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

Resumo Introdução A pandemia por SARS-CoV-2, iniciada em dezembro de 2019, foi declarada pela Organização Mundial da Saúde (OMS) como emergência de saúde pública internacional em janeiro de 2020, com impacto sobre o acesso a serviços de saúde sexual e reprodutiva para as mulheres. Objetivo Discutir a contracepção no contexto pandêmico, a partir das políticas públicas vigentes e do cenário mundial e brasileiro. Método Trata-se de um artigo de opinião, onde se descreve as barreiras e possíveis soluções para o acesso à assistência de saúde sexual e reprodutiva qualificada para as mulheres. Resultados Explorou-se temas relevantes como: mudança na logística dos serviços, redução do número de consultas, dificuldade na importação de contraceptivos, falta de profissionais capacitados, burocratização do acesso a métodos contraceptivos. O uso da telemedicina e o fortalecimento da Atenção Primária à Saúde são consideradas estratégias para garantia do acesso e modificação da realidade das mulheres. Conclusão Faz-se necessário nesse contexto, a manutenção das ações dos serviços de planejamento sexual e reprodutivo para prevenir agravos provenientes de gestações não planejadas e aumento na morbimortalidade materna.

Abstract Background The SARS-CoV-2 pandemic, which started in December 2019, was declared by the World Health Organization (WHO) as an international public health emergency in January 2020, with an impact on access to sexual and reproductive health services for women. Objective To discuss contraception in the pandemic context, based on current public policies and the world and Brazilian scenario. Method This is an opinion article, which describes the barriers and possible solutions for access to qualified sexual and reproductive health care for women. Results Relevant topics were explored, such as: the change in the logistics of services, the reduction in the number of consultations, the difficulty in importing contraceptives, the lack of trained professionals, and the bureaucratization of access to contraceptives methods. The use of telemedicine and the strengthening of Primary Health Care are considered strategies to guarantee access and change the reality of women. Conclusion In this context, it is necessary to maintain the actions of sexual and reproductive planning services to prevent injuries from unplanned pregnancies and increase maternal morbidity and mortality.

Resumo Introdução A pandemia por SARS-CoV-2, iniciada em dezembro de 2019, foi declarada pela Organização Mundial da Saúde (OMS) como emergência de saúde pública internacional em janeiro de 2020, com impacto sobre o acesso a serviços de saúde sexual e reprodutiva para as mulheres. Objetivo Discutir a contracepção no contexto pandêmico, a partir das políticas públicas vigentes e do cenário mundial e brasileiro. Método Trata-se de um artigo de opinião, onde se descreve as barreiras e possíveis soluções para o acesso à assistência de saúde sexual e reprodutiva qualificada para as mulheres. Resultados Explorou-se temas relevantes como: mudança na logística dos serviços, redução do número de consultas, dificuldade na importação de contraceptivos, falta de profissionais capacitados, burocratização do acesso a métodos contraceptivos. O uso da telemedicina e o fortalecimento da Atenção Primária à Saúde são consideradas estratégias para garantia do acesso e modificação da realidade das mulheres. Conclusão Faz-se necessário nesse contexto, a manutenção das ações dos serviços de planejamento sexual e reprodutivo para prevenir agravos provenientes de gestações não planejadas e aumento na morbimortalidade materna.

Abstract Background The SARS-CoV-2 pandemic, which started in December 2019, was declared by the World Health Organization (WHO) as an international public health emergency in January 2020, with an impact on access to sexual and reproductive health services for women. Objective To discuss contraception in the pandemic context, based on current public policies and the world and Brazilian scenario. Method This is an opinion article, which describes the barriers and possible solutions for access to qualified sexual and reproductive health care for women. Results Relevant topics were explored, such as: the change in the logistics of services, the reduction in the number of consultations, the difficulty in importing contraceptives, the lack of trained professionals, and the bureaucratization of access to contraceptives methods. The use of telemedicine and the strengthening of Primary Health Care are considered strategies to guarantee access and change the reality of women. Conclusion In this context, it is necessary to maintain the actions of sexual and reproductive planning services to prevent injuries from unplanned pregnancies and increase maternal morbidity and mortality.

