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Introduction: The Study Describes The Epidemiological Scenario Of Hiv And Syphilis In The Biggest... more Introduction: The Study Describes The Epidemiological Scenario Of Hiv And Syphilis In The Biggest Reference Center For Drug Addiction In Brazil. This Country Is The Number One Country For Violence, Torture And Death Of Transgender People. Crack Cocaine Addiction Is Frequent And Contributes To The Extreme Social Vulnerability And Exposure To Sexual And Violence-Related Risks. Methods: We Hereby Present Our Findings From A Cross-Sectional Study Focused On The Social Vulnerability And Sexually Transmissible Infections Amongst Transgender Crack Cocaine Users. Results: In Our Sample Hiv Prevalence Was Higher (P<.0001) In The Transgender Group (10%) Than In Non-Transgender Women And Men (6% And 3% Respectively). Hiv And Syphilis Rates Of 5.86% And 21.9%, Respectively, Were Noted. Women Were Nearly 2.5 Times More Likely To Have Syphilis (Or: 2.44, P = 0.001, 95%Ci: 1.67"3.65). Hiv Infection Was Associated With Unprotected Sex (61.4%, Or: 3.27, P = 0.003 95%Ci: 1.51"7.11) And Suicidal Ideation (33.6%, Or: 6.63, P = 0Introdução: O Estudo Descreve O Cenário Epidemiológico Do Hiv E Sífilis No Maior Centro De Referência Para Toxicodependência No Brasil. Este País É O País Número Um Da Violência, Tortura E Morte De Pessoas Transexuais. O Vício Em Cocaína É Freqüente E Contribui Para A Extrema Vulnerabilidade Social E A Exposição A Riscos Sexuais E Relacionados À Violência. Métodos: Apresentamos Nossos Resultados De Um Estudo Transversal Focado Na Vulnerabilidade Social E Nas Infecções Sexualmente Transmissíveis Entre Usuários De Cocaína De Cracking Transgênero. Resultados: Em Nossa Amostra, A Prevalência Do Hiv Foi Maior (P <.0001) No Grupo Transgênero (10%) Do Que Nas Mulheres E Homens Não Transgêneros (6% E 3%, Respectivamente). As Taxas De Hiv E Sífilis De 5,86% E 21,9%, Respectivamente, Foram Observadas. As Mulheres Tinham Quase 2,5 Vezes Mais Probabilidades De Ter Sífilis (Or: 2,44, P = 0,001, Ic 95%: 1,67-3,65). A Infecção Pelo Hiv Foi Associada Ao Sexo Desprotegido (61,4%, Or: 3,27, P = 0,003 Ic 95%: 1,51-7,11) E IdeaçDados abertos - Sucupira - Teses e dissertações (2018
Health Education & Behavior, Feb 6, 2023
Drug misuse among people living with HIV (human immunodeficiency virus) is associated with higher... more Drug misuse among people living with HIV (human immunodeficiency virus) is associated with higher mortality. It is a frequently observed reason for treatment abandonment, with people who misuse drugs showing a 10 to 25 times higher risk of HIV than the general population. The authors conducted a systematic review and meta-analysis to assess the efficacy of contingency management (CM) to improve adherence to antiretroviral therapy in people living with HIV and substance use disorder (SUD). The inclusion criteria consisted of studies written in English, Italian, Spanish, German, and French; studies conducted with humans; and clinical trials that combined SUD treatment with CM for people living with HIV. Two hundred twenty-two articles were identified, five met all inclusion criteria, and three provided enough data to perform the meta-analysis. We considered treatment adherence by measuring the increase in the CD4 count as our primary outcome. We found a significant increase in treatment adherence in the patient group compared with the control groups during the intervention phase. Positive findings did not persist after the cessation of the incentives. The meta-analysis showed that the intervention improved patient adherence by 2.69 (95% confidence interval: [0.08, 0.51]; p = .007) compared with the control group during the intervention period. All short-term CM studies converged on a positive result for adherence to antiretroviral therapy.
Saúde e Sociedade
Resumo Esta revisão integrativa teve por objetivo identificar quais aspectos de saúde mental dos ... more Resumo Esta revisão integrativa teve por objetivo identificar quais aspectos de saúde mental dos policiais têm sido mais investigados na literatura, considerando o período de 2012 a 2018. Foram realizadas buscas nas bases de dados PubMed, LILACS, SciELO e PePSIC. Foram analisados 84 artigos, quanto a 4 categorias: características dos estudos; saúde mental dos policiais; fatores de risco para problemas mentais; e fatores protetivos e para desenvolvimento da saúde. A análise dos artigos mostrou que Estados Unidos e Brasil produziram mais sobre o tema e que depressão, estresse e transtornos de ansiedade foram as patologias mais frequentes nos artigos analisados. Fatores individuais e do trabalho associaram-se ao adoecimento e fatores protetivos e intervenções foram pouco investigados. Estudos futuros poderão abordar essas lacunas.
