Carmen Domingues - Academia.edu (original) (raw)

Papers by Carmen Domingues

Research paper thumbnail of Case investigation protocol and committee as strategies to reduce and eliminate mother-to-child transmission of HIV: Experience of the state of São Paulo, Brazil

Journal of the International AIDS Society, 2016

Research paper thumbnail of P139 The racial impact of AIDS trends among women in sao paulo, brazil

Research paper thumbnail of P3.33 Surveillance of syphilis in the state of sÃo paulo, brazil

infection among men who have sex with men over 50 years in Shenzhen, China. Methods Snowball samp... more infection among men who have sex with men over 50 years in Shenzhen, China. Methods Snowball sampling and respondent driven sampling were used to recruit MSM from 2009 to 2015 in Shenzhen, China. Questionnaire-based interviews were conducted on a one-on-one basis to collect data of socio-demographic information, HIV testing history, history of blood donation in recent two years, self-identified sexual orientation, role in homosexual behaviour, ever being money boy(MB) and clients of MB. 5 ml blood samples were taken and tested for treponema pallidum and HIV antibodies. Results Among the total of 5221 MSM recruited, 186 (3.56%) cases were aged 50 years and older. MSM aged 50 years and older were more likely to get married, have high school or below level of education, have monthly income less than 3000 Yuan, work in service industry or be jobless. Most of them never used condoms for every act with female sexual partners. About one-third had more than 5 anal sexual partners in recent six months. They had higher rate of never using condoms when having anal sex compared with MSM aged less than 50 years. The rate of syphilis, HIV infection and syphilis-HIV co-infection among MSM aged 50 and older were 1.8917, 1.7387, 2.0365 times as high as that among MSM aged less 50 years, respectively. Conclusion MSM aged 50 and older had higher prevalence of syphilis and HIV and acted as bridge population to transmit syphilis/HIV. It is necessary to carry intervention measures targeted to them.

Research paper thumbnail of Syphilis in the state of São Paulo, Brazil, 2011â2017

Revista Brasileira De Epidemiologia, 2020

Research paper thumbnail of P545 Trends in HIV infection and AIDS in men who have sex with men (MSM): adults compared to young people in sao paulo, brazil

Background Recreational drug use (RDU), particularly during sex, may contribute to human immunode... more Background Recreational drug use (RDU), particularly during sex, may contribute to human immunodeficiency virus (HIV) and sexually transmitted infections (STI) transmission by increasing sexual risk behaviour. We studied changes in RDU, including chemsex, and associations with condomless anal sex (CAS), HIV and STI among HIV-negative men who have sex with men (MSM). Methods MSM enrolled in the Amsterdam Cohort Studies with !1 study visit between 2008-2017 (n=887) were asked questions on behaviors in the preceding 6 months and underwent HIV/STI testing (chlamydia, gonorrhea, syphilis) biannually. Changes in RDU (overall/during sex) and chemsex (GHB/ GBL, mephedrone, methamphetamine, ketamine, amphetamine, cocaine and/or XTC during sex), and their associations with CAS, HIV and any STI (<6 months), were tested across calendar years using logistic regression with generalized estimating equations, while adjusting for age, calendar year, country of birth and education level.

Research paper thumbnail of A construção e o tratamento da Base Integrada Paulista de Aids

Research paper thumbnail of Sífilis no estado de São Paulo, Brasil, 2011‒2017

Revista Brasileira de Epidemiologia, 2020

RESUMO: Objetivo: Analisar a evolução, de 2011 a 2017, das taxas de detecção de sífilis notificad... more RESUMO: Objetivo: Analisar a evolução, de 2011 a 2017, das taxas de detecção de sífilis notificada por sexo, faixa etária e região de residência no estado de São Paulo (ESP). Métodos: Foi organizada série histórica com dados do Sistema de Informação de Agravos de Notificação (SINAN). Foram descritas as taxas de detecção de sífilis adquirida (TDSA) e de sífilis adquirida incluindo as gestantes com sífilis (TDSAG), por 100.000 hab. Para análise de tendência da evolução das taxas no período estudado, foi empregado o modelo Jointpoint (ponto de inflexão), bem como foram estimadas a variação percentual anual (VPA) por segmento e a média da variação percentual anual (MVPA), com os respectivos intervalos de confiança de 95% (IC95%). Resultados: Foram notificados 205.424 casos de sífilis adquirida e sífilis em gestantes no período. Entre 2011 e 2017, a TDSA por 100 mil habitantes variou de 26,0 a 84,6 e a TDSAG por 100 mil habitantes, de 33,7 a 108,9; a tendência foi crescente em ambas as c...

