Abstract Introduction In Brazil, though Antiretroviral Therapy (ART) is available to all, the benefits may not be experienced uniformly. We projected Life Expectancy (LE) for People Living with HIV (PLHIV) in care as currently observed and estimated the impact of guideline-concordant care. Methods Using a microsimulation model, we projected LE for a cohort of PLHIV and for four population groups: cisgender Men who have Sex with Men (MSM), cisgender Men who have Sex with Women (MSW), Cisgender Women (CGW), and Transgender Women (TGW). Cohort data from Evandro Chagas National Institute of Infectious Diseases/Oswaldo Cruz Foundation (INI/Fiocruz) informed model parameters. We modeled five scenarios: 1) Current care: ART initiation, adherence, and retention in care as currently observed, 2) Guideline-concordant care: immediate ART initiation, full adherence to treatment, and consistent retention in care, 3) Immediate ART initiation with observed adherence to treatment and retention in care, 4) Full adherence to treatment with observed timing of ART initiation and retention in care, and 5) Consistent retention in care with observed timing of ART initiation and adherence. Results With current care, LE from age 15 would be 45.9, 44.4, 54.2, and 42.3 years, for MSM, MSW, CGW, and TGW. With guideline-concordant care, LE would be 54.2, 54.4, 63.1, and 53.2 years, for MSM, MSW, CGW and TGW, with TGW experiencing the greatest potential increase in LE (10.9 years). When investigating the components of care separately, MSW and CGW would gain most LE with immediate ART initiation, whereas for MSM and TGW consistent retention in care would be most impactful. Conclusions In settings like INI/Fiocruz, MSW and CGW would benefit most from interventions focused on earlier diagnosis and linkage to care, whereas TGW and MSM would benefit from interventions to sustain engagement in care. Assessment of the HIV care continuum for specific populations should inform care priorities. Brazil (ART all uniformly (LE (PLHIV guidelineconcordant guideline concordant groups , (MSM) (MSW) (CGW) . (TGW) DiseasesOswaldo Diseases Oswaldo INI/Fiocruz INIFiocruz INI Fiocruz (INI/Fiocruz parameters scenarios 1 2 Guidelineconcordant Guideline 3 4 5 459 45 9 45.9 444 44 44.4 542 54 54.2 423 42 42. years 544 54.4 631 63 63.1 532 53 53. 10.9 109 10 (10. years. years) separately impactful priorities (MSM (MSW (CGW (TGW 45. 44. 54. 6 63. 10. (10 (1 (

ABSTRACT Introduction: Antiretroviral therapy increased the survival and life expectancy of People living With HIV (PWH). Frailty-related syndromes among older PWH (aged 50+ years) may affect their Health-related Quality of Life (HQoL). Additionally, the COVID-19 pandemic has impacted health-related outcomes. This study aimed to estimate the prevalence of frailty and pre-frailty among older PWH, and to explore associations of HQoL with the study assessment period and frailty status. Methods: Cross-sectional study conducted pre- (23-Mar-2019 to 5-Mar-2020) and post-COVID-19 pandemic onset (23-Jun-2021 to 5-May-2022), among older PWH at INI-Fiocruz, the largest cohort of PWH in Rio de Janeiro, Brazil. We measured