Efficacy of daily emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) for PrEP is strongly dependent on the adherence. We examined the concordance between indirect adherence measures and protective ...drug levels among participants retained through 48 weeks in the PrEP Brasil Study.
PrEP Brasil was a prospective, multicenter, open-label demonstration project evaluating PrEP provision for men who have sex with men (MSM) and transgender women (TGW) at higher risk for HIV infection within the setting of Brazilian Public Health System. Three indirect adherence measures were obtained at week 48: medication possession ratio (MPR), pill count and self-report (30-days recall). Tenofovir diphosphate (TFV-DP) concentration in Dried Blood Spot (DBS) was measured at week 48. Areas under (AUC) the receiver operating characteristics (ROC) curve were used to evaluate the concordance between achieving protective drug levels (TFV-DP≥700fmol/punch) and the indirect adherence measures. Youden's index and distance to corner were used to determine the optimal cutoff points for each indirect adherence measure. We calculated sensitivity, specificity, negative (NPV) and positive (PPV) predictive values for the found cutoff points. Finally, Delong test was used to compare AUCs.
From April, 2014 to July, 2016, 450 participants initiated PrEP, 375(83.3%) were retained through 48 weeks. Of these, 74% (277/375) had TFV-DP ≥700fmol/punch. All adherence measures discriminated between participants with and without protective drug levels (AUC>0.5). High indirect adherence measure was predictive of protective drug levels (PPV>0.8) while low indirect adherence measure was not predictive of lack of protective drug levels (NPV<0.5). No significant differences were found between the adherence methods (p = 0.44).
Low-burden measurements such as MPR and self-report can be used to predict PrEP adherence in a public health context in Brazil for MSM and TGW retained through 48 weeks. Clinical Trial Number: NCT01989611.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Introduction
We aimed to evaluate daily oral pre‐exposure prophylaxis (PrEP) uptake, retention, and adherence and predictors of study non‐attendance and low PrEP adherence in a Brazilian ...trans‐specific 48‐week study (PrEParadas).
Methods
We enrolled transgender women (TGW) engaging in high‐risk sexual behaviours between August 2017 and December 2018. PrEP adherence was based on tenofovir diphosphate concentrations in dried blood spots (DBS). We used random effects logistic regression models and ordinal models to estimate the odds of having a missed visit and of low PrEP adherence, respectively. Multivariable models were adjusted for variables with p‐value<0.10 in the univariate analysis.
Results
From the 271 eligible, 130 participants were enrolled in the study (PrEP uptake: 48%), out of which 111 (85.4%) were retained at 48 weeks. Multivariable model for study non‐attendance included study visit, age, main sexual partner and stimulant use. The odds of missing a visit increased after the week 24. Participants aged 18–24 (adjusted odds ratio aOR = 8.76, 95% CI: 2.09–36.7) and 25–34 years (aOR = 6.79, 95% CI: 1.72–26.8) compared to TGW aged 35+ years had significantly higher odds of having a missed visit. The odds of a missed visit were higher among participants reporting stimulant use (aOR = 4.99, 95% CI: 1.37–18.1) compared to no stimulant use. DBS levels at week 48 showed that 42 (38.5%), 14 (12.8%) and 53 (48.6%) of 109 participants had low, moderate and high PrEP adherence. Multivariable model for low PrEP adherence included study visit, age, schooling, race/colour, housing, binge drinking, stimulant use, feminizing hormone therapy (FHT) use and received text message. Low PrEP adherence was significantly higher among participants with less years of schooling (aOR = 6.71, 95% CI: 1.30–34.5) and had a borderline association with Black colour/race (aOR = 6.72, 95% CI: 0.94–47.8). Participants using the FHT available at the site had decreased odds of low PrEP adherence (aOR = 0.38, 95% CI: 0.16–0.88). No participant seroconverted over the course of the study.
Conclusions
Although high PrEP retention can be achieved in a gender‐affirming setting, PrEP adherence may be an important challenge faced among TGW due to social disparities. The scale‐up of prevention tools like PrEP will have to address systemic social determinants as these stand as important barriers for TGW's access to health services.
To evaluate outcomes of resident-performed cataract surgeries in different training levels in a retrospective case series.
A total of 730 surgeries performed by residents were evaluated into three ...groups: surgeries performed during residents' first semester of training in phacoemulsification (Level 1 - L1), surgeries performed during the second semester (Level 2 - L2), and surgeries performed during the third semester (Level 3 - L3). The primary outcome was the incidence of intraoperative complications in each group. Secondary outcomes were the comparisons between initial and final corrected distance visual acuity (CDVA), intraocular pressure (IOP), endothelial cell density (ECD), and central corneal thickness (CCT) in each group. Descriptive statistical analyses were employed in the presentation of the results using central tendency and variance measurements.