Health Education & Behavior
Drug misuse among people living with HIV (human immunodeficiency virus) is associated with higher... more Drug misuse among people living with HIV (human immunodeficiency virus) is associated with higher mortality. It is a frequently observed reason for treatment abandonment, with people who misuse drugs showing a 10 to 25 times higher risk of HIV than the general population. The authors conducted a systematic review and meta-analysis to assess the efficacy of contingency management (CM) to improve adherence to antiretroviral therapy in people living with HIV and substance use disorder (SUD). The inclusion criteria consisted of studies written in English, Italian, Spanish, German, and French; studies conducted with humans; and clinical trials that combined SUD treatment with CM for people living with HIV. Two hundred twenty-two articles were identified, five met all inclusion criteria, and three provided enough data to perform the meta-analysis. We considered treatment adherence by measuring the increase in the CD4 count as our primary outcome. We found a significant increase in treatme...
Health Education & Behavior
Introduction Overcoming misinformation is essential considering stigma and discrimination in the ... more Introduction Overcoming misinformation is essential considering stigma and discrimination in the HIV/AIDS epidemic. This report presents the preliminary results of a health education strategy based on the massive open online course (MOOC) on Zero Discrimination in Brazil. Methods Case study describing the development of the MOOC and its validation using the Delphi technique. Pre- and posttests were administered. People who enrolled from October 2021 to March 2022 were included in the study. Results and discussion MOOC was made available free of charge for mobile phones, tablets, and desktops and included a 90-hr study certificate. Over 6 months, there were n = 665 people enrolled from different regions, mainly from the health field or working in the public health system. The completion rate of people included in the study (26.62%; n = 177) was above the average for other MOOCs. Conclusions Initial results are promising but demand more extensive monitoring.
Archives of Sexual Behavior
Drug and Alcohol Dependence, 2017
Experimental and clinical psychopharmacology, Dec 1, 2017
Although contingency management (CM) is effective in promoting abstinence and treatment retention... more Although contingency management (CM) is effective in promoting abstinence and treatment retention among crack cocaine users who meet the criteria for cocaine dependence, less is known about its off-target effects. In this secondary analysis, we evaluated the impact of CM on depressive and anxiety symptoms in a sample of cocaine-dependent individuals under treatment. Sixty-five crack cocaine users who met the criteria for cocaine dependence were randomly assigned to receive 12 weeks of standard treatment alone (STA; n = 32) or 12 weeks of standard treatment plus CM (STCM; n = 33). The outcome measures of the secondary analysis were depressive and anxiety symptoms assessed with the Beck Depression Inventory-II (BDI-II) and the Beck Anxiety Inventory (BAI). At baseline, 59 (90.8%) of the participants reported at least mild depressive symptoms and 47 (72.5%) reported at least mild anxiety symptoms. The mean BDI-II (24.5 ± 12.1) and BAI (20.7 ± 13.5) scores in the sample as a whole was m...
Trends in Psychiatry and Psychotherapy
Introduction: This study describes the epidemiological scenario of human immunodeficiency virus (... more Introduction: This study describes the epidemiological scenario of human immunodeficiency virus (HIV) and syphilis at the biggest specialist drug addiction center in Brazil. The great challenge is to find strategies to reduce the impact of inequality and discrimination and develop policies to protect individuals living with-or at risk of-infections. Methods: During the period from January 1 to May 31, 2016, a cross-sectional study was conducted on which all patients (N = 806) seeking inpatient treatment were enrolled. A structured diagnostic interview and rapid tests were conducted initially, and diagnoses were confirmed by tests conducted at a venereal disease research laboratory (VDRL). Results: HIV and syphilis rates were 5.86% and 21.9%, respectively. Women were nearly 2.5 times more likely to have syphilis. HIV infection was associated with unprotected sex (odds ratio [OR]: 3.27, p = 0.003, 95% confidence interval [95%CI]: 1.51-7.11), and suicidal ideation (OR: 6.63, p = 0.001, 95%CI: 3.37-14.0). Although only 1.86% reported injecting drugs at any point during their lifetimes, this variable was associated with both HIV and syphilis. Elevated rates of HIV and syphilis were observed in the context of this severe social vulnerability scenario. Conclusion: The risk factors identified as associated with HIV and syphilis should be taken into consideration for implementation of specific prevention strategies including early diagnosis and treatment of sexually transmitted infections (STI) to tackle the rapid spread of STIs in this population.