Research paper thumbnail of Sífilis no estado de São Paulo, Brasil, 2011‒2017

Revista Brasileira de Epidemiologia, 2020

RESUMO: Objetivo: Analisar a evolução, de 2011 a 2017, das taxas de detecção de sífilis notificad... more RESUMO: Objetivo: Analisar a evolução, de 2011 a 2017, das taxas de detecção de sífilis notificada por sexo, faixa etária e região de residência no estado de São Paulo (ESP). Métodos: Foi organizada série histórica com dados do Sistema de Informação de Agravos de Notificação (SINAN). Foram descritas as taxas de detecção de sífilis adquirida (TDSA) e de sífilis adquirida incluindo as gestantes com sífilis (TDSAG), por 100.000 hab. Para análise de tendência da evolução das taxas no período estudado, foi empregado o modelo Jointpoint (ponto de inflexão), bem como foram estimadas a variação percentual anual (VPA) por segmento e a média da variação percentual anual (MVPA), com os respectivos intervalos de confiança de 95% (IC95%). Resultados: Foram notificados 205.424 casos de sífilis adquirida e sífilis em gestantes no período. Entre 2011 e 2017, a TDSA por 100 mil habitantes variou de 26,0 a 84,6 e a TDSAG por 100 mil habitantes, de 33,7 a 108,9; a tendência foi crescente em ambas as c...

Research paper thumbnail of 405-PA12 Analysis of the intervals between diagnosis of tuberculosis, disseminated MAC disease and AIDS and death in HIV-infected in greater Sao Paulo, Brazil

Tubercle and Lung Disease, 1995

Research paper thumbnail of 310 Towards Elimination of Vertical Transmission of Hiv in SãO Paulo State, Brazil - Analysis of the Period 1984-2008

Pediatric Research, Nov 1, 2010

Research paper thumbnail of Spatiotemporal dynamics of syphilis in pregnant women and congenital syphilis in the state of São Paulo, Brazil

Scientific Reports, Jan 12, 2022

We aimed to estimate the occurrence of syphilis in pregnant women (SPW) and congenital syphilis (... more We aimed to estimate the occurrence of syphilis in pregnant women (SPW) and congenital syphilis (CS) in the municipalities of the state of São Paulo (SP) and evaluate their relationship with socioeconomic, demographic, and health care variables. We developed an ecological study based on secondary data of SPW and CS with spatiotemporal components from 645 municipalities in SP including data from 2007 to 2018. We modeled the data in a Bayesian context, considered spatial and temporal random effects, and used binomial negative probability distributions. We found a continuous increase in the relative temporal risk of SPW, from 2007 to 2018, and CS, from 2007 to 2017, when their incidences increased by 8.6 and 6.6 times, respectively. This increase occurred en bloc in practically all municipalities of SP. The increase in SPW was associated with teenage pregnancy, municipalities with a large number of inhabitants, and acquired immunodeficiency syndrome (AIDS) incidence. The increase in CS was associated with municipalities with a large number of inhabitants, incomplete antenatal care, and AIDS incidence. Although actions to control these diseases are required in all municipalities of SP, the identification of high-risk areas points to priority regions for development. Syphilis is a disease whose etiological agent is Treponema pallidum. With the discovery of penicillin, the disease was expected to be eliminated. Nevertheless, the number of infected adults, pregnant women, and children has increased significantly 1,2. Pregnant women with syphilis who do not receive the correct treatment may experience fetal and neonatal deaths, preterm births, and babies with low birth weight. Live births (LB) can suffer from the clinical effects and consequences of T. pallidum infections. The factors that contribute to the acquisition of syphilis by the women are related to socioeconomic and cultural aspects, such as gender inequalities, low education level, adolescent early sexual activity, and drug use. These factors are complemented by certain biological characteristics of women, such as genital epithelial disruptions and the difficulty to identify the signs and symptoms of syphilis 3. To manage this scenario, it is necessary for women to have access to health care and adequate treatment; this highlights the role of primary health care (PHC) to deal with the diagnosis, notification, surveillance, and treatment of syphilis. In 2006, the Pan American Health Organization and other organizations agreed on the targets for the elimination of congenital syphilis (CS) 4. However, even with the implementation of these initiatives, CS and syphilis in pregnant women (SPW) have remained increasingly serious public health problems 1,2. Korenromp et al. 5 estimated that in 2016, the global prevalence of SPW was 0.69% and the global occurrence of CS was 661,000 cases. Accordingly, 355,000 cases with adverse outcomes were estimated, with 143,000 early fetal deaths and stillbirths, and 61,000 neonatal deaths. They also estimated the occurrence of 41,000 and 109,000 preterm or lowbirth-weight births and children with clinical illnesses, respectively 5. To deal with this picture, the Pan American Health Organization recently developed a specific model for transmissible diseases, including acquired syphilis (AS), SPW, and CS, that articulates directly to the sustainable development goal number 3 of the 2030 Agenda 6. In Brazil, the detection rate of AS has increased significantly in all age groups, especially in those aged 20-29 years.