Abstract 19. Literature points to the existent diversity in medical graduate courses’ curriculums, reinforcing the need to systematise and deepen more studies in this area with the aim of qualifying the formation of our future professionals. This study aims to understand the methods used in the teaching of Bioethics in medical graduation worldwide. It was characterised as an integrative review and the databases used were Pubmed, Scopus and Web of Science. In total 2993 articles were identified and 72 met the pre-selected criteria and were included in the review. The characteristics of teaching bioethics that stood out the most in the analysis were: teaching still very heterogeneous between different universities, use of various methodologies in the process of teaching/learning, teaching disconnected from the medical practice of students showing the need to integrate the curriculum with clinical practice and challenges of teaching-learning process. Most of the studies in this review lead us to understand that there is still no minimum parameters on the ideal method to teach bioethics, suggesting that it may affect the feeling of unpreparedness felt by students in face of ethical issues in clinical practice, despite the theoretical basis acquired.

Resumen 23. La literatura apunta a la diversidad existente en los currículos de los posgrados de medicina, reforzando la necesidad de sistematizar y profundizar más estudios en esta área, con el fin de capacitar la formación de nuestros futuros profesionales. Este estudio tiene como objetivo comprender los métodos utilizados en la enseñanza de la bioética en la graduación médica en el mundo. Se caracterizó como una revisión integradora y las bases de datos utilizadas fueron Pubmed, Scopus y Web of Science. En total se identificaron 2.993 artículos, 72 cumplieron los criterios preseleccionados y se incluyeron en la revisión. Las características de la enseñanza de la bioética que más se destacaron en el análisis fueron: docencia aún muy heterogénea entre diferentes universidades, uso de diversas metodologías en el proceso de enseñanza/aprendizaje, docencia desconectada de la práctica médica de los estudiantes, mostrando la necesidad de integrar el currículo con la práctica clínica y los desafíos del proceso de enseñanza/aprendizaje. La mayoría de los estudios de esta revisión nos lleva a entender que aún no existen parámetros mínimos sobre el método ideal para enseñar bioética, sugiriendo que puede impactar en la falta de preparación que sienten los estudiantes ante cuestiones éticas en la práctica clínica, a pesar de las teorías base adquiridas.

Resumo: 27. Vários estudos relatam a diversidade existente nos currículos da graduação em medicina, reforçando a necessidade de sistematizar e aprofundar mais estudos nesta área com o objetivo de qualificar a formação dos nossos futuros profissionais. Este estudo tem como objetivo compreender os métodos utilizados no ensino da Bioética na graduação em medicina em todo o mundo. Esse estudo caracterizou-se como revisão integrativa e as bases de dados utilizadas foram Pubmed, Scopus e Web of Science. No total, foram identificados 2.993 artigos e 72 atenderam aos critérios pré-selecionados e foram incluídos na revisão. As características do ensino da bioética que mais se destacaram nas análises foram: ensino ainda muito heterogêneo entre as diferentes universidades, utilização de diversas metodologias no processo de ensino / aprendizagem, ensino desvinculado da prática médica dos alunos evidenciando a necessidade de integração curricular com a prática clínica e os desafios do processo ensino-aprendizagem. A maioria dos estudos desta revisão nos leva a entender que ainda não existem parâmetros mínimos sobre o método ideal de ensino da bioética e traz como um desafio importante o despreparo sentido pelos alunos frente às questões éticas na prática, apesar da fundamentação teórica adquirida.

Resumo O tema corrimento vaginal é um dos capítulos que compõem o Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde do Brasil em 2020. Tal documento foi elaborado com base em evidências científicas e validado em discussões com especialistas. Neste artigo, são apresentados aspectos epidemiológicos e clínicos relacionados às situações de corrimento vaginal, bem como orientações aos gestores e profissionais de saúde na triagem, diagnóstico e tratamento desses agravos, que constituem uma das principais queixas entre mulheres que procuram serviços de saúde e que podem ser causados por fatores infecciosos ou não infecciosos. Além disso, são apresentadas informações sobre estratégias para as ações de vigilância, prevenção e controle, a fim de promover o conhecimento do problema e a oferta de assistência de qualidade e tratamento efetivo.