Addictive Disorders & Their Treatment
Trends in Psychiatry and Psychotherapy
Introduction Brazil is the world’s biggest consumer of crack cocaine, and dependence is a major p... more Introduction Brazil is the world’s biggest consumer of crack cocaine, and dependence is a major public health issue. This is the first study to investigate the prevalence of potentially harmful adulterants present in hair samples from Brazilian patients with crack cocaine dependence. Method We evaluated adulterants in hair samples extracted by convenience from 100 patients admitted at the 48 hour-observation unit of Centro de Referência de Álcool, Tabaco e Outras Drogas (CRATOD), Brazil’s largest center for addiction treatment. A cross-sectional analysis was performed with the data obtained. Results Adulterants were found in 97% of the analyzed hair samples. The most prevalent adulterant was lidocaine (92%), followed by phenacetin (69%) and levamisole (31%). Conclusion Adulterants were widely prevalent in hair samples from crack users treated at CRATOD: at least one adulterant was present in virtually all the hair samples collected. This points to a need to monitor adverse effects i...
Trends in psychiatry and psychotherapy
The recovery housing (RH) program was initiated in São Paulo with the objective of providing trea... more The recovery housing (RH) program was initiated in São Paulo with the objective of providing treatment for substance use disorders and addressing users' housing and employment problems. The purpose of this study was to describe the model based on its first 11 months of operation, it was launched in June 2016 in Brazil. We carried out a retrospective analysis of the records of all subjects treated in the RH of the Restart Program (Programa Recomeço) since its creation, from June 2016 to May 2017. Sixty-nine subjects were included. Thirty-five (51%) remained in the household until the end of treatment or were reinserted in society. Thirty-four (49%) presented recurrence during their stay, of which 16 (47%) volunteered for treatment in a therapeutic community or psychiatric hospital, 8 (23.5%) chose to continue with outpatient treatment only, 6 (17.7%) returned to their families and continued to receive outpatient treatment, and 4 (11.8%) discontinued the treatment. Of the 35 subje...
Introduction: The Study Describes The Epidemiological Scenario Of Hiv And Syphilis In The Biggest... more Introduction: The Study Describes The Epidemiological Scenario Of Hiv And Syphilis In The Biggest Reference Center For Drug Addiction In Brazil. This Country Is The Number One Country For Violence, Torture And Death Of Transgender People. Crack Cocaine Addiction Is Frequent And Contributes To The Extreme Social Vulnerability And Exposure To Sexual And Violence-Related Risks. Methods: We Hereby Present Our Findings From A Cross-Sectional Study Focused On The Social Vulnerability And Sexually Transmissible Infections Amongst Transgender Crack Cocaine Users. Results: In Our Sample Hiv Prevalence Was Higher (P<.0001) In The Transgender Group (10%) Than In Non-Transgender Women And Men (6% And 3% Respectively). Hiv And Syphilis Rates Of 5.86% And 21.9%, Respectively, Were Noted. Women Were Nearly 2.5 Times More Likely To Have Syphilis (Or: 2.44, P = 0.001, 95%Ci: 1.67"3.65). Hiv Infection Was Associated With Unprotected Sex (61.4%, Or: 3.27, P = 0.003 95%Ci: 1.51"7.11) And Suicidal Ideation (33.6%, Or: 6.63, P = 0Introdução: O Estudo Descreve O Cenário Epidemiológico Do Hiv E Sífilis No Maior Centro De Referência Para Toxicodependência No Brasil. Este País É O País Número Um Da Violência, Tortura E Morte De Pessoas Transexuais. O Vício Em Cocaína É Freqüente E Contribui Para A Extrema Vulnerabilidade Social E A Exposição A Riscos Sexuais E Relacionados À Violência. Métodos: Apresentamos Nossos Resultados De Um Estudo Transversal Focado Na Vulnerabilidade Social E Nas Infecções Sexualmente Transmissíveis Entre Usuários De Cocaína De Cracking Transgênero. Resultados: Em Nossa Amostra, A Prevalência Do Hiv Foi Maior (P <.0001) No Grupo Transgênero (10%) Do Que Nas Mulheres E Homens Não Transgêneros (6% E 3%, Respectivamente). As Taxas De Hiv E Sífilis De 5,86% E 21,9%, Respectivamente, Foram Observadas. As Mulheres Tinham Quase 2,5 Vezes Mais Probabilidades De Ter Sífilis (Or: 2,44, P = 0,001, Ic 95%: 1,67-3,65). A Infecção Pelo Hiv Foi Associada Ao Sexo Desprotegido (61,4%, Or: 3,27, P = 0,003 Ic 95%: 1,51-7,11) E IdeaçDados abertos - Sucupira - Teses e dissertações (2018
Health Education & Behavior, Feb 6, 2023