Research paper thumbnail of Syphilis in Pregnant Women and Congenital Syphilis: Spatio-temporal Dynamics and Covariates in the Middle-income Country – São Paulo, Brazil

Research Square (Research Square), Jun 4, 2021

We aimed to estimate the occurrence of syphilis in pregnant women (SPW) and congenital syphilis (... more We aimed to estimate the occurrence of syphilis in pregnant women (SPW) and congenital syphilis (CS) in the municipalities of the state of São Paulo (SP) and evaluate their relationship with socioeconomic, demographic, and health care variables. We developed an ecological study based on secondary data of SPW and CS with spatial and temporal components from 645 municipalities in SP and included data from 2007 to 2018. We modeled the data in a Bayesian context, considered spatial and temporal random effects, and used a binomial negative probability distribution. We found a continuous increase in the relative temporal risk of SPW, from 2007 to 2018, and CS, from 2007 to 2017, when their incidences increased by 8.7 and 6.6 times, respectively. Moreover, this increase occurred in en bloc in practically all municipalities of SP. The increase in SPW was associated with teenage pregnancy, municipalities with a large number of inhabitants, and aids incidence. The increase in CS was associated with municipalities with a large number of inhabitants, incomplete antenatal care, inadequate technology to perform deliveries in the municipality, and aids incidence. Interventions to control these diseases are needed in almost all the municipalities of the SP.

Research paper thumbnail of Survival of people living with AIDS with or without tuberculosis in Sao Paulo, Brazil

European journal of public health, Sep 1, 2020

cases of respiratory disease, diphtheria toxin testing significantly increased (p = 0.0001), with... more cases of respiratory disease, diphtheria toxin testing significantly increased (p = 0.0001), with 86% of toxin tests performed on cutaneous isolates. Subsequent public health investigations of each case of toxigenic cutaneous diphtheria mandated the collection of 315 total specimens from 92 individuals, revealing low rates of C. diphtheriae colonization among contacts and no further cases. Conclusions: This study challenges the value of reflexive diphtheria toxin testing in uncomplicated cutaneous diphtheria among highly vaccinated populations. Cutaneous diphtheria investigations demanded disproportionate public health and laboratory resources and demonstrated a discrepancy between toxin pathophysiology and disease. Therefore, we recommend stewarding diphtheria toxin tests for toxin-mediated disease forms and ensuring adequate vaccination. This approach would spare public health and laboratory resources by customizing responses around the role of the diphtheria toxin in each form of disease. Key messages: Investigations for cutaneous diphtheria increased demand for toxin testing in Alberta, Canada, though the toxin plays no role in this form of disease. In populations with high vaccination rates against diphtheria toxoid, cutaneous diphtheria cases do not require additional laboratory testing for the presence of the diphtheria toxin.

Research paper thumbnail of Syphilis in Pregnant Women and Congenital Syphilis: Spatio-temporal Dynamics and Covariates in the Middle-income Country – São Paulo, Brazil

We aimed to estimate the occurrence of syphilis in pregnant women (SPW) and congenital syphilis (... more We aimed to estimate the occurrence of syphilis in pregnant women (SPW) and congenital syphilis (CS) in the municipalities of the state of São Paulo (SP) and evaluate their relationship with socioeconomic, demographic, and health care variables. We developed an ecological study based on secondary data of SPW and CS with spatial and temporal components from 645 municipalities in SP and included data from 2007 to 2018. We modeled the data in a Bayesian context, considered spatial and temporal random effects, and used a binomial negative probability distribution. We found a continuous increase in the relative temporal risk of SPW, from 2007 to 2018, and CS, from 2007 to 2017, when their incidences increased by 8.7 and 6.6 times, respectively. Moreover, this increase occurred in en bloc in practically all municipalities of SP. The increase in SPW was associated with teenage pregnancy, municipalities with a large number of inhabitants, and aids incidence. The increase in CS was associate...

