MARIA FERNANDA TOURINHO PERES
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Medicina Preventiva, Faculdade de Medicina - Docente
LIM/39 - Laboratório de Processamento de Dados Biomédicos, Hospital das Clínicas, Faculdade de Medicina
LIM/39 - Laboratório de Processamento de Dados Biomédicos, Hospital das Clínicas, Faculdade de Medicina
4 resultados
Resultados de Busca
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- 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.
- Pre-exposure and postexposure prophylaxes and the combination HIV prevention methods (The Combine! Study): protocol for a pragmatic clinical trial at public healthcare clinics in Brazil(2015) GRANGEIRO, Alexandre; COUTO, Marcia Thereza; PERES, Maria Fernanda; LUIZ, Olinda; ZUCCHI, Eliana Miura; CASTILHO, Euclides Ayres de; ESTEVAM, Denize Lotufo; ALENCAR, Rosa; WOLFFENBUETTEL, Karina; ESCUDER, Maria Mercedes; CALAZANS, Gabriela; FERRAZ, Dulce; ARRUDA, Erico; CORREA, Maria da Gloria; AMARAL, Fabiana Rezende; SANTOS, Juliane Cardoso Villela; ALVAREZ, Vivian Salles; KIETZMANN, TiagoIntroduction: Few results from programmes based on combination prevention methods are available. We propose to analyse the degree of protection provided by postexposure prophylaxis (PEP) for consensual sexual activity at healthcare clinics, its compensatory effects on sexual behaviour; and the effectiveness of combination prevention methods and pre-exposure prophylaxis (PrEP), compared with exclusively using traditional methods. Methods and analysis: A total of 3200 individuals aged 16 years or older presenting for PEP at 5 sexually transmitted disease (STD)/HIV clinics in 3 regions of Brazil will be allocated to one of two groups: the PEP group-individuals who come to the clinic within 72 h after a sexual exposure and start PEP; and the non-PEP group-individuals who come after 72 h but within 30 days of exposure and do not start PEP. Clinical follow-up will be conducted initially for 6 months and comprise educational interventions based on information and counselling for using prevention methods, including PrEP. In the second study phase, individuals who remain HIV negative will be regrouped according to the reported use of prevention methods and observed for 18 months: only traditional methods; combined methods; and PrEP. Effectiveness will be analysed according to the incidence of HIV, syphilis and hepatitis B and C and protected sexual behaviour. A structured questionnaire will be administered to participants at baseline and every 6 months thereafter. Qualitative methods will be employed to provide a comprehensive understanding of PEP-seeking behaviour, preventive choices and exposure to HIV. Ethics and dissemination: This study will be conducted in accordance with the resolution of the School of Medicine Research Ethics Commission of Universidade de Sao Paulo (protocol no. 251/14). The databases will be available for specific studies, after management committee approval. Findings will be presented to researchers, health managers and civil society members by means of newspapers, electronic media and scientific journals and meetings.
- Violence, discrimination, and sexual health practices among adolescent men who have sex with men, transgender women and travestis in three cities in Brazil(2023) RYNGELBLUM, Marcelo; GRANGEIRO, Alexandre; ZUCCHI, Eliana Miura; COUTO, Marcia Thereza; DOURADO, Ines; MAGNO, Laio; TUPINAMBAS, Unai; PERES, Maria Fernanda TourinhoThe HIV epidemic has a disproportionate impact on adolescent and young men who have sex with men (AMSM) and transgender women and travestis (ATGW), with an increased HIV prevalence over the last 10 years. Violence affects the lives of these populations, undermining their ability to self-care and making them more vulnerable to HIV infection. In this study, we aimed to examine the association between different types of victimization by violence and discrimination and sexual health practices of these adolescent populations in steady and casual relationships. We conducted a cross-sectional study using baseline data from the cohort of PrEP1519 project. We used the mean score of sexual health practices as our outcome and the cumulative score of discrimi-nati on (within family, community, education, religious, online and public spaces) and violence (physical, sexual and intimate partner) as our exposure variable. We performed linear regression analyses to estimate the association between exposure and outcome. We found that 90% of AMSM and 95% of ATGW experienced at least one form of violence in the three months prior to this study and about 45% of ATGW suffered sexual violence during the same period. Experiencing discrimination within healthcare settings (from facilities or providers) was negatively associated with sexual health practices. Discrimi-nation and violence negatively affect sexual health practices. HIV prevention and care of AMSM and ATGW people should involve listening to their experi-ences and addressing discrimination and violence in this population.
- Intersectional insights into racism and health: not just a question of identity(2022) SHANNON, Geordan; MORGAN, Rosemary; ZEINALI, Zahra; BRADY, Leanne; COUTO, Marcia Thereza; DEVAKUMAR, Delon; EDER, Ben; KARADAG, Ozge; MUKHERJEE, Maki; PERES, Maria Fernando Tourinho; RYNGELBLUM, Marcelo; SABHARWAL, Nidhi; SCHONFIELD, Amos; SILWANE, Pamela; SINGH, David; RYNEVELD, Manya Van; VILAKATI, Siyasanga; WATEGO, Chelsea; WHYLE, Eleanor; MURAYA, KuiIntersectionality is a useful tool to address health inequalities, by helping us understand and respond to the individual and group effects of converging systems of power. Intersectionality rejects the notion of inequalities being the result of single, distinct factors, and instead focuses on the relationships between overlapping processes that create inequities. In this Series paper, we use an intersectional approach to highlight the intersections of racism, xenophobia, and discrimination with other systems of oppression, how this affects health, and what can be done about it. We present five case studies from different global locations that outline different dimensions of discrimination based on caste, ethnicity and migration status, Indigeneity, religion, and skin colour. Although experiences are diverse, the case studies show commonalities in how discrimination operates to affect health and wellbeing: how historical factors and coloniality shape contemporary experiences of race and racism; how racism leads to separation and hierarchies across shifting lines of identity and privilege; how racism and discrimination are institutionalised at a systems level and are embedded in laws, regulations, practices, and health systems; how discrimination, minoritisation, and exclusion are racialised processes, influenced by visible factors and tacit knowledge; and how racism is a form of structural violence. These insights allow us to begin to articulate starting points for justice-based action that addresses root causes, engages beyond the health sector, and encourages transnational solidarity.