Resumen El tema del flujo vaginal es uno de los capítulos del Protocolo Clínico y Directrices Terapéuticas para la Atención Integral a las Personas con Infecciones de Transmisión Sexual, publicado por el Ministerio de Salud de Brasil en 2020. El documento fue desarrollado en base a evidencia científica y validado en discusiones con especialistas. En este artículo se presentan aspectos epidemiológicos y clínicos relacionados a las situaciones de flujo vaginal, así como pautas para gestores y profesionales de la salud en el cribado, diagnóstico y tratamiento de esas complicaciones, que son una de las principales quejas entre las mujeres que buscan servicios de salud y que pueden ser causadas por factores infecciosos o no infecciosos. Además, se presenta información sobre estrategias para acciones de vigilancia, prevención y control, con el fin de promover la comprensión del problema y la oferta de asistencia de calidad y tratamiento eficaz.

Abstract The topic of vaginal discharge is one of the chapters of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. The chapter has been developed based on scientific evidence and validated in discussions with specialists. This article presents epidemiological and clinical aspects related to vaginal discharge conditions, as well as guidelines for health service managers and health professionals about screening, diagnosing and treating these conditions, which are one of the main complaints among women seeking health services, and which may be caused by infectious or non-infectious factors. In addition, information is presented on strategies for surveillance, prevention and control actions, in order to promote knowledge of the problem and provision of quality care and effective treatment.

Resumo O tema corrimento vaginal é um dos capítulos que compõem o Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde do Brasil em 2020. Tal documento foi elaborado com base em evidências científicas e validado em discussões com especialistas. Neste artigo, são apresentados aspectos epidemiológicos e clínicos relacionados às situações de corrimento vaginal, bem como orientações aos gestores e profissionais de saúde na triagem, diagnóstico e tratamento desses agravos, que constituem uma das principais queixas entre mulheres que procuram serviços de saúde e que podem ser causados por fatores infecciosos ou não infecciosos. Além disso, são apresentadas informações sobre estratégias para as ações de vigilância, prevenção e controle, a fim de promover o conhecimento do problema e a oferta de assistência de qualidade e tratamento efetivo.

Abstract The topic of vaginal discharge is one of the chapters of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. The chapter has been developed based on scientific evidence and validated in discussions with specialists. This article presents epidemiological and clinical aspects related to vaginal discharge conditions, as well as guidelines for health service managers and health professionals about screening, diagnosing and treating these conditions, which are one of the main complaints among women seeking health services, and which may be caused by infectious or non-infectious factors. In addition, information is presented on strategies for surveillance, prevention and control actions, in order to promote knowledge of the problem and provision of quality care and effective treatment.

Resumen El tema del flujo vaginal es uno de los capítulos del Protocolo Clínico y Directrices Terapéuticas para la Atención Integral a las Personas con Infecciones de Transmisión Sexual, publicado por el Ministerio de Salud de Brasil en 2020. El documento fue desarrollado en base a evidencia científica y validado en discusiones con especialistas. En este artículo se presentan aspectos epidemiológicos y clínicos relacionados a las situaciones de flujo vaginal, así como pautas para gestores y profesionales de la salud en el cribado, diagnóstico y tratamiento de esas complicaciones, que son una de las principales quejas entre las mujeres que buscan servicios de salud y que pueden ser causadas por factores infecciosos o no infecciosos. Además, se presenta información sobre estrategias para acciones de vigilancia, prevención y control, con el fin de promover la comprensión del problema y la oferta de asistencia de calidad y tratamiento eficaz.

Abstract The topic of vaginal discharge is one of the chapters of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Health Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. The chapter has been developed based on scientific evidence and validated in discussions with specialists. This article presents epidemiological and clinical aspects associated with vaginal discharge conditions, as well as guidance to health service managers and health professionals. Screening, diagnosing, and treating these conditions, the main complaints among women seeking health services, caused by infectious or non-infectious factors, also are presented. Besides, information is presented on surveillance, prevention, and control actions to promote knowledge of the problem and provide quality care and effective treatment.