frailty using Fried assessment, consisting of five domains: unintentional weight loss; self-reported exhaustion, weakness, slow walking speed, low physical activity. HQoL was assessed using the ACTG SF-21, which contains 21 questions divided into 8 domains. We used Chi-Square test, Fisher’s exact test, Kruskal-Wallis and ranksum test for comparisons. Results: We included 250 older PWH: 109 (43.6 %) pre- and 141 (56.4 %) post-COVID-19 pandemic onset. Median age was 60-years (IQR: 55‒64). Most self-identified as cisgender men 152 (60.8 %), Pardo/Black 146 (58.4 %), with completed secondary education or less 181 (72.7 %) and low income 132 (52.8 %). Overall, prevalence of frailty and pre-frailty were 9.2 % (95 % CI: 8.1‒10.3) and 61.6 % (95 % CI: 54.0‒69.2). Prevalence of frailty in the pre- and pos-COVID-19 pandemic periods were 7.3 % and 10.6 % (p = 0.66). HQoL scores were lower among participants with frailty compared to those with non-frailty and pre-frailty in all eight domains, and among those included in the post-COVID-19 compared to pre-COVID-19 period for four domains. Conclusions: We observed low prevalence of frailty, but high prevalence of pre-frailty among older PWH. Frailty status did not differ according to the COVID-19 assessment period. Assessment of frailty and HQoL should be incorporated in clinical practice for older PWH. Programs to reverse or prevent frailty should be implemented within the public health system. Introduction . (PWH) Frailtyrelated related aged 50 years Healthrelated Health HQoL. (HQoL) Additionally COVID19 COVID 19 COVID-1 healthrelated outcomes prefrailty pre Methods Crosssectional Cross sectional 23Mar2019 Mar 23 2019 (23-Mar-201 5Mar2020 5 2020 5-Mar-2020 postCOVID19 postCOVID post post-COVID-1 23Jun2021 Jun 2021 (23-Jun-202 5May2022, 5May2022 May 2022 , 5-May-2022) INIFiocruz, INIFiocruz INI Fiocruz, Fiocruz INI-Fiocruz Janeiro Brazil domains loss selfreported self reported exhaustion weakness speed activity SF21, SF21 SF 21, SF-21 2 ChiSquare Chi Square Fishers Fisher s KruskalWallis Kruskal Wallis comparisons Results 25 10 43.6 436 43 6 (43. 14 56.4 564 56 4 (56. 60years 60 IQR (IQR 55‒64. 5564 55‒64 55 64 55‒64) selfidentified identified 15 60.8 608 (60. %, PardoBlack Pardo Black 58.4 584 58 (58. 18 72.7 727 72 7 (72. 13 52.8 528 52 (52. %. Overall 92 9 9. 95 (9 CI 8.1‒10.3 81103 1 3 616 61 61. 54.0‒69.2. 540692 54.0‒69.2 54 0 69 54.0‒69.2) posCOVID19 posCOVID pos pos-COVID-1 73 7. 106 10. p 0.66. 066 0.66 66 0.66) nonfrailty non preCOVID19 preCOVID pre-COVID-1 Conclusions system (PWH (HQoL COVID1 COVID- 23Mar201 201 (23-Mar-20 5Mar202 202 5-Mar-202 postCOVID1 post-COVID- 23Jun202 (23-Jun-20 5May202 5-May-2022 SF2 SF-2 43. (43 56. (56 556 55‒6 60. (60 58. (58 72. (72 52. (52 ( 8.1‒10. 8110 54069 54.0‒69. posCOVID1 pos-COVID- 06 0.6 preCOVID1 pre-COVID- 23Mar20 20 (23-Mar-2 5Mar20 5-Mar-20 post-COVID 23Jun20 (23-Jun-2 5May20 5-May-202 SF- (4 (5 55‒ (6 (7 8.1‒10 811 5406 54.0‒69 pos-COVID 0. pre-COVID 23Mar2 (23-Mar- 5Mar2 5-Mar-2 23Jun2 (23-Jun- 5May2 5-May-20 8.1‒1 81 540 54.0‒6 23Mar (23-Mar 5Mar 5-Mar- 23Jun (23-Jun 5May 5-May-2 8.1‒ 54.0‒ 5-Mar 5-May- 8.1 54.0 5-May 8. 54.

