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LIM/38 - Laboratório de Epidemiologia e Imunobiologia, Hospital das Clínicas, Faculdade de Medicina - Líder
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- Recent changes in trends of mortality from cervical cancer in Southeastern Brazil(2023) LUIZAGA, Carolina Terra de Moraes; JARDIM, Beatriz Cordeiro; WUENSCH-FILHO, Victor; ELUF-NETO, Jose; SILVA, Gulnar Azevedo eOBJECTIVE: To analyze the trends of cervical cancer mortality in Brazilian Southeastern states, and to compare them to Brazil and other regions between 1980 and 2020. METHODS: Time series study based on data from the Sistema de Informacoes de Mortalidade (Brazilian Mortality Information System). Death data were corrected by proportional redistribution of deaths from ill-defined causes and cervical cancer of unspecified portion. Age-standardized and age-specific rates were calculated by screening target (25-39 years; 40-64 years) and non-target (65 years or older) age groups. Annual percentage changes (APC) were estimated by linear regression model with breakpoints. The coverage of Pap Smear exam in the Unified Health System (SUS) was evaluated between 2009 and 2020 according to age group and locality. RESULTS: There were increases in corrected mortality rates both in 1980 and in 2020 in all regions, with most evident increments at the beginning of the series. There was a decrease in mortality nationwide between 1980-2020; however, the state of Sao Paulo showed a discrete upward trend in 2014-2020 (APC=1.237; 95%CI 0.046-2.443). Noteworthy is the trend increment in the 25-39 year-old group in all study localities, being sharper in the Southeast region in 2013-2020 (APC=5.072; 95%CI 3.971-6.185). Screening coverage rates were highest in Sao Paulo and lowest in Rio de Janeiro, with a consistent decline from 2012 onwards at all ages. CONCLUSIONS: Sao Paulo is the first Brazilian state to show a reversal trend in mortality coverage, quality, and adequate follow-up of all women with altered test results.
- Telehealth effectiveness for pre-exposure prophylaxis delivery in Brazilian public services: the Combine! Study(2023) GRANGEIRO, Alexandre; SANTOS, Lorruan Alves do; ESTEVAM, Denize Lotufo; MUNHOZ, Rosemeire; ARRUDA, Erico; MORAES, Renata Amaral de; WINKLER, Lisiane de Quadros; NEVES, Lis Aparecida de Souza; SANTOS, Juliane Cardoso Villela; KRUPPA, Mariele; ZUCCHI, Eliana Miura; ESCUDER, Maria Mercedes; LEAL, Andrea Fachel; KOYAMA, Mitti Ayako Hara; PERES, Maria Fernanda Tourinho; COUTO, Marcia Thereza; NETO, Jose Eluf; Combine Res GrpIntroductionPre-exposure prophylaxis (PrEP) delivery based on user needs can enhance PrEP access and impact. We examined whether telehealth for daily oral PrEP delivery could change the indicators of care related to prophylactic use in five Brazilian public HIV clinics (testing centres, outpatient clinics and infectious disease hospitals).MethodsBetween July 2019 and December 2020, clients on PrEP for at least 6 months could transition to telehealth or stay with in-person follow-up. Clients were clinically monitored until June 2021. A desktop or mobile application was developed, comprising three asynchronous consultations and one annual in-person consultation visit. Predictors influencing telehealth preference and care outcomes were examined. The analysis encompassed intent-to-treat (first choice) and adjustments for sexual practices, schooling, age, duration of PrEP use and PrEP status during the choice period.ResultsOf 470 users, 52% chose telehealth, with the adjusted odds ratio (aOR) increasing over time for PrEP use (aOR for 25-months of use: 4.90; 95% CI: 1.32-18.25), having discontinued PrEP at the time of the choice (aOR: 2.91; 95% CI: 1.40-6.06) and having health insurance (aOR: 1.91; 95% CI: 1.24-2.94) and decreasing for those who reported higher-risk behaviour (aOR for unprotected anal sex: 0.51; 95% CI: 0.29-0.88). After an average follow-up period of 1.6 years (95% CI: 1.5-1.7), the risk of discontinuing PrEP (not having the medication for more than 90 days) was 34% lower with telehealth (adjusted hazard ratio: 0.66; 95% CI: 0.45-0.97). When adjusted by mixed linear regression, no differences in adherence (measured by mean medication possession rate) were found between in-person and telehealth (p = 0.486) or at pre- and post-telehealth follow-ups (p = 0.245). Sexually transmitted infections increased between the pre-follow-up and post-follow-up choices and were not associated with in-person or telehealth (p = 0.528). No HIV infections were observed.ConclusionsOur findings indicate that telehealth for PrEP delivery can enhance service rationalization and reinforce the prevention cascade. This approach reduces prophylaxis interruptions and is mainly preferred by individuals with lower demands for healthcare services.
- Implementation of an organized colorectal cancer screening program through quantitative fecal immunochemical test followed by colonoscopy in an urban low-income community: Guidance and strategies(2023) JR, Ulysses Ribeiro; SAFATLE-RIBEIRO, Adriana Vaz; SORBELLO, Mauricio; KISHI, Poliana Helena Rosolem; COHEND, Diane Dede; MATTAR, Rejane; CASTILHO, Vera Lucia Pagliusi; GONCALVES, Elenice Messias Do Nascimento; KAWAGUTI, Fabio; MARQUES, Carlos Frederico Sparapan; ALVES, Venancio Avancini Ferreira; NAHAS, Sergio Carlos; ELUF-NETO, JoseFecal Immunochemical Test (FIT) followed by a colonoscopy is an efficacious strategy to improve the adenoma detection rate and Colorectal Cancer (CRC). There is no organized national screening program for CRC in Brazil. The aim of this research was to describe the implementation of an organized screening program for CRC through FIT followed by colonoscopy, in an urban low-income community of S (a) over tildeo Paulo city. The endpoints of the study were: FIT participation rate, FIT positivity rate, colonoscopy compliance rate, Positive Predictive Values (PPV) for adenoma and CRC, and the rate of complications. From May 2016 to October 2019, asymptomatic individuals, 50-75 years old, received a free kit to perform the FIT. Positive FIT (>= 50 ng/mL) individuals were referred to colonoscopy. 10,057 individuals resumed the stool sample for analysis, of which (98.2%) 9,881 were valid. Women represented 64.8% of the participants. 55.3% of individuals did not complete elementary school. Positive FIT was 7.8% (776/9881). The colonoscopy compliance rate was 68.9% (535/776). There were no major colonoscopy complications. Adenoma were detected in 63.2% (332/525) of individuals. Advanced adenomatous lesions were found in 31.4% (165/525). CRC was diagnosed in 5.9% (31/525), characterized as adenocarcinoma: in situ in 3.2% (1/31), intramucosal in 29% (9/31), and invasive in 67.7% (21/31). Endoscopic treatment with curative intent for CRC was performed in 45.2% (14/31) of the cases. Therefore, in an urban low-income community, an organized CRC screening using FIT followed by colonoscopy ensued a high participation rate, and high predictive positive value for both, adenoma and CRC.