Abstract Background: Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) cause infections in the female genital tract, increasing susceptibility to and infectiousness of HIV. The objectives of the present study were to determine the prevalence and associated factors of CT and GC infection among HIV-infected women in Brazil. Methods: Cross-sectional study conducted from March to December 2015, including HIV-infected women attending referral centers in nine states of Brazil, aged 18-49 years, nonpregnant. An interview was conducted including socio-demographic, epidemiological and clinical characteristics. After the interview, gynecological examination was conducted to collect cervical cytology and vaginal secretion to C. trachomatis and N. gonorrhoeae tests through molecular biology. Results: A total of 802 (89.1%) women participated. The prevalence of CT was 2.1% (17/802) and CG was 0.9% (7/802). The prevalence of a positive test for both CT and/or GC was 2.7%. The factors associated with positive CT/GC test in the multivariate logistic regression analysis were abnormal Papanicolau smear (OR 4.1; 95% CI: 1.54-11.09) and the presence of abnormal cervical discharge (OR 2.6; 95% CI: 1.02-6.71). Among 377 women who reported previous STI 245 (65.0%) reported using condom more frequently after being diagnosed. 62 (16.4%) discovered the STI after the partner told he was infected; 157 (41.6%) had STI symptoms and looked for care, and 158 (41.9%) discovered it in a routine consultation for another reason. Conclusions: The control of STI represents a unique opportunity to improve reproductive health of women living with HIV. STI diagnosis can change their behavior and reduce the sexual transmission of HIV and bacterial STI.

ABSTRACT Background: Infections caused by Chlamydia trachomatis and Neisseria gonorrhoeae are the most common bacterial sexually transmitted infections throughout the world. These sexually transmitted infections are a growing problem in people living with HIV/AIDS. However, the presence of these agents in extra genital sites, remains poorly studied in our country. The objective of this study was to estimate the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae anal and genital infection in people living with HIV/AIDS followed in a reference center in Salvador, Brazil. Methods: Cross-sectional study, from June 2013 to June 2015. Proven HIV-infected people attending this reference center were invited. Clinical and epidemiological data were obtained through interview with standardized form. Chlamydia trachomatis and Neisseria gonorrhoeae screening was performed using qPCR (COBAS 4800® Roche). Results: The frequency of positive cases of Chlamydia trachomatis and Neisseria gonorrhoeae was 12.3% in total, 9.2% cases amongst women and 17.1% amongst men. We found 14.0% of positive cases in anus and 3.1% in genital region in men, while 5.6% and 3.6%, in women, respectively. Among men, anal infection was associated with age <29 years (p = 0.033), report of anal intercourse (p = 0.029), pain during anal intercourse (p = 0.028). On the other hand, no association between genital infection and other variables were detected in bivariate analysis. Among women, we detected an association between Chlamydia trachomatis genital infection and age <29 years (p < 0.001), younger age at first sexual intercourse (p = 0.048), pregnancy (p < 0.001), viral load >50 copies/mL (p = 0.020), and no antiretroviral use (p = 0.008). Anal infection in women was associated with age <29 years old (p < 0.001) and pregnancy (p = 0.023), and was not associated with report of anal intercourse (p = 0.485). Conclusion: Missed opportunities for diagnosis in extra genital sites could impact on HIV transmission. The extra genital sites need to be considered to break the HIV and bacterial sexually transmitted infections chain-of-transmission.

OBJETIVO: Verificar a adesão à dupla contracepção entre mulheres infectadas pelo HIV usando acetato de medroxiprogesterona de depósito (AMPD) e condom.MÉTODOS: Corte transversal realizado em centro de referência de dezembro 2013 a setembro 2014. Entrevistadas 114 mulheres HIV (+), 15 a 49 anos, em uso de AMPD e condom para contracepção, aplicando questionário clínico epidemiológico, construído após painel Delphi e validação de conteúdo.RESULTADOS: As médias foram de 33,2±7,2 anos de idade, 8,1±5,2 anos de detecção do HIV, 6,8±5 anos de uso de terapia antirretroviral (TARV) e 737,6±341,1 células CD4/mm3. Adquiriram HIV pelo sexo 98,2% (112/114). Identificadas 85,9% (98/114) usuárias de TARV e 77,7% (84/114) com CD4>500/mm3. Relato de parceria fixa em 78,9% (90/114), havendo sorodiscordância para HIV em 41,2% (47/114), status sorológico do parceiro desconhecido em 21,9% e o parceiro desconhece que era infectada em 37,7% (43/114). Última gestação não planejada referida por 71,9% (82/114). Engravidaram no último ano 14,9%, sendo 70,5% (12/17) não planejadas. Relato de uso atual de AMPD em 64,9% (74/114) com sangramento genital em 48,2% (55/114) e ganho de peso em 67,5% (77/114). O uso de condom masculino foi referido por 62,2% (71/114). Três usuárias de condom feminino sempre e dez eventualmente. Tinham sexo desprotegido vaginal 37,7% (43/114) e anal, 32,4% (37/114). Relato de resistência do parceiro para usar preservativo em 30,7% (35/114). A dupla contracepção com AMPD e condom foi relatada por 42,9% (49/114). Resistência do parceiro para usar condom foi associada com má adesão (RP=0,3; IC95% 0,2-0,7; p<0,001). Parceiro desconhecer a infecção da parceira pelo HIV favoreceu a adesão (RP=1,8; IC95% 1,2-2,7; p=0,013).CONCLUSÃO: Neste estudo, adesão à dupla contracepção com AMPD e condomfoi de 42,9%, mantendo gestações não planejadas e sexo desprotegido. Resistência do parceiro para usar condom aumenta três vezes a chance de a mulher não aderir à dupla proteção e parceiro desconhecer a infecção da mulher quase duplica a chance de ela aderir. Metas: ampliar oferta de novos contraceptivos e envolver parceiros na contracepção e testagem.

