistas y usuarios de la PrEP. Se trata de un estudio cualitativo con uso de metodología comprensiva, realizado en seis capitales brasileñas, en las que fueron entrevistados 71 actores-clave, durante el período de noviembre de 2018 a mayo de 2019. El análisis se pautó mediante modelos analíticos sobre acceso, propuestos por Giovanella & Fleury, McIntyre et al. y Penchansky & Thomas. Los resultados se presentan a partir de tres ejes: “percepciones sobre prevención combinada y PrEP”, “disponibilidad y adecuación: perfil y estructura de los servicios en el contexto de la ImPrEP” y “aceptabilidad: actitudes y prácticas de los profesionales de salud y usuarios”.

Resumo: A profilaxia pré-exposição ao HIV (PrEP) tem sido considerada uma estratégia fundamental para o controle da epidemia de HIV/aids, e desde 2018 tem sido objeto de estudo de implementação (Estudo ImPrEP Stakeholders), realizado no Brasil, no México e no Peru. Um componente qualitativo desse estudo foi desenvolvido com o objetivo de identificar os contextos sociais e estruturais que envolvem e organizam a oferta de serviços de PrEP no Brasil, as subjetividades dos atores envolvidos e as diferentes percepções que podem impactar a efetivação dessa estratégia. O presente artigo teve como foco de análise o acesso das populações vulneráveis aos serviços de PrEP, na perspectiva de gestores, profissionais de saúde, lideranças ou ativistas e usuários de PrEP. É um estudo qualitativo com o uso de metodologia compreensiva, realizado em seis capitais brasileiras, em que foram entrevistados 71 atores-chave no período de novembro de 2018 a maio de 2019. A análise foi pautada pelos modelos analíticos sobre acesso propostos por Giovanella & Fleury, McIntyre et al. e Penchansky & Thomas. Os resultados são apresentados com base em três eixos: “percepções sobre prevenção combinada e PrEP”; “disponibilidade e adequação: perfil e estrutura dos serviços no contexto do ImPrEP”; e “aceitabilidade: atitudes e práticas dos profissionais de saúde e usuários”.

Abstract: HIV preexposure prophylaxis (PrEP) has been considered a fundamental strategy for controlling the HIV/AIDS epidemic, and since 2018 it has been the object of an implementation study (ImPrEP Stakeholders Study), conducted in Brazil, México, and Peru. A qualitative component of this study was developed with the objective of identifying the social and structural contexts that involve and organize the supply of PrEP services in Brazil, the stakeholders’ subjectivities, and the different perceptions that can impact the strategy’s implementation. The current article’s focus was to analyze access by vulnerable populations to PrEP services from the perspective of managers, health professionals, leaders or activists, and users of PrEP. This was a qualitative study using a comprehensive methodology, conducted in six Brazilian state capitals, interviewing 71 key actors from November 2018 to May 2019. The analysis was based on access analysis models as proposed by Giovanella & Fleury, McIntyre et al. and Penchansky & Thomas. The results are presented along three lines: “perceptions of combined prevention and PrEP”, “availability and adequacy: profile and structure of services in the context of ImPrEP”, and “acceptability: attitudes and practices of health professionals and users”.

Resumen: La profilaxis preexposición al VIH (PrEP) ha sido considerada una estrategia fundamental para el control de la epidemia de VIH/sida y desde 2018 ha sido objeto de estudio de implementación (Estudio ImPrEP Stakeholders), realizado en Brasil, México y Perú. Un componente cualitativo de este estudio se desarrolló con el objetivo de identificar los contextos sociales y estructurales que engloban y organizan la oferta de servicios de PrEP en Brasil, las subjetividades de los actores implicados y las diferentes percepciones que pueden impactar en hacer efectiva esa estrategia. El objetivo de este artículo es el análisis del acceso de las poblaciones vulnerables a los servicios de PrEP, desde la perspectiva de los gestores, profesionales de salud, líderes o activistas y usuarios de la PrEP. Se trata de un estudio cualitativo con uso de metodología comprensiva, realizado en seis capitales brasileñas, en las que fueron entrevistados 71 actores-clave, durante el período de noviembre de 2018 a mayo de 2019. El análisis se pautó mediante modelos analíticos sobre acceso, propuestos por Giovanella & Fleury, McIntyre et al. y Penchansky & Thomas. Los resultados se presentan a partir de tres ejes: “percepciones sobre prevención combinada y PrEP”, “disponibilidad y adecuación: perfil y estructura de los servicios en el contexto de la ImPrEP” y “aceptabilidad: actitudes y prácticas de los profesionales de salud y usuarios”.