The rate of complications within six weeks of follow-up was 24 out of 102 eyes (23.53%) in the L1 group, 63 out of 301 eyes (20.93%) in the L2 group, and 37 out of 327 (11.31%) in the L3 group (
=0.001). Posterior capsule rupture (PCR) was the most frequent intercurrence observed in all three semesters: it occurred in 12.7% of the surgeries in the first semester (13/102), 16.9% of surgeries in the second semester (51/301), and 9.5% of surgeries in the third semester (31/327). There was no significant difference in CDVA (
=0.298), ECD (
=0.067), IOP (
=0.217), or CCT (
=0.807) between the groups.
When measured by rates of complications and by the aforementioned parameters, surgical competency was found to improve as surgical experience and frequency increased. Therefore, this study identified some patterns of skill development that can be applied to teaching strategies and better assist surgeons in training.
Introduction: We aimed to evaluate daily oral pre-exposure prophylaxis (PrEP) uptake, retention, and adherence and predictors of study non-attendance and low PrEP adherence in a Brazilian ...trans-specific 48-week study (PrEParadas). Methods: We enrolled transgender women (TGW) engaging in high-risk sexual behaviours between August 2017 and December 2018. PrEP adherence was based on tenofovir diphosphate concentrations in dried blood spots (DBS). We used random effects logistic regression models and ordinal models to estimate the odds of having a missed visit and of low PrEP adherence, respectively. Multivariable models were adjusted for variables with p-value<0.10 in the univariate analysis. Results: From the 271 eligible, 130 participants were enrolled in the study (PrEP uptake: 48%), out of which 111 (85.4%) were retained at 48 weeks. Multivariable model for study non-attendance included study visit, age, main sexual partner and stimulant use. The odds of missing a visit increased after the week 24. Participants aged 18-24 (adjusted odds ratio aOR = 8.76, 95% CI: 2.09-36.7) and 25-34 years (aOR = 6.79, 95% CI: 1.72-26.8) compared to TGW aged 35+ years had significantly higher odds of having a missed visit. The odds of a missed visit were higher among participants reporting stimulant use (aOR = 4.99, 95% CI: 1.37-18.1) compared to no stimulant use. DBS levels at week 48 showed that 42 (38.5%), 14 (12.8%) and 53 (48.6%) of 109 participants had low, moderate and high PrEP adherence. Multivariable model for low PrEP adherence included study visit, age, schooling, race/colour, housing, binge drinking, stimulant use, feminizing hormone therapy (FHT) use and received text message. Low PrEP adherence was significantly higher among participants with less years of schooling (aOR = 6.71, 95% CI: 1.30-34.5) and had a borderline association with Black colour/race (aOR = 6.72, 95% CI: 0.94-47.8). Participants using the FHT available at the site had decreased odds of low PrEP adherence (aOR = 0.38, 95% CI: 0.16-0.88). No participant seroconverted over the course of the study. Conclusions: Although high PrEP retention can be achieved in a gender-affirming setting, PrEP adherence may be an important challenge faced among TGW due to social disparities. The scale-up of prevention tools like PrEP will have to address systemic social determinants as these stand as important barriers for TGW's access to health services. Keywords: adherence; HIV; hormones; PrEP; prevention; transgender women
The current study estimated DALY (disability-adjusted life years), an indicator of burden of disease, for Brazil in 2008. The North and Northeast regions showed higher burden of disease. Chronic ...noncommunicable diseases predominated in all regions of the country, especially cardiovascular diseases, mental disorders (particularly depression), diabetes, and chronic obstructive pulmonary disease. The study also showed a high burden of homicides and traffic accidents. Brazil's epidemiological profile appears even more complex when one considers the non-negligible burden of communicable diseases, maternal and perinatal conditions, and nutritional deficiencies. The analyses allowed a more detailed understanding of the Brazilian's population's health status, underscoring the need for crosscutting actions beyond specific health sector policies and greater attention to the quality of information on morbidity and mortality.
Herbivorous arthropods can induce their host to form structures where they shelter during unfavourable periods. The boll weevil, Anthonomus grandis grandis Boheman (Coleoptera: Curculionidae), can ...spend the off‐season inside cotton plant structures, known as dry bolls, protected from pesticides, natural enemies and heat and desiccation on the soil surface, thereby increasing its survival and preserving its reproductive capacity. However, the relationship between the boll weevil and dry boll formation is not fully understood and requires further study. The formation and external and internal characteristics of dry bolls on cotton plants infested with different densities of boll weevils, and the emergence and survival of this insect from these structures, were evaluated. Compared with non‐infested control plants, plants infested with boll weevil formed almost twice as many dry bolls, which were 2.3 times heavier and with a diameter 1.7 times larger than those on non‐infested plants. Boll weevil infestation reduces the number of bolls and commercial mass of fibre + seeds, reducing productivity and increasing cotton harvest contaminants. However, dry bolls on non‐infested plants demonstrate that other factors are involved in their formation.