PURPOSE: To determine adherence to dual contraception using depot-medroxyprogesterone acetate (DMPA) and condom among HIV-infected women.METHODS: A cross-sectional study carried out from December 2013 to September 2014 at a local reference center, with application of questionnaire elaborated after Delphi panel and content validation to 114 HIV(+) women aged 15 to 49 years, using DMPA plus condom for contraception.RESULTS: Mean age was 33.2±7.2 years, mean time since HIV detection was 8.1±5.2 years, mean time of antiretroviral use was 6.8±5 years and mean CD4 cells/mm3 count was 737.6±341.1. Sexual HIV acquisition was reported by 98.2% (112/114), antiretroviral use by 85.9% (98/114), and 77.7% (84/114) had a CD4>500/mm3 count. Having a single sex partner was reported by 78.9% (90/114), with HIV serodiscordance in 41.2% (47/114) of couples, 21.9% did not know the serological status of their partner and in 37.7% of cases (43/114) the partner was unaware of the HIV(+) status of the woman. The last pregnancy was unplanned in 71.9% of cases (82/114) and 14.9% of the women had become pregnant the year before, with pregnancy being unplanned in 70.5% (12/17) of cases. Current use of DMPA was reported by 64.9% (74/114), with genital bleeding in 48.2% (55/114) and weight gain in 67.5% (77/114). Use of a male condom was reported by 62.2% of the subjects (71/114). Three reported that they always used a female condom and ten that they eventually used it. Unprotected vaginal sex was reported by 37.7% (43/114) and unprotected anal intercourse was reported by 32.4% (37/114). Partner resistance to use a condom occurred in 30.7% of cases (35/114). Dual contraception using DMPA with condom was reported by 42.9% (49/114). A partner who resisted wearing a condom was associated with poor adhesion (PR=0.3; 95%CI 0.2-0.7; p<0.001). A partner who was unaware that a woman was infected with HIV favored adherence (PR=1.8; 95%CI 1.2-2.7; p=0.013).CONCLUSION: The percentage of dual contraception using DMPA plus condom was 42.9%, maintaining unplanned pregnancies and unprotected sex. Resistance of partners to use a condom increased three times the chance of a woman not adhering to dual contraception, and the partner not knowing women's HIV infection almost doubled the chance to adhere to safe contraception. Goals: to offer new hormonal contraceptives and to involve the partners in contraception and serologic detection tests.