ABSTRACT Background: Antiretroviral therapy use has led to a decline in HIV-related mortality yet disparities by gender and/or sexual orientation may exist. In this study, we estimated hazards of death in people living with HIV (PLWH) according to gender and sexual orientation. Methods: We included PLWH ≥ 18 years enrolled between 2000 and 2018 at INI/Fiocruz, Rio de Janeiro, Brazil. Participants were grouped as cisgender or transgender women, cisgender men who have sex with men (MSM) or men who have sex with women, or cisgender men with unknown sexual orientation. We assessed disparities in the hazard of death using Cox proportional hazards models. Results: Among 5,576 PLWH, median age at enrollment was 35 years, 39% were MSM, 28% cisgender women, 23% men who have sex with women, 5% transgender women, and 5% men with unknown sexual orientation. A total of 795 deaths occurred in 39,141 person-years of follow-up. Mortality rates per 1,000 person-years were: 82.4 for men with unknown sexual orientation, 24.5 for men who have sex with women, 18.3 for cisgender, 16.6 for transgender women, and 15.1 for MSM. Compared to MSM, men with unknown sexual orientation had the highest death hazard ratio (adjusted hazard ratio [aHR] 2.93, 95% confidence interval [CI] 2.35–3.81), followed by men who have sex with women (aHR 1.17, 95%CI 0.96, 1.43); death hazard ratios for cisgender and transgender women were not statistically different. Conclusion: We observed disparities in the hazard of death for men with unknown sexual orientation and men who have sex with women despite universal access to antiretroviral therapy in Brazil. Future work should characterize and assist men with unknown sexual orientation with tailored policies and interventions. Increased hazard of death was not observed for transgender women, which probably results from interventions implemented in our service to reach, engage, retain, and support this population. Background HIVrelated related andor exist study (PLWH Methods 1 200 201 INIFiocruz INI Fiocruz INI/Fiocruz Janeiro Brazil MSM (MSM models Results 5576 5 576 5,57 3 39 28 23 79 39141 141 39,14 personyears person followup. followup follow up. up follow-up 1000 000 1,00 824 82 4 82. 245 24 24. 183 18. 166 16 6 16. 151 15 15. adjusted aHR [aHR 293 2 93 2.93 95 CI [CI 2.35–3.81, 235381 2.35–3.81 , 81 2.35–3.81) 117 17 1.17 95CI 096 0 96 0.96 1.43 143 43 1.43) different Conclusion reach engage retain population 20 557 57 5,5 7 3914 14 39,1 100 00 1,0 8 29 9 2.9 23538 2.35–3.8 11 1.1 09 0.9 1.4 55 5, 391 39, 10 1, 2. 2353 2.35–3. 1. 0. 235 2.35–3 2.35– 2.35 2.3

ABSTRACT Syndemic psychosocial and reproductive factors affecting women’s retention in HIV care remain understudied. We analyzed correlates of non-retention in a cohort of women with HIV in Brazil from 2000–2015. Participants self-reported exposure to physical/sexual violence, illicit drug use, adolescent pregnancy, or induced abortion. Lifetime history of these psychosocial stressors were used to create a syndemic score based on the presence or absence of these conditions. All dichotomous variables were summed (range 0 to 4), with greater scores indicating more syndemic factors experienced. Logistic regression models identified predictors of non-retention, defined as < 2 HIV viral load or CD4 results within the first year of enrollment. Of 915 women, non-retention was observed for 18%. Prevalence of syndemic factors was adolescent pregnancy (53.2%), physical/sexual violence (38.3%), induced abortion (27.3%), and illicit drug use (17.2%); 41.2% experienced > 2 syndemic conditions. Syndemic scores of 2 and 3 