Research paper thumbnail of COVID-19 and HIV/AIDS in a cohort study in Sao Paulo, Brazil: outcomes and disparities by race and schooling

AIDS Care, 2021

Studies describing characteristics and outcomes of COVID-19 among people living with HIV are curr... more Studies describing characteristics and outcomes of COVID-19 among people living with HIV are currently limited, lacking detailed evaluation of the interplay among demographics, HIV-related variables, and comorbidities on COVID-19 outcomes. This retrospective cohort study describes mortality rates overall and according to demographic characteristics and explores predictors of admission to intensive care unit and death among 255 persons living with HIV with severe acute respiratory syndrome and confirmed SARS-CoV-2 infection in the State of Sao Paulo, Brazil. We found that the overall mortality rate was 4.1/1,000 person-days, with a case-fatality of 34%. Higher rates occurred among older adults, Black/Mixed skin color/race patients, and those with lower schooling. In a multivariable analysis adjusted for age, sex, CD4 count, viral load and number of comorbidities, skin color/race, and schooling remained significantly associated with higher mortality. Although tenofovir use was more frequent among survivors in the univariable analysis, we failed to find a statistically significant association between tenofovir use and survival in the multivariable analysis. Our findings suggest that social vulnerabilities related to both HIV and COVID-19 significantly impact the risk of death, overtaking traditional risk factors such as age, sex, CD4 count, and comorbidities.

Research paper thumbnail of Spatiotemporal dynamics of syphilis in pregnant women and congenital syphilis in the state of São Paulo, Brazil

Scientific Reports, 2022

We aimed to estimate the occurrence of syphilis in pregnant women (SPW) and congenital syphilis (... more We aimed to estimate the occurrence of syphilis in pregnant women (SPW) and congenital syphilis (CS) in the municipalities of the state of São Paulo (SP) and evaluate their relationship with socioeconomic, demographic, and health care variables. We developed an ecological study based on secondary data of SPW and CS with spatiotemporal components from 645 municipalities in SP including data from 2007 to 2018. We modeled the data in a Bayesian context, considered spatial and temporal random effects, and used binomial negative probability distributions. We found a continuous increase in the relative temporal risk of SPW, from 2007 to 2018, and CS, from 2007 to 2017, when their incidences increased by 8.6 and 6.6 times, respectively. This increase occurred en bloc in practically all municipalities of SP. The increase in SPW was associated with teenage pregnancy, municipalities with a large number of inhabitants, and acquired immunodeficiency syndrome (AIDS) incidence. The increase in CS...

Research paper thumbnail of Sífilis congênita no estado de São Paulo: O desafio continua

Research paper thumbnail of P139 The racial impact of AIDS trends among women in sao paulo, brazil

Poster Presentations, 2019

Research paper thumbnail of P745 The pregnancy syphilis cascade of care: “95–95–95” goals for reducing of congenital syphilis in the state of sao paulo, brazil

Poster Presentations, 2019

36), and did not use condoms with last sex (OR 1.50, 95%CI:1.05-2.16). Conclusion Findings indica... more 36), and did not use condoms with last sex (OR 1.50, 95%CI:1.05-2.16). Conclusion Findings indicate that lottery-based incentives might be a feasible approach to increase syphilis testing uptake in Chinese MSM, particularly amongst men with higher risk attitude scores and sexually risky behaviors. Disclosure No significant relationships.

Research paper thumbnail of The QualiRede intervention: improving the performance of care continuum in HIV, congenital syphilis, and hepatitis C in health regions

Revista Brasileira de Epidemiologia, 2019

Introduction: Care continuum models have supported recent strategies against sexually transmitted... more Introduction: Care continuum models have supported recent strategies against sexually transmitted diseases, such as HIV and Hepatitis C (HCV). Methods: HIV, HCV, and congenital syphilis care continuum models were developed, including all stages of care, from promotion/prevention to clinical control/cure. The models supported the intervention QualiRede, developed by a University-Brazilian National Health System (SUS) partnership focused on managers and other professionals from six priority health regions in São Paulo and Santa Catarina. Indicators were selected for each stage of the care continuum from the SUS information systems and from the Qualiaids and QualiAB facility’s process evaluation questionnaires. The indicators acted as the technical basis of two workshops with professionals and managers in each region: the first one to identify problems and to create a Regional Technical Group; and the second one to design action plans for improving regional performance. Results: The in...