OBJETIVO: O objetivo foi descrever a distribuição dos genótipos do papilomavírus humano e a frequência de infecções por múltiplos genótipos, bem como avaliar a associação entre genótipos de papilomavírus humano, faixa etária e resultados cito-histopatológicos.MÉTODOS: Estudo retrospectivo de corte transversal realizado entre junho de 2010 e outubro de 2013 em Salvador, Bahia, Brasil. Foram revisados 351 prontuários de mulheres com genotipagem positiva pelo teste PapilloCheck(r), usado para detectar 24 tipos de papilomavírus humano. Os achados cito-histopatológicos foram classificados em grupos de: achados negativos para neoplasia (exames citopatológico e histopatológico negativos), lesão de baixo grau (achado citopatológico - lesão intraepitelial de baixo grau - ou achado histopatológico - neoplasia intraepitelial cervical grau 1, neoplasia intraepitelial vaginal grau 1 ou condiloma e lesão de alto grau (achado citopatológico - lesão intraepitelial de alto grau - ou histopatologia com laudo maior ou igual a neoplasia intraepitelial cervical grau 2 ou neoplasia intraepitelial vaginal grau 2).RESULTADOS: O genótipo de alto risco mais frequente foi o HPV 16, com 18,5%; intervalo de confiança de 95% (IC95%) 14,6-23,0, seguido pelo HPV 56 (14%; IC95% 10,5-18,0) e o HPV 39 (13,4%; IC95% 9,5-16,8). O HPV 18 (5,4%; IC95% 3,3-8,3) esteve entre os menos comuns. Entre os tipos de baixo grau, o HPV 42 (15,7%; IC 95% 12,0-20,0), o HPV 6 (11,4%; IC95% 8,3-15,2) e o HPV 44/55 (11,1%; IC95% 8,0-14,9) foram os mais encontrados, enquanto o HPV 11 (2,8%; IC95% 1,4-5,2) foi o menos frequente. A proporção do HPV 16 aumentou com a severidade das anormalidades cito-histopatológicas de 13,8% (12/87) nas lesões de baixo grau para 42,4% (14/33) nas lesões de alto grau. Houve associação significativa entre a presença de lesão cito-histopatológica de baixo ou alto grau e os genótipos de alto risco, HPV 16, HPV 52, HPV 73 e HPV 82, e o de baixo risco, HPV 43. Mulheres com menos de 30 anos apresentaram frequência significativamente maior do HPV 16 (22,2 versus12,9%, p=0,01), do HPV 42 (19,7 versus 10,9%, p=0,01) e do HPV 45 (6,6 versus1,4%, p=0,01), além de infecção múltipla (58,1 versus47,4%, p=0,04).CONCLUSÕES: Observou-se uma variabilidade da distribuição dos diversos genótipos de papilomavírus humano em mulheres no estado da Bahia. Na amostra estudada, o HPV 16 foi o mais frequente, assim como em outras regiões do Brasil e do mundo. Encontramos o HPV 56 e o HPV 39 como o segundo e o terceiro mais frequentes. Entretanto, o HPV 18 esteve entre os menos comuns. Os tipos não oncogênicos, HPV 42, 6 e 44/55, foram os mais observados, enquanto o HPV11 foi o menos frequente.

PURPOSE: The aim of this study was to evaluate the human papillomavirus genotypes and the frequency of multiple human papillomavirus infections, as well as to assess the association between human papillomavirus genotype, cyto-histopathological abnormalities and age range.METHODS: A retrospective cross-sectional study was carried out between June 2010 and October 2013 in Salvador, Bahia, Brazil. We analyzed 351 results of positive human papillomavirus genotyping performed using the PapilloCheck(r) test, designed to detect 24 human papillomavirus types. The cyto-histopathological abnormalities were classified as negative (negative cytology and histopathology), low-grade lesions (cytologic low-grade squamous intraepithelial lesion diagnosis or histopathologic cervical intraepithelial neoplasia 1 or vaginal intraepithelial neoplasia 1 diagnosis) and high-grade lesions (cytologic high-grade squamous intraepithelial lesion diagnosis or histopathologic cervical intraepithelial neoplasia 2+ or vaginal intraepithelial neoplasia 2+ diagnosis).RESULTS: The most frequently detected high risk human papillomavirus genotype was HPBV 16, with 18.5%, 95% confidence interval (95%CI) 14.6-23.0, followed by HPV 56 (14%; 95%CI 10.5-18.0) and HPV 39 (13.4%; 95%CI 9.5-16.8). HPV 18 (5.4%; 95%CI 3.3-8.3) was among the least frequent types. Among the low risk types, HPV 42 (15.7%; 95%CI 12.0-20.0), HPV 6 (11.4%; 95%CI 8.3-15.2) and HPV 44/55 (11.1%; 95%CI 8.0-14.9) were the most frequent, while HPV 11 (2.8%; 95%CI 1.4-5.2) was the least common. The proportion of HPV 16-positive women increased with severity of cyto-histopathological abnormalities: 13.8% (12/87) in low-grade lesion and 42.4% (14/33) in high-grade lesion. There was association between low- or high-grade cyto-histopathological lesion and the high risk genotypes, HPV16, HPV 52, HPV 73 and HPV 82, and the low risk type, HPV 43. Women under 30 years showed a significantly higher frequency of HPV 16 (22.2 versus12.9%, p =0.01), HPV 42 (19.7 versus 10.9%, p=0.01) and HPV 45 (6.6 versus1.4%, p=0.01), and multiple human papillomavirus infections (58.1 versus47.4%, p=0.04).CONCLUSIONS: We observed variability of human papillomavirus genotype distribution in women from the state of Bahia. HPV 16 was the most frequently detected high risk human papillomavirus, as also reported for other geographic areas of Brazil and for the world in general. HPV 56 and HPV 39 were the second and the third most common genotypes, whereas HPV 18 was among the least frequent types. HPV 42, 6 and 44/55 were the most frequently detected low risk human papillomavirus, and HPV 11 was the least common.