were associated with non-retention, as well as low education, years with HIV and seroprevalent syphilis. Psychosocial and reproductive syndemics can limit women’s retention in HIV care. Syphilis infection predicted non-retention and could be explored as a syndemic factor in future studies. womens s understudied nonretention non 20002015 2000 2015 2000–2015 selfreported self reported physicalsexual physical sexual conditions range 4, 4 , 4) nonretention, retention, CD enrollment 91 18 18% 53.2%, 532 53.2% 53 (53.2%) 38.3%, 383 38.3% 38 (38.3%) 27.3%, 273 27.3% 27 (27.3%) 17.2% 172 17 (17.2%) 412 41 41.2 education syphilis studies 2000201 200 201 2000–201 9 1 53.2 5 (53.2% 38.3 (38.3% 27.3 (27.3% 17.2 (17.2% 41. 200020 20 2000–20 53. (53.2 38. (38.3 27. (27.3 17. (17.2 20002 2000–2 (53. (38. (27. (17. 2000– (53 (38 (27 (17 (5 (3 (2 (1 (

ABSTRACT Background: An outbreak of acute hepatitis of unknown etiology in children was recently reported worldwide. We aimed to describe the burden of hospitalizations due to hepatitis of unknown etiology in children/adolescents in Brazilian public hospitals. Methods: We retrieved a database of all hospitalizations in the Brazilian Unified Health System (SUS) from January/2019 to February/2022 using the “microdatasus” R package. Hepatitis of unknown etiology was defined by the following International Classification of Diseases [ICD-10] codes: B19, B19.0, B19.9, K72.0, K72.9, K75, K75.9, R94.5, or R93.2. The incidence rates (95% confidence interval, IC) per 1,000 all-cause hospitalizations in different age strata [< 6 years; 6–11 years and 12–17 years] were estimated. Results: A total of 94,198 hospitalizations due to hepatic or infectious diseases with potential liver injury were analyzed. Of them, 1,535 children/adolescents [48.2% male sex, 41.6% aged < 6 years] were hospitalized with hepatitis with unknown etiology. The top ICD-10 codes were B19.9 [unspecified viral hepatitis without hepatic coma; 39.9% (n = 612)], K72.9 [hepatic failure, unspecified; 29.8% (n = 457)], and K72.0 [hepatic failure, not elsewhere classified; 14.5% (n = 223)]. A total of 8.5% (n = 131) of individuals required liver transplantation and 7.0% (n = 107) died during the hospital-stay. In 2021, the incidence rates (95% CI) of hospitalizations for hepatitis with unknown etiology were 7.80 (7.63–7.98), 17.96 (17.46–18.48) and 13.28 (12.95–13.62) per 1,000 all-cause hospitalizations in subjects aged < 6 years, 6–11 years and 12–17 years-old, respectively. Similarly, the incidence rates of hospitalization due to hepatitis with unknown etiology per 1,000 all-cause hospitalizations (CI95%) in January-February/2022 were 7.52 (7.11–7.94), 16.82 (15.68–18.03), and 13.96 (13.10–14.85) for children/adolescents with age < 6 years, 6–11 years, and 12–17 years, respectively. Conclusions: A non-negligible number of hospitalizations due to hepatitis with unknown etiology in children/adolescents was observed in the last years in Brazil. Up to 15% of those cases needed liver transplantation or died. Background worldwide childrenadolescents adolescents hospitals Methods SUS (SUS January2019 January 2019 January/201 February2022 February 2022 February/202 microdatasus “microdatasus package ICD10 ICD 10 [ICD-10 B19 B B190 0 B19.0 B199 9 K720 K K72 K729 K75 K759 K75.9 R945 R94 5 R94.5 R932 R93 2 R93.2 95% 95 (95 interval IC 1000 1 000 1,00 allcause cause [ 611 11 6–1 1217 12 17 12–1 estimated Results 94198 94 198 94,19 analyzed them 1535 535 1,53 48.2% 482 48 [48.2 sex 416 41 41.6 ICD-1 B19. unspecified coma 399 39 39.9 n 612, 612 , 612)] K72. failure 298 29 8 29.8 457, 457 457)] classified 145 14 14.5 223. 