Battarrea stevenii (Libosch.) Fr. (Tulostomataceae), um raro fungo xerófilo: primeiro registro para o Brasil Silva, Bianca Denise Barbosa(Universidade Federal do Rio Grande do Norte CB Departamento de Botânica, Ecologia e Zoologia); Leite, Anileide Gomes(Universidade Federal do Rio Grande do Norte CB Departamento de Botânica, Ecologia e Zoologia); Baseia, Iuri Goulart(Universidade Federal do Rio Grande do Norte CB Departamento de Botânica, Ecologia e Zoologia)
Acta Botanica Brasílica/Acta Botânica Brasílica,
2007, Letnik:
21, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Battarrea stevenii, uma rara espécie ocorrente em regiões áridas, é descrita macro- e microscopicamente pela primeira vez para o Brasil e comparada com a espécie similar Battarrea phalloides.
...Battarrea stevenii, a rare species from xeric areas, is described macro- and microscopically for the first time from Brazil, and compared to the closest species, Battarrea phalloides.
ABSTRACT IN FRENCH: La prévalence de la contraception est relativement élevée parmi les femmes brésiliennes, la pilule étant la méthode réversible la plus populaire. Cependant, des disparités en ...matière d'événements reproductifs persistent selon la région de résidence et le groupe social. Cette étude analyse les facteurs associés avec l'interruption, l'échec et le changement de méthode contraceptive au Brésil, dans le but d'améliorer la base factuelle sur les dynamiques de la pratique contraceptive. Des modèles statistiques de mesure de risque concurrent multi-niveaux sont appliqués aux données provenant de l'Enquête démographique et de santé de 1996. Les résultats indiquent que les risques les plus faibles d'échec contraceptif et d'abandon de la contraception - c'est-à-dire le fait de ne plus recourir à aucune méthode -, sont associés à certaines caractéristiques dont on soupçonne fortement qu'elles sont reliées à une plus grande motivation pour la régulation de la fécondité. Ces caractéristiques sont, notamment, l'âge de la femme, son niveau d'études et son exposition aux médias. En outre, la probabilité de passer de la pilule au condom, d'un intérêt particulier dans cette ère du VIH/SIDA, augmente avec la scolarité. Élargir l'accès aux différentes méthodes contraceptives, améliorer la connaissance chez le personnel de la santé des technologies contraceptives et accroître la supervision médicale de la pratique contraceptive pourraient être considérés comme les clés de l'amélioration de la qualité des services de santé reproductive. // ABSTRACT IN ENGLISH: Contraceptive prevalence is relatively high among Brazilian women, with orals the most popular reversible method. However, important differentials persist across regions and social groups in reproductive outcomes. This study examined the factors associated with discontinuation, failure and switching of orals in Brazil, with the aim of increasing the evidence base on contraceptive use dynamics. Multilevel competing risks hazard models were applied to data from the 1996 Demographic and Health Survey. Results showed lower risks of contraceptive failure and of switching to no method associated with certain characteristics-notably woman's age, education and media exposure-presumably related to increased motivation for fertility control. The risk of switching from orals to condoms, of particular interest in the era of HIV/AIDS, increased with level of education. Expanding access to a range of contraceptive methods, improving knowledge among health agents of contraceptive technologies and increasing medical supervision of contraceptive practice may be considered key to expanding quality reproductive health care services for all.
Résumé
La prévalence de la contraception est relativement élevée parmi les femmes brésiliennes, la pilule étant la méthode réversible la plus populaire. Cependant, des disparités en matière ...d’événements reproductifs persistent selon la région de résidence et le groupe social. Cette étude analyse les facteurs associés avec l’interruption, l’échec et le changement de méthode contraceptive au Brésil, dans le but d’améliorer la base factuelle sur les dynamiques de la pratique contraceptive. Des modèles statistiques de mesure de risque concurrent multi-niveaux sont appliqués aux données provenant de l’Enquête démographique et de santé de 1996. Les résultats indiquent que les risques les plus faibles d’échec contraceptif et d’abandon de la contraception – c’est-à-dire le fait de ne plus recourir à aucune méthode –, sont associés à certaines caractéristiques dont on soupçonne fortement qu’elles sont reliées à une plus grande motivation pour la régulation de la fécondité. Ces caractéristiques sont, notamment, l’âge de la femme, son niveau d’études et son exposition aux médias. En outre, la probabilité de passer de la pilule au condom, d’un intérêt particulier dans cette ère du VIH/SIDA, augmente avec la scolarité. Élargir l’accès aux différentes méthodes contraceptives, améliorer la connaissance chez le personnel de la santé des technologies contraceptives et accroître la supervision médicale de la pratique contraceptive pourraient être considérés comme les clés de l’amélioration de la qualité des services de santé reproductive.
É descrito o processo de desenvolvimento do sistema de classificação de pacientes internados em hospitais que atendem casos agudos, denominada Diagnosis Relatd Group - DRGs, desenvolvido e difundido ...por pesquisadores da Universidade de Yale, USA. Esse sistema vem a ser um instrumento que permite a mensuração do produto hospitalar, principalmente sob o ponto de vista gerencial. São apresentadas considerações acerca do que é entendido como produto hospitalar, seguindo nos meandros do desenvolvimento dos primeiros DRGs, até a mais recente revisão do sistema. É descrita sua utilização em alguns países e diversos usos potenciais desse sistema, que abrangem desde o uso para pagamento a instrumento de controle de qualidade.
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