Identifying the barriers in the access to health care to breast cancer perceived by women undergoing chemotherapy.Method: An exploratory descriptive study. The sample consisted of 58 women with breast cancer receiving chemotherapy and registered in the public oncology ambulatory of Aracaju-Sergipe. Data collection was carried out between October 2011 and March 2012 by semistructured interviews, and data were processed using the SPSS, version 17.Results: Among the interviewed women, 37 (63.8%) reported at least a barrier in the trajectory of care for breast cancer. The organizational and health services barriers were the most reported in the periods of investigation and treatment of breast cancer.Conclusion: In face of these findings, the barriers should be considered in public health policies and programs for the control of breast cancer in Sergipe.



Identificar las barreras en el acceso a la atención en salud percibidos por mujeres con cáncer de mama en tratamiento quimioterapéutico.Método: Estudio descriptivo- exploratorio, cuya muestra estuvo constituida por 58 mujeres con cáncer de mama en quimioterapia inscritas en el servicio ambulatorio público de oncología de Aracaju-Sergipe. La recolección de datos fue realizada entre octubre de 2011 a marzo de 2012, por medio de entrevistas semi-estructuradas. Los datos fueron procesados en el software SPSS, versión 17.Resultados: Entre las entrevistadas, 37 mujeres (63,8%) relataron haber enfrentado por lo menos una barrera en la trayectoria de cuidado del cáncer de mama. Las barreras organizacionales o de los servicios de salud fueron las más citadas en los periodos de investigación y tratamiento del cáncer de mama.Conclusión: Las barreras deben ser consideradas en las políticas públicas de salud y de los programas de control del cáncer de mama en Sergipe.


Identifying the barriers in the access to health care to breast cancer perceived by women undergoing chemotherapy.Method: An exploratory descriptive study. The sample consisted of 58 women with breast cancer receiving chemotherapy and registered in the public oncology ambulatory of Aracaju-Sergipe. Data collection was carried out between October 2011 and March 2012 by semistructured interviews, and data were processed using the SPSS, version 17.Results: Among the interviewed women, 37 (63.8%) reported at least a barrier in the trajectory of care for breast cancer. The organizational and health services barriers were the most reported in the periods of investigation and treatment of breast cancer.Conclusion: In face of these findings, the barriers should be considered in public health policies and programs for the control of breast cancer in Sergipe.



Identificar las barreras en el acceso a la atención en salud percibidos por mujeres con cáncer de mama en tratamiento quimioterapéutico.Método: Estudio descriptivo- exploratorio, cuya muestra estuvo constituida por 58 mujeres con cáncer de mama en quimioterapia inscritas en el servicio ambulatorio público de oncología de Aracaju-Sergipe. La recolección de datos fue realizada entre octubre de 2011 a marzo de 2012, por medio de entrevistas semi-estructuradas. Los datos fueron procesados en el software SPSS, versión 17.Resultados: Entre las entrevistadas, 37 mujeres (63,8%) relataron haber enfrentado por lo menos una barrera en la trayectoria de cuidado del cáncer de mama. Las barreras organizacionales o de los servicios de salud fueron las más citadas en los periodos de investigación y tratamiento del cáncer de mama.Conclusión: Las barreras deben ser consideradas en las políticas públicas de salud y de los programas de control del cáncer de mama en Sergipe.