223 . 223)] 85 8.5 131 70 7 7.0 107 hospitalstay. hospitalstay hospital stay. stay hospital-stay 2021 CI 780 80 7.8 7.63–7.98, 763798 7.63–7.98 63 98 (7.63–7.98) 1796 96 17.9 17.46–18.48 17461848 46 18 (17.46–18.48 1328 13 28 13.2 12.95–13.62 12951362 62 (12.95–13.62 yearsold, yearsold old, old years-old respectively Similarly CI95% CI95 (CI95% JanuaryFebruary/2022 JanuaryFebruary2022 JanuaryFebruary January-February/202 752 52 7.5 7.11–7.94, 711794 7.11–7.94 (7.11–7.94) 1682 16 82 16.8 15.68–18.03, 15681803 15.68–18.03 15 68 03 (15.68–18.03) 1396 13.9 13.10–14.85 13101485 (13.10–14.85 Conclusions nonnegligible non negligible Brazil January201 201 January/20 February202 202 February/20 ICD1 [ICD-1 B1 K7 K75. R9 R94. R93. (9 100 00 1,0 61 6– 121 12– 9419 19 94,1 153 53 1,5 48.2 4 [48. 41. ICD- 3 39. 612) 29. 45 457) 14. 22 223) 8. 7. 78 76379 7.63–7.9 (7.63–7.98 179 17. 17.46–18.4 1746184 (17.46–18.4 132 13. 12.95–13.6 1295136 (12.95–13.6 CI9 (CI95 JanuaryFebruary/202 JanuaryFebruary202 January-February/20 75 71179 7.11–7.9 (7.11–7.94 168 16. 1568180 15.68–18.0 (15.68–18.03 139 13.10–14.8 1310148 (13.10–14.8 January20 20 January/2 February20 February/2 [ICD- ( 1, 941 94, 48. [48 7637 7.63–7. (7.63–7.9 17.46–18. 174618 (17.46–18. 12.95–13. 129513 (12.95–13. (CI9 JanuaryFebruary/20 JanuaryFebruary20 January-February/2 7117 7.11–7. (7.11–7.9 156818 15.68–18. (15.68–18.0 13.10–14. 131014 (13.10–14. January2 January/ February2 February/ [ICD [4 763 7.63–7 (7.63–7. 17.46–18 17461 (17.46–18 12.95–13 12951 (12.95–13 (CI JanuaryFebruary/2 JanuaryFebruary2 January-February/ 711 7.11–7 (7.11–7. 15681 15.68–18 (15.68–18. 13.10–14 13101 (13.10–14 76 7.63– (7.63–7 17.46–1 1746 (17.46–1 12.95–1 1295 (12.95–1 JanuaryFebruary/ January-February 71 7.11– (7.11–7 1568 15.68–1 (15.68–18 13.10–1 1310 (13.10–1 7.63 (7.63– 17.46– 174 (17.46– 12.95– 129 (12.95– 7.11 (7.11– 156 15.68– (15.68–1 13.10– (13.10– 7.6 (7.63 17.46 (17.46 12.95 (12.95 7.1 (7.11 15.68 (15.68– 13.10 (13.10 (7.6 17.4 (17.4 12.9 (12.9 (7.1 15.6 (15.68 13.1 (13.1 (7. (17. 12. (12. 15. (15.6 (13. (7 (17 (12 (15. (13 (1 (15

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 In March 2020, telemedicine and HIV self-testing were adopted by Brazilian Public Health services to minimize disruptions in pre-exposure prophylaxis (PrEP) access and delivery during the COVID-19 pandemic. To understand the acceptability of PrEP teleconsultation and HIV self-testing, we conducted a web-based study during social distancing period (April–May, 2020) among men who have sex with men and transgender/non-binary individuals using social media. Out of the 2375 HIV negative respondents, 680 reported PrEP use and were included in this analysis. Median age was 33 years (IQR: 28–40), 98% cisgender men, 56% white, 74% high education, and 68% middle/high income. Willingness to use HIVST was 79% and 32% received an HIV self-testing during social distancing period. The majority reported preference for PrEP/HIV self-testing home delivery instead of collecting at the service. PrEP teleconsultation was experienced by 21% and most reported feeling satisfied with the procedures. High acceptability of PrEP teleconsultation was reported by 70%. In ordinal logistic model, having higher education was associated with high aceptability of PrEP teleconsultation (aOR:1.62; 95%CI: 1.07–2.45). Our results point out that PrEP teleconsultation and PrEP/HIV self-testing home delivery could be implemented by PrEP services in Brazil to avoid PrEP shortage during the COVID-19 pandemic and thereafter as an option to increase retention and adherence.