Research paper thumbnail of Case investigation protocol and committee as strategies to reduce and eliminate mother-to-child transmission of HIV: Experience of the state of São Paulo, Brazil

Journal of the International AIDS Society, 2016

Research paper thumbnail of P139 The racial impact of AIDS trends among women in sao paulo, brazil

Research paper thumbnail of P3.33 Surveillance of syphilis in the state of sÃo paulo, brazil

infection among men who have sex with men over 50 years in Shenzhen, China. Methods Snowball samp... more infection among men who have sex with men over 50 years in Shenzhen, China. Methods Snowball sampling and respondent driven sampling were used to recruit MSM from 2009 to 2015 in Shenzhen, China. Questionnaire-based interviews were conducted on a one-on-one basis to collect data of socio-demographic information, HIV testing history, history of blood donation in recent two years, self-identified sexual orientation, role in homosexual behaviour, ever being money boy(MB) and clients of MB. 5 ml blood samples were taken and tested for treponema pallidum and HIV antibodies. Results Among the total of 5221 MSM recruited, 186 (3.56%) cases were aged 50 years and older. MSM aged 50 years and older were more likely to get married, have high school or below level of education, have monthly income less than 3000 Yuan, work in service industry or be jobless. Most of them never used condoms for every act with female sexual partners. About one-third had more than 5 anal sexual partners in recent six months. They had higher rate of never using condoms when having anal sex compared with MSM aged less than 50 years. The rate of syphilis, HIV infection and syphilis-HIV co-infection among MSM aged 50 and older were 1.8917, 1.7387, 2.0365 times as high as that among MSM aged less 50 years, respectively. Conclusion MSM aged 50 and older had higher prevalence of syphilis and HIV and acted as bridge population to transmit syphilis/HIV. It is necessary to carry intervention measures targeted to them.

Research paper thumbnail of Syphilis in the state of São Paulo, Brazil, 2011â2017

Revista Brasileira De Epidemiologia, 2020

Research paper thumbnail of P545 Trends in HIV infection and AIDS in men who have sex with men (MSM): adults compared to young people in sao paulo, brazil

Background Recreational drug use (RDU), particularly during sex, may contribute to human immunode... more Background Recreational drug use (RDU), particularly during sex, may contribute to human immunodeficiency virus (HIV) and sexually transmitted infections (STI) transmission by increasing sexual risk behaviour. We studied changes in RDU, including chemsex, and associations with condomless anal sex (CAS), HIV and STI among HIV-negative men who have sex with men (MSM). Methods MSM enrolled in the Amsterdam Cohort Studies with !1 study visit between 2008-2017 (n=887) were asked questions on behaviors in the preceding 6 months and underwent HIV/STI testing (chlamydia, gonorrhea, syphilis) biannually. Changes in RDU (overall/during sex) and chemsex (GHB/ GBL, mephedrone, methamphetamine, ketamine, amphetamine, cocaine and/or XTC during sex), and their associations with CAS, HIV and any STI (<6 months), were tested across calendar years using logistic regression with generalized estimating equations, while adjusting for age, calendar year, country of birth and education level.

Research paper thumbnail of A construção e o tratamento da Base Integrada Paulista de Aids

Research paper thumbnail of Sífilis no estado de São Paulo, Brasil, 2011‒2017

Revista Brasileira de Epidemiologia, 2020

RESUMO: Objetivo: Analisar a evolução, de 2011 a 2017, das taxas de detecção de sífilis notificad... more RESUMO: Objetivo: Analisar a evolução, de 2011 a 2017, das taxas de detecção de sífilis notificada por sexo, faixa etária e região de residência no estado de São Paulo (ESP). Métodos: Foi organizada série histórica com dados do Sistema de Informação de Agravos de Notificação (SINAN). Foram descritas as taxas de detecção de sífilis adquirida (TDSA) e de sífilis adquirida incluindo as gestantes com sífilis (TDSAG), por 100.000 hab. Para análise de tendência da evolução das taxas no período estudado, foi empregado o modelo Jointpoint (ponto de inflexão), bem como foram estimadas a variação percentual anual (VPA) por segmento e a média da variação percentual anual (MVPA), com os respectivos intervalos de confiança de 95% (IC95%). Resultados: Foram notificados 205.424 casos de sífilis adquirida e sífilis em gestantes no período. Entre 2011 e 2017, a TDSA por 100 mil habitantes variou de 26,0 a 84,6 e a TDSAG por 100 mil habitantes, de 33,7 a 108,9; a tendência foi crescente em ambas as c...

