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Injection drug use and heterosexual transmission from male key populations to their female partners have been the dominant modes of HIV transmission in Vietnam. A demonstration project was conducted to offer immediate antiretroviral therapy (ART) (regardless of CD4 cell count) to HIV-seropositive partners in serodiscordant couples. During March–December 2013, couples HIV testing and counselling (HTC) and immediate ART were offered in two drug use-affected provinces. Of 256 couples receiving couples HTC, 146 (57%) were serodiscordant; 134 (92%) seropositive partners initiated ART irrespective of CD4 cell count. Of these, 86% were male; 57% reported ever using illicit drugs; median CD4 cell count before ART initiation was 374 cells/mm3. Consistent condom use was reported by 58, 70 and 71% among HIV-positive partners at months 0, 3 and 12. At 12 months after ART initiation, 119 (89%) HIV-positive partners were retained in care; 96 (95% of those tested) achieved viral suppression (

Background: Maintaining essential HIV services has being a Global challenge during the COVID-19 crises. Myanmar has 54 million inhabitants. Neighbor of China, Thailand, India and Bangladesh it was impacted by COVID-19, but came up with a comprehensive and effective response, following WHO recommendations. The HIV Prevalence is 0.58% and it is concentrated among key population. A HIV Contingency Plan was developed to face this challenge. Methodology: The programme-based cross-sectional descriptive study with analysis of routinely collected data from MoHS data system, between 2019 and 2020 was conducted, comparing first six months of 2019 and 2020. Results: HIV outreach activities and HIV testing were slightly affected after detection of first COVID-19 case, till mid May 2020. After that, outreach activities resumed. Introduction of HIV self-testing was initiated. 72% of more than 21,000 PWID on MMT were receiving take home dose up to 14 days and 60% of ART patients were receiving 6 months ARV dispensing. Conclusion: Essential HIV services were maintained.

Objective: Rapid HIV testing and counselling in community settings delivered by trained peers can allow easier access to and uptake of HIV testing and care. The programme 'Live Better Knowing' offers rapid HIV testing to key populations across Brazil. This cross-sectional study aims at describing the HIV prevalence in population subgroups and at assessing the association of sex work (SW) and/or drug use with a positive HIV result. Methods: Between January 2013 and April 2016, key populations were invited for HIV rapid oral fluid tests (DPP HIV- 1/2 Bio-Manguinhos/Fiocruz, Rio de Janeiro, Brazil) by peers. HIV testing was offered in identified venues and areas where these populations socialize. Participants were interviewed using a brief questionnaire about their socio-demographic and risk behaviour. Multivariable logistic regression was used to assess the effect of SW and/or drug use on the risk of HIV. Results: Among the 43,358 participants, 42.9% were ciswomen, 2.9% were transvestites, 2.7% were transgender, 19.8% were men who have sex with men (MSM) and 31.9% were heterosexual men. Overall, 52.1% were first-time HIV testers. The HIV prevalence among the ciswomen, transvestites, transgender people, MSM and heterosexual men was 0.9%, 7.2%, 4%, 3.4% and 1%, respectively. Individuals who performed SW and used drugs had the highest HIV prevalence within each population group (ciswomen 1.7%, transvestites 8.1%, transgender 7.4%, MSM 5.9% and heterosexual men 2.6%). The adjusted odds ratios with 95% confidence intervals for selling sex combined with drug use were 2.90 (1.21-6.96) in ciswomen, 25.01 (2.67-234.57) in transgender people and 2.42 (1.31-4.48) in MSM. Conclusion: This