ABSTRACT After more than a year since the novel coronavirus (SARS-CoV-2) disease 2019 or COVID-19 has reached the status of a global pandemic, the number of COVID-19 cases continues to rise in Brazil. As no effective treatment been approved yet, only mass vaccination can stop the spread of SARS-CoV-2 and end the COVID-19 pandemic. Multiple COVID-19 vaccine candidates are under development and some are currently in use. This study aims to describe the characteristics of individuals who have registered in an online platform to participate in clinical trials for COVID-19 vaccines. Additionally, participants’ characteristics according to age and presence of comorbidities associated with severe COVID-19 and differences of SARS-CoV-2 testing across different geographical areas/neighborhoods are provided. This was a cross-sectional web-based study conducted between September and December/2020, aiming to reach individuals aged ≥18 years who live in Rio de Janeiro metropolitan area, Brazil. Among 21,210 individuals who completed the survey, 20,587 (97.1%) were willing to participate in clinical trials for COVID-19 vaccines. Among those willing to participate, 57.8% individuals were aged 18-59 years and had no comorbidity, 33.7% were aged 18-59 years and had at least one comorbidity, and 8.6% were aged ≥ 60 years regardless the presence of any comorbidity. Almost half (42.6%) reported ever testing for COVID-19, and this proportion was lower among those aged ≥ 60 years (p < 0.001). Prevalence of positive PCR results was 16.0%, higher among those aged 18-59 years (p < 0.009). Prevalence of positive antibody result was 10.0%, with no difference across age and comorbidity groups. Participants from areas/neighborhoods with higher Human Development Index (HDI) reported ever testing for SARS-CoV-2 more frequently than those from lower HDI areas. Interest to participate in clinical trials for COVID-19 vaccines candidates in Rio de Janeiro was significantly high. The online registry successfully reached out a large number of individuals with diverse sociodemographic, economic and clinical backgrounds.

Abstract COVID-19 public health responses such as social distancing and community containment measures protocols are critical to preventing and containing the spread of coronavirus. Brazil accounts for almost half of Latin American HIV cases and Rio de Janeiro is the city with the second largest number of AIDS. Clinical appointments and pharmacy antiretroviral refills may be impaired due to restricted traffic and possible lockdowns, preventing people living with HIV and those using PrEP from accessing needed antiretrovirals. We hereby describe the telemedicine procedures implemented in a large PrEP delivery service in Rio de janeiro in the context of the COVID-19 pandemic. At the initial teleconsultation, individuals undergoe HIV rapid testing and are assessed by phone for PrEP related procedures. Individuals receive a digital prescription to retrieve a 120-day PrEP supply plus two HIV self-test kits. Subsequent follow-up teleconsultations will be performed remotely by phone call, including instructions for the HIV self-test performance, which results are to be sent using a digital picture. Participants will attend the service only for PrEP refill. The use of telemedicine procedures is being effective to avoid PrEP shortage and reduce the time PrEP users spend at the service during the COVID-19 pandemic and social distancing recommendations.

ABSTRACT The accuracy of commercially available tests for COVID-19 in Brazil remains unclear. We aimed to perform a meta-analysis to describe the accuracy of available tests to detect COVID-19 in Brazil. We searched at the Brazilian Health Regulatory Agency (ANVISA) online platform to describe the pooled sensitivity (Se), specificity (Sp), diagnostic odds ratio (DOR) and summary receiver operating characteristic curves (SROC) for detection of IgM/IgG antibodies and for tests using naso/oropharyngeal swabs in the random-effects models. We identified 16 tests registered, mostly rapid-tests. Pooled diagnostic accuracy measures [95%CI] were: (i) for IgM antibodies Se = 82% [76-87]; Sp = 97% [96-98]; DOR = 168 [92-305] and SROC = 0.98 [0.96-0.99]; (ii) for IgG antibodies Se = 97% [90-99]; Sp = 98% [97-99]; DOR = 1994 [385-10334] and SROC = 0.99 [0.98-1.00]; and (iii) for detection of SARS-CoV-2 by antigen or molecular assays in naso/oropharyngeal swabs Se = 97% [85-99]; Sp = 99% [77-100]; DOR = 2649 [30-233056] and SROC = 0.99 [0.98-1.00]. These tests can be helpful for emergency testing during the COVID-19 pandemic in Brazil. However, it is important to highlight the high rate of false negative results from tests which detect SARS-CoV-2 IgM antibodies in the initial course of the disease and the scarce evidence-based validation results published in Brazil. Future studies addressing the diagnostic performance of tests for COVID-19 in the Brazilian population are urgently needed.

Abstract In this study, we evaluated trends in hospitalization rates, length of stay and in-hospital mortality in a cohort of HIV-infected patients in Rio de Janeiro, Brazil, from 2007 through 2013. Among the 3991 included patients, 1861 hospitalizations occurred (hospitalization rate of 10.44/100 person-years, 95% confidence interval 9.98–10.93/100 person-years). Hospitalization rates decreased annually (per year incidence rate ratio 0.92, 95% confidence interval 0.89–0.95) as well as length of stay (median of 15 days in 2007 vs. 11 days in 2013, p-value for trend < 0.001), and in-hospital mortality (13.4% in 2007 to 8.1% in 2013, p-value for trend = 0.053). Our results show that, in a middle-income setting, hospitalization rates are decreasing over time and non-AIDS hospitalizations are currently more frequent than those related to AIDS. Notwithstanding, compared with high-income settings, our patients had longer length of stay and higher in-hospital mortality. Further studies addressing these outcomes are needed to provide information that may guide protocols and interventions to further reduce health-care costs and in-hospital mortality.

Toxicity is the most frequently reported reason for modifying or discontinuing the first combined antiretroviral therapy regimens, and it can cause significant morbidity, poor quality of life and also can be an important barrier to adherence, ultimately resulting in treatment failure and viral resistance. Elderly patients with HIV/AIDS (≥50 years) may have a different profile in terms of treatment modification due to higher incidence of comorbidities and polypharmacy. The aim of this study was to describe the incidence of modifying or discontinuing first combined antiretroviral therapy regimen due to toxicity (TOX-MOD) during the first year of treatment at the IPEC – FIOCRUZ HIV/AIDS cohort, Rio de Janeiro, Brazil, stratified by age. Demographic, clinical and treatment characteristics from antiretroviral-naïve patients who first received combined antiretroviral therapy between Jan/1996 and Dec/2010 were collected. Incidence rate and confidence interval of each event were estimated using quasipoisson model. To estimate hazard ratio (HR) of TOX-MOD during the first year of combined antiretroviral therapy Cox's proportional hazards regression was applied. Overall, 1558 patients were included; 957 (61.4%), 420 (27.0%) and 181 (11.6%) were aged <40, 40–49, and ≥50 years, respectively. 239 (15.3%) events that led to any modifying or discontinuing within the first year of treatment were observed; 228 (95.4%) of these were TOX-MOD, corresponding to an incidence rate of 16.6/100 PY (95% CI: 14.6–18.9). The most frequent TOX-MOD during first combined antiretroviral therapy regimen were hematologic (59; 26.3%), central nervous system (47; 20.9%), rash (42; 19.1%) and gastrointestinal (GI) (38; 16.7%). In multivariate analysis, incidence ratio of TOX-MOD during the first year of combined antiretroviral therapy progressively increases with age, albeit not reaching statistical significance. This profile was maintained after adjusting the model for sex, combined antiretroviral therapy regimen and year of combined antiretroviral therapy initiation. These results are important because not only patients are living longer and aging with HIV, but also new diagnoses are being made among the elderly. Prospective studies are needed to evaluate the safety profile of first line combined antiretroviral therapy on elderly individuals, especially in resource-limited countries, where initial regimens are mostly NNRTI-based.