Research paper thumbnail of Sífilis no estado de São Paulo, Brasil, 2011‒2017

Revista Brasileira de Epidemiologia, 2020

RESUMO: Objetivo: Analisar a evolução, de 2011 a 2017, das taxas de detecção de sífilis notificad... more RESUMO: Objetivo: Analisar a evolução, de 2011 a 2017, das taxas de detecção de sífilis notificada por sexo, faixa etária e região de residência no estado de São Paulo (ESP). Métodos: Foi organizada série histórica com dados do Sistema de Informação de Agravos de Notificação (SINAN). Foram descritas as taxas de detecção de sífilis adquirida (TDSA) e de sífilis adquirida incluindo as gestantes com sífilis (TDSAG), por 100.000 hab. Para análise de tendência da evolução das taxas no período estudado, foi empregado o modelo Jointpoint (ponto de inflexão), bem como foram estimadas a variação percentual anual (VPA) por segmento e a média da variação percentual anual (MVPA), com os respectivos intervalos de confiança de 95% (IC95%). Resultados: Foram notificados 205.424 casos de sífilis adquirida e sífilis em gestantes no período. Entre 2011 e 2017, a TDSA por 100 mil habitantes variou de 26,0 a 84,6 e a TDSAG por 100 mil habitantes, de 33,7 a 108,9; a tendência foi crescente em ambas as c...

Research paper thumbnail of 405-PA12 Analysis of the intervals between diagnosis of tuberculosis, disseminated MAC disease and AIDS and death in HIV-infected in greater Sao Paulo, Brazil

Tubercle and Lung Disease, 1995

Research paper thumbnail of 310 Towards Elimination of Vertical Transmission of Hiv in SãO Paulo State, Brazil - Analysis of the Period 1984-2008

Pediatric Research, Nov 1, 2010

Research paper thumbnail of Spatiotemporal dynamics of syphilis in pregnant women and congenital syphilis in the state of São Paulo, Brazil

Scientific Reports, Jan 12, 2022

We aimed to estimate the occurrence of syphilis in pregnant women (SPW) and congenital syphilis (... more We aimed to estimate the occurrence of syphilis in pregnant women (SPW) and congenital syphilis (CS) in the municipalities of the state of São Paulo (SP) and evaluate their relationship with socioeconomic, demographic, and health care variables. We developed an ecological study based on secondary data of SPW and CS with spatiotemporal components from 645 municipalities in SP including data from 2007 to 2018. We modeled the data in a Bayesian context, considered spatial and temporal random effects, and used binomial negative probability distributions. We found a continuous increase in the relative temporal risk of SPW, from 2007 to 2018, and CS, from 2007 to 2017, when their incidences increased by 8.6 and 6.6 times, respectively. This increase occurred en bloc in practically all municipalities of SP. The increase in SPW was associated with teenage pregnancy, municipalities with a large number of inhabitants, and acquired immunodeficiency syndrome (AIDS) incidence. The increase in CS was associated with municipalities with a large number of inhabitants, incomplete antenatal care, and AIDS incidence. Although actions to control these diseases are required in all municipalities of SP, the identification of high-risk areas points to priority regions for development. Syphilis is a disease whose etiological agent is Treponema pallidum. With the discovery of penicillin, the disease was expected to be eliminated. Nevertheless, the number of infected adults, pregnant women, and children has increased significantly 1,2. Pregnant women with syphilis who do not receive the correct treatment may experience fetal and neonatal deaths, preterm births, and babies with low birth weight. Live births (LB) can suffer from the clinical effects and consequences of T. pallidum infections. The factors that contribute to the acquisition of syphilis by the women are related to socioeconomic and cultural aspects, such as gender inequalities, low education level, adolescent early sexual activity, and drug use. These factors are complemented by certain biological characteristics of women, such as genital epithelial disruptions and the difficulty to identify the signs and symptoms of syphilis 3. To manage this scenario, it is necessary for women to have access to health care and adequate treatment; this highlights the role of primary health care (PHC) to deal with the diagnosis, notification, surveillance, and treatment of syphilis. In 2006, the Pan American Health Organization and other organizations agreed on the targets for the elimination of congenital syphilis (CS) 4. However, even with the implementation of these initiatives, CS and syphilis in pregnant women (SPW) have remained increasingly serious public health problems 1,2. Korenromp et al. 5 estimated that in 2016, the global prevalence of SPW was 0.69% and the global occurrence of CS was 661,000 cases. Accordingly, 355,000 cases with adverse outcomes were estimated, with 143,000 early fetal deaths and stillbirths, and 61,000 neonatal deaths. They also estimated the occurrence of 41,000 and 109,000 preterm or lowbirth-weight births and children with clinical illnesses, respectively 5. To deal with this picture, the Pan American Health Organization recently developed a specific model for transmissible diseases, including acquired syphilis (AS), SPW, and CS, that articulates directly to the sustainable development goal number 3 of the 2030 Agenda 6. In Brazil, the detection rate of AS has increased significantly in all age groups, especially in those aged 20-29 years.