Abstract This article summarizes the chapter on epidemiological surveillance of sexually transmitted infections (STI) that comprises the 2020 Clinical Protocol and Therapeutic Guidelines (PCDT) for Comprehensive Care for People with STI, published by the Health Surveillance Department of the Brazilian Ministry of Health. It presents some reflections on the new case definitions for surveillance of acquired syphilis, syphilis in pregnant women, and congenital syphilis. The 2020 PCDT-IST was elaborated grounded on scientific evidence and validated in discussions with specialists. Epidemiological and clinical aspects are addressed, and health service managers' guidelines regarding programmatic and operational management of these diseases are presented. Guidelines for health professionals on screening, diagnosing, and treating people with STI and their sex partners, in addition to strategies for surveillance, prevention, and control actions, are also published.

ABSTRACT A retrospective cohort of 11,308 chronic hepatitis C infected patients treated with regimens that included Sofosbuvir (SOF), Daclatasvir (DCV), Simeprevir (SMV), or an association of Ombitasvir, Veruprevir/Ritonavir and Dasabuvir (3D) with or without Ribavirin (RBV) were assessed for sustained virologic response (SVR) or viral cure after a 12-week treatment. Logistic regression analyses were used to identify factors independently associated with positive response to direct-acting antivirals (DAA)-based therapies.Overall 57.1% were male; 48.3% self-identified as white; 78.3% were over 50 years old; 44.1% were from the Southeast region; 47.7% had genotype 1b; and 84.5% were treated for 12 weeks. The SVR rates with DAAs ranged from 87% to 100%. Genotypes 1 and 4 had higher SVR rates (96.3–100%), and genotypes 2 and 3 had SVR of 90.6–92.2%, respectively. Treatment durations of 12 and 24 weeks were associated with an average SVR of 95.0% and 95.9%, respectively. Females were half as likely (OR 0.5; 95% CI 0.4−0.6) to have a negative response to therapy compared to males, and those with genotypes 2 and 3 were one and half fold more likely (OR 1.5–2.2; 95 CI% 0.7–2.9; 1.2–3.6 and OR 2.7–2.8; 95% CI 2.0–3.8, respectively) to not have SVR compared to genotype 1. Patients in the age-range of 50–69 years old were 1.2-fold (OR 1.2; 95% CI 0.7–1.9) more likely to not have SVR compared to other age groups, although not statistically significant.This study is the first of this magnitude to be held in a Latin-American country with high SVR results, supported by a free-of-charge universal and public health system. The high performance found in this study gives support to the Brazilian public health policy decision of adopting DAA-based therapies as a strategy to eliminate HCV by 2030.

O objetivo foi caracterizar aspectos sociodemográficos, comportamentais e clínicos entre conscritos brasileiros, segundo a prevalência de sífilis. Estudo descritivo desenvolvido valendo-se de pesquisa nacional de base populacional, realizada em 2016, com amostra probabilística de jovens conscritos de 17 a 22 anos de idade. Realizou-se autoaplicação de questionários confidenciais. As amostras de sangue total dos participantes foram coletadas para testagem de sífilis, com a utilização de testes treponêmicos e não treponêmicos. Empregaram-se técnicas de estatística descritiva para estimar as prevalências de sífilis e a distribuição de frequências entre as variáveis pesquisadas, considerando os intervalos de 95% de confiança (IC95%), após a ponderação dos dados. Do total de 37.282 participantes, 73,7% haviam iniciado a vida sexual. As prevalências de sífilis na vida e de sífilis confirmada foram de 1,6% e 1,1%, respectivamente. As seguintes variáveis populacionais apresentaram maior prevalência de sífilis: ausência de acesso à Internet no domicílio; início da atividade sexual antes dos 14 anos; categoria de exposição homens que fazem sexo com homens; práticas sexuais com mais de cinco parcerias; recebimento de presentes, drogas ou outros incentivos em troca de sexo; e história prévia de sintomatologia de infecções sexualmente transmissíveis. Observou-se o aumento de sífilis entre os jovens conscritos brasileiros, em comparação aos inquéritos anteriores. Tal incremento reforça a importância dessa população sentinela para realizar vigilância ativa, de forma a subsidiar estratégias de atenção à saúde dos jovens, incluindo cenários escolares.

The objective was to characterize sociodemographic, behavioral, and clinical aspects in young Brazilian military recruits according to prevalence of syphilis. This was a descriptive study based on a nationwide population-based survey in 2016 with a probabilistic sample of military recruits 17 to 22 years of age. A confidential self-applied questionnaire was used. Blood samples were drawn from participants for treponemal and non-treponemal syphilis tests. Descriptive statistical techniques were used to estimate syphilis prevalence rates and distribution of frequencies between the target variables, considering 95% confidence intervals (95%CI), after weighting the data. Of the total of 37,282 participants, 73.7% were sexually initiated. Prevalence rates for lifetime and confirmed syphilis were 1.6% and 1.1%, respectively. The following population variables showed higher prevalence of syphilis: lack of Internet access at home; initiation of sexual activity before 14 years of age; men who have sex with men; more than five sexual partners; having received presents, drugs, or other incentives in exchange for sex; and prior history of symptoms of sexually transmissible infections. An increase was observed in syphilis in Brazilian military recruits when compared to previous surveys. This increase emphasizes the importance of this sentinel population for performing active surveillance in order to support healthcare strategies for youth, including in the school system.

El objetivo fue caracterizar aspectos sociodemográficos, comportamentales y clínicos entre reclutas brasileños, según la prevalencia de sífilis. Se trata de un estudio descriptivo, desarrollado a partir de una investigación nacional de base poblacional, realizada en 2016, con una muestra probabilística de jóvenes reclutas de 17 a 22 años de edad. Se realizó una autoaplicación de cuestionarios confidenciales. Las muestras de sangre total de los participantes fueron recogidas para la prueba de sífilis, con la utilización de pruebas treponémicas y no treponémicas. Se emplearon técnicas de estadística descriptiva para estimar las prevalencias de sífilis y distribución de frecuencias entre las variables investigadas, considerando intervalos del 95% de confianza (IC95%), tras la ponderación de los datos. Del total de 37.282 participantes, un 73,7% habían iniciado su vida sexual. Las prevalencias de sífilis en la vida y de sífilis confirmada fueron de 1,6% y 1,1%, respectivamente. Las siguientes variables poblacionales presentaron una mayor prevalencia de sífilis: ausencia de acceso a Internet en el domicilio; inicio de la actividad sexual antes de los 14 años; categoría de exposición hombres que practican sexo con hombres; prácticas sexuales con más de cinco personas; recibimiento de regalos, drogas u otros incentivos a cambio de sexo; e historia previa de sintomatología de infecciones sexualmente transmisibles. Se observó el aumento de sífilis entre los jóvenes reclutas brasileños, en comparación con las encuestas anteriores. Tal incremento refuerza la importancia de esa población centinela para realizar una vigilancia activa, de forma que se apoyen estrategias de atención a la salud de los jóvenes, incluyendo escenarios escolares.

O objetivo foi caracterizar aspectos sociodemográficos, comportamentais e clínicos entre conscritos brasileiros, segundo a prevalência de sífilis. Estudo descritivo desenvolvido valendo-se de pesquisa nacional de base populacional, realizada em 2016, com amostra probabilística de jovens conscritos de 17 a 22 anos de idade. Realizou-se autoaplicação de questionários confidenciais. As amostras de sangue total dos participantes foram coletadas para testagem de sífilis, com a utilização de testes treponêmicos e não treponêmicos. Empregaram-se técnicas de estatística descritiva para estimar as prevalências de sífilis e a distribuição de frequências entre as variáveis pesquisadas, considerando os intervalos de 95% de confiança (IC95%), após a ponderação dos dados. Do total de 37.282 participantes, 73,7% haviam iniciado a vida sexual. As prevalências de sífilis na vida e de sífilis confirmada foram de 1,6% e 1,1%, respectivamente. As seguintes variáveis populacionais apresentaram maior prevalência de sífilis: ausência de acesso à Internet no domicílio; início da atividade sexual antes dos 14 anos; categoria de exposição homens que fazem sexo com homens; práticas sexuais com mais de cinco parcerias; recebimento de presentes, drogas ou outros incentivos em troca de sexo; e história prévia de sintomatologia de infecções sexualmente transmissíveis. Observou-se o aumento de sífilis entre os jovens conscritos brasileiros, em comparação aos inquéritos anteriores. Tal incremento reforça a importância dessa população sentinela para realizar vigilância ativa, de forma a subsidiar estratégias de atenção à saúde dos jovens, incluindo cenários escolares.

The objective was to characterize sociodemographic, behavioral, and clinical aspects in young Brazilian military recruits according to prevalence of syphilis. This was a descriptive study based on a nationwide population-based survey in 2016 with a probabilistic sample of military recruits 17 to 22 years of age. A confidential self-applied questionnaire was used. Blood samples were drawn from participants for treponemal and non-treponemal syphilis tests. Descriptive statistical techniques were used to estimate syphilis prevalence rates and distribution of frequencies between the target variables, considering 95% confidence intervals (95%CI), after weighting the data. Of the total of 37,282 participants, 73.7% were sexually initiated. Prevalence rates for lifetime and confirmed syphilis were 1.6% and 1.1%, respectively. The following population variables showed higher prevalence of syphilis: lack of Internet access at home; initiation of sexual activity before 14 years of age; men who have sex with men; more than five sexual partners; having received presents, drugs, or other incentives in exchange for sex; and prior history of symptoms of sexually transmissible infections. An increase was observed in syphilis in Brazilian military recruits when compared to previous surveys. This increase emphasizes the importance of this sentinel population for performing active surveillance in order to support healthcare strategies for youth, including in the school system.

El objetivo fue caracterizar aspectos sociodemográficos, comportamentales y clínicos entre reclutas brasileños, según la prevalencia de sífilis. Se trata de un estudio descriptivo, desarrollado a partir de una investigación nacional de base poblacional, realizada en 2016, con una muestra probabilística de jóvenes reclutas de 17 a 22 años de edad. Se realizó una autoaplicación de cuestionarios confidenciales. Las muestras de sangre total de los participantes fueron recogidas para la prueba de sífilis, con la utilización de pruebas treponémicas y no treponémicas. Se emplearon técnicas de estadística descriptiva para estimar las prevalencias de sífilis y distribución de frecuencias entre las variables investigadas, considerando intervalos del 95% de confianza (IC95%), tras la ponderación de los datos. Del total de 37.282 participantes, un 73,7% habían iniciado su vida sexual. Las prevalencias de sífilis en la vida y de sífilis confirmada fueron de 1,6% y 1,1%, respectivamente. Las siguientes variables poblacionales presentaron una mayor prevalencia de sífilis: ausencia de acceso a Internet en el domicilio; inicio de la actividad sexual antes de los 14 años; categoría de exposición hombres que practican sexo con hombres; prácticas sexuales con más de cinco personas; recibimiento de regalos, drogas u otros incentivos a cambio de sexo; e historia previa de sintomatología de infecciones sexualmente transmisibles. Se observó el aumento de sífilis entre los jóvenes reclutas brasileños, en comparación con las encuestas anteriores. Tal incremento refuerza la importancia de esa población centinela para realizar una vigilancia activa, de forma que se apoyen estrategias de atención a la salud de los jóvenes, incluyendo escenarios escolares.