Drug misuse among people living with HIV (human immunodeficiency virus) is associated with higher... more Drug misuse among people living with HIV (human immunodeficiency virus) is associated with higher mortality. It is a frequently observed reason for treatment abandonment, with people who misuse drugs showing a 10 to 25 times higher risk of HIV than the general population. The authors conducted a systematic review and meta-analysis to assess the efficacy of contingency management (CM) to improve adherence to antiretroviral therapy in people living with HIV and substance use disorder (SUD). The inclusion criteria consisted of studies written in English, Italian, Spanish, German, and French; studies conducted with humans; and clinical trials that combined SUD treatment with CM for people living with HIV. Two hundred twenty-two articles were identified, five met all inclusion criteria, and three provided enough data to perform the meta-analysis. We considered treatment adherence by measuring the increase in the CD4 count as our primary outcome. We found a significant increase in treatment adherence in the patient group compared with the control groups during the intervention phase. Positive findings did not persist after the cessation of the incentives. The meta-analysis showed that the intervention improved patient adherence by 2.69 (95% confidence interval: [0.08, 0.51]; p = .007) compared with the control group during the intervention period. All short-term CM studies converged on a positive result for adherence to antiretroviral therapy.
Saúde e Sociedade
Resumo Esta revisão integrativa teve por objetivo identificar quais aspectos de saúde mental dos ... more Resumo Esta revisão integrativa teve por objetivo identificar quais aspectos de saúde mental dos policiais têm sido mais investigados na literatura, considerando o período de 2012 a 2018. Foram realizadas buscas nas bases de dados PubMed, LILACS, SciELO e PePSIC. Foram analisados 84 artigos, quanto a 4 categorias: características dos estudos; saúde mental dos policiais; fatores de risco para problemas mentais; e fatores protetivos e para desenvolvimento da saúde. A análise dos artigos mostrou que Estados Unidos e Brasil produziram mais sobre o tema e que depressão, estresse e transtornos de ansiedade foram as patologias mais frequentes nos artigos analisados. Fatores individuais e do trabalho associaram-se ao adoecimento e fatores protetivos e intervenções foram pouco investigados. Estudos futuros poderão abordar essas lacunas.
Health Education & Behavior
Drug misuse among people living with HIV (human immunodeficiency virus) is associated with higher... more Drug misuse among people living with HIV (human immunodeficiency virus) is associated with higher mortality. It is a frequently observed reason for treatment abandonment, with people who misuse drugs showing a 10 to 25 times higher risk of HIV than the general population. The authors conducted a systematic review and meta-analysis to assess the efficacy of contingency management (CM) to improve adherence to antiretroviral therapy in people living with HIV and substance use disorder (SUD). The inclusion criteria consisted of studies written in English, Italian, Spanish, German, and French; studies conducted with humans; and clinical trials that combined SUD treatment with CM for people living with HIV. Two hundred twenty-two articles were identified, five met all inclusion criteria, and three provided enough data to perform the meta-analysis. We considered treatment adherence by measuring the increase in the CD4 count as our primary outcome. We found a significant increase in treatme...
Health Education & Behavior
Introduction Overcoming misinformation is essential considering stigma and discrimination in the ... more Introduction Overcoming misinformation is essential considering stigma and discrimination in the HIV/AIDS epidemic. This report presents the preliminary results of a health education strategy based on the massive open online course (MOOC) on Zero Discrimination in Brazil. Methods Case study describing the development of the MOOC and its validation using the Delphi technique. Pre- and posttests were administered. People who enrolled from October 2021 to March 2022 were included in the study. Results and discussion MOOC was made available free of charge for mobile phones, tablets, and desktops and included a 90-hr study certificate. Over 6 months, there were n = 665 people enrolled from different regions, mainly from the health field or working in the public health system. The completion rate of people included in the study (26.62%; n = 177) was above the average for other MOOCs. Conclusions Initial results are promising but demand more extensive monitoring.