Research paper thumbnail of Syphilis in Pregnant Women and Congenital Syphilis: Spatio-temporal Dynamics and Covariates in the Middle-income Country – São Paulo, Brazil

Research Square (Research Square), Jun 4, 2021

We aimed to estimate the occurrence of syphilis in pregnant women (SPW) and congenital syphilis (... more We aimed to estimate the occurrence of syphilis in pregnant women (SPW) and congenital syphilis (CS) in the municipalities of the state of São Paulo (SP) and evaluate their relationship with socioeconomic, demographic, and health care variables. We developed an ecological study based on secondary data of SPW and CS with spatial and temporal components from 645 municipalities in SP and included data from 2007 to 2018. We modeled the data in a Bayesian context, considered spatial and temporal random effects, and used a binomial negative probability distribution. We found a continuous increase in the relative temporal risk of SPW, from 2007 to 2018, and CS, from 2007 to 2017, when their incidences increased by 8.7 and 6.6 times, respectively. Moreover, this increase occurred in en bloc in practically all municipalities of SP. The increase in SPW was associated with teenage pregnancy, municipalities with a large number of inhabitants, and aids incidence. The increase in CS was associated with municipalities with a large number of inhabitants, incomplete antenatal care, inadequate technology to perform deliveries in the municipality, and aids incidence. Interventions to control these diseases are needed in almost all the municipalities of the SP.

Research paper thumbnail of Survival of people living with AIDS with or without tuberculosis in Sao Paulo, Brazil

European journal of public health, Sep 1, 2020

cases of respiratory disease, diphtheria toxin testing significantly increased (p = 0.0001), with... more cases of respiratory disease, diphtheria toxin testing significantly increased (p = 0.0001), with 86% of toxin tests performed on cutaneous isolates. Subsequent public health investigations of each case of toxigenic cutaneous diphtheria mandated the collection of 315 total specimens from 92 individuals, revealing low rates of C. diphtheriae colonization among contacts and no further cases. Conclusions: This study challenges the value of reflexive diphtheria toxin testing in uncomplicated cutaneous diphtheria among highly vaccinated populations. Cutaneous diphtheria investigations demanded disproportionate public health and laboratory resources and demonstrated a discrepancy between toxin pathophysiology and disease. Therefore, we recommend stewarding diphtheria toxin tests for toxin-mediated disease forms and ensuring adequate vaccination. This approach would spare public health and laboratory resources by customizing responses around the role of the diphtheria toxin in each form of disease. Key messages: Investigations for cutaneous diphtheria increased demand for toxin testing in Alberta, Canada, though the toxin plays no role in this form of disease. In populations with high vaccination rates against diphtheria toxoid, cutaneous diphtheria cases do not require additional laboratory testing for the presence of the diphtheria toxin.

Research paper thumbnail of Syphilis in Pregnant Women and Congenital Syphilis: Spatio-temporal Dynamics and Covariates in the Middle-income Country – São Paulo, Brazil

We aimed to estimate the occurrence of syphilis in pregnant women (SPW) and congenital syphilis (... more We aimed to estimate the occurrence of syphilis in pregnant women (SPW) and congenital syphilis (CS) in the municipalities of the state of São Paulo (SP) and evaluate their relationship with socioeconomic, demographic, and health care variables. We developed an ecological study based on secondary data of SPW and CS with spatial and temporal components from 645 municipalities in SP and included data from 2007 to 2018. We modeled the data in a Bayesian context, considered spatial and temporal random effects, and used a binomial negative probability distribution. We found a continuous increase in the relative temporal risk of SPW, from 2007 to 2018, and CS, from 2007 to 2017, when their incidences increased by 8.7 and 6.6 times, respectively. Moreover, this increase occurred in en bloc in practically all municipalities of SP. The increase in SPW was associated with teenage pregnancy, municipalities with a large number of inhabitants, and aids incidence. The increase in CS was associate...

Research paper thumbnail of COVID-19 and HIV/AIDS in a cohort study in Sao Paulo, Brazil: outcomes and disparities by race and schooling

AIDS Care, 2021

Studies describing characteristics and outcomes of COVID-19 among people living with HIV are curr... more Studies describing characteristics and outcomes of COVID-19 among people living with HIV are currently limited, lacking detailed evaluation of the interplay among demographics, HIV-related variables, and comorbidities on COVID-19 outcomes. This retrospective cohort study describes mortality rates overall and according to demographic characteristics and explores predictors of admission to intensive care unit and death among 255 persons living with HIV with severe acute respiratory syndrome and confirmed SARS-CoV-2 infection in the State of Sao Paulo, Brazil. We found that the overall mortality rate was 4.1/1,000 person-days, with a case-fatality of 34%. Higher rates occurred among older adults, Black/Mixed skin color/race patients, and those with lower schooling. In a multivariable analysis adjusted for age, sex, CD4 count, viral load and number of comorbidities, skin color/race, and schooling remained significantly associated with higher mortality. Although tenofovir use was more frequent among survivors in the univariable analysis, we failed to find a statistically significant association between tenofovir use and survival in the multivariable analysis. Our findings suggest that social vulnerabilities related to both HIV and COVID-19 significantly impact the risk of death, overtaking traditional risk factors such as age, sex, CD4 count, and comorbidities.

Research paper thumbnail of Spatiotemporal dynamics of syphilis in pregnant women and congenital syphilis in the state of São Paulo, Brazil

Scientific Reports, 2022

We aimed to estimate the occurrence of syphilis in pregnant women (SPW) and congenital syphilis (... more We aimed to estimate the occurrence of syphilis in pregnant women (SPW) and congenital syphilis (CS) in the municipalities of the state of São Paulo (SP) and evaluate their relationship with socioeconomic, demographic, and health care variables. We developed an ecological study based on secondary data of SPW and CS with spatiotemporal components from 645 municipalities in SP including data from 2007 to 2018. We modeled the data in a Bayesian context, considered spatial and temporal random effects, and used binomial negative probability distributions. We found a continuous increase in the relative temporal risk of SPW, from 2007 to 2018, and CS, from 2007 to 2017, when their incidences increased by 8.6 and 6.6 times, respectively. This increase occurred en bloc in practically all municipalities of SP. The increase in SPW was associated with teenage pregnancy, municipalities with a large number of inhabitants, and acquired immunodeficiency syndrome (AIDS) incidence. The increase in CS...

Research paper thumbnail of Sífilis congênita no estado de São Paulo: O desafio continua

Research paper thumbnail of P139 The racial impact of AIDS trends among women in sao paulo, brazil

Poster Presentations, 2019

Research paper thumbnail of P745 The pregnancy syphilis cascade of care: “95–95–95” goals for reducing of congenital syphilis in the state of sao paulo, brazil

Poster Presentations, 2019

36), and did not use condoms with last sex (OR 1.50, 95%CI:1.05-2.16). Conclusion Findings indica... more 36), and did not use condoms with last sex (OR 1.50, 95%CI:1.05-2.16). Conclusion Findings indicate that lottery-based incentives might be a feasible approach to increase syphilis testing uptake in Chinese MSM, particularly amongst men with higher risk attitude scores and sexually risky behaviors. Disclosure No significant relationships.

Research paper thumbnail of The QualiRede intervention: improving the performance of care continuum in HIV, congenital syphilis, and hepatitis C in health regions

Revista Brasileira de Epidemiologia, 2019

Introduction: Care continuum models have supported recent strategies against sexually transmitted... more Introduction: Care continuum models have supported recent strategies against sexually transmitted diseases, such as HIV and Hepatitis C (HCV). Methods: HIV, HCV, and congenital syphilis care continuum models were developed, including all stages of care, from promotion/prevention to clinical control/cure. The models supported the intervention QualiRede, developed by a University-Brazilian National Health System (SUS) partnership focused on managers and other professionals from six priority health regions in São Paulo and Santa Catarina. Indicators were selected for each stage of the care continuum from the SUS information systems and from the Qualiaids and QualiAB facility’s process evaluation questionnaires. The indicators acted as the technical basis of two workshops with professionals and managers in each region: the first one to identify problems and to create a Regional Technical Group; and the second one to design action plans for improving regional performance. Results: The in...