Archives of Sexual Behavior
Drug and Alcohol Dependence, 2017
Experimental and clinical psychopharmacology, Dec 1, 2017
Although contingency management (CM) is effective in promoting abstinence and treatment retention... more Although contingency management (CM) is effective in promoting abstinence and treatment retention among crack cocaine users who meet the criteria for cocaine dependence, less is known about its off-target effects. In this secondary analysis, we evaluated the impact of CM on depressive and anxiety symptoms in a sample of cocaine-dependent individuals under treatment. Sixty-five crack cocaine users who met the criteria for cocaine dependence were randomly assigned to receive 12 weeks of standard treatment alone (STA; n = 32) or 12 weeks of standard treatment plus CM (STCM; n = 33). The outcome measures of the secondary analysis were depressive and anxiety symptoms assessed with the Beck Depression Inventory-II (BDI-II) and the Beck Anxiety Inventory (BAI). At baseline, 59 (90.8%) of the participants reported at least mild depressive symptoms and 47 (72.5%) reported at least mild anxiety symptoms. The mean BDI-II (24.5 ± 12.1) and BAI (20.7 ± 13.5) scores in the sample as a whole was m...
Trends in Psychiatry and Psychotherapy
Introduction: This study describes the epidemiological scenario of human immunodeficiency virus (... more Introduction: This study describes the epidemiological scenario of human immunodeficiency virus (HIV) and syphilis at the biggest specialist drug addiction center in Brazil. The great challenge is to find strategies to reduce the impact of inequality and discrimination and develop policies to protect individuals living with-or at risk of-infections. Methods: During the period from January 1 to May 31, 2016, a cross-sectional study was conducted on which all patients (N = 806) seeking inpatient treatment were enrolled. A structured diagnostic interview and rapid tests were conducted initially, and diagnoses were confirmed by tests conducted at a venereal disease research laboratory (VDRL). Results: HIV and syphilis rates were 5.86% and 21.9%, respectively. Women were nearly 2.5 times more likely to have syphilis. HIV infection was associated with unprotected sex (odds ratio [OR]: 3.27, p = 0.003, 95% confidence interval [95%CI]: 1.51-7.11), and suicidal ideation (OR: 6.63, p = 0.001, 95%CI: 3.37-14.0). Although only 1.86% reported injecting drugs at any point during their lifetimes, this variable was associated with both HIV and syphilis. Elevated rates of HIV and syphilis were observed in the context of this severe social vulnerability scenario. Conclusion: The risk factors identified as associated with HIV and syphilis should be taken into consideration for implementation of specific prevention strategies including early diagnosis and treatment of sexually transmitted infections (STI) to tackle the rapid spread of STIs in this population.
Addictive Disorders & Their Treatment
Trends in Psychiatry and Psychotherapy
Introduction Brazil is the world’s biggest consumer of crack cocaine, and dependence is a major p... more Introduction Brazil is the world’s biggest consumer of crack cocaine, and dependence is a major public health issue. This is the first study to investigate the prevalence of potentially harmful adulterants present in hair samples from Brazilian patients with crack cocaine dependence. Method We evaluated adulterants in hair samples extracted by convenience from 100 patients admitted at the 48 hour-observation unit of Centro de Referência de Álcool, Tabaco e Outras Drogas (CRATOD), Brazil’s largest center for addiction treatment. A cross-sectional analysis was performed with the data obtained. Results Adulterants were found in 97% of the analyzed hair samples. The most prevalent adulterant was lidocaine (92%), followed by phenacetin (69%) and levamisole (31%). Conclusion Adulterants were widely prevalent in hair samples from crack users treated at CRATOD: at least one adulterant was present in virtually all the hair samples collected. This points to a need to monitor adverse effects i...
Trends in psychiatry and psychotherapy
The recovery housing (RH) program was initiated in São Paulo with the objective of providing trea... more The recovery housing (RH) program was initiated in São Paulo with the objective of providing treatment for substance use disorders and addressing users' housing and employment problems. The purpose of this study was to describe the model based on its first 11 months of operation, it was launched in June 2016 in Brazil. We carried out a retrospective analysis of the records of all subjects treated in the RH of the Restart Program (Programa Recomeço) since its creation, from June 2016 to May 2017. Sixty-nine subjects were included. Thirty-five (51%) remained in the household until the end of treatment or were reinserted in society. Thirty-four (49%) presented recurrence during their stay, of which 16 (47%) volunteered for treatment in a therapeutic community or psychiatric hospital, 8 (23.5%) chose to continue with outpatient treatment only, 6 (17.7%) returned to their families and continued to receive outpatient treatment, and 4 (11.8%) discontinued the treatment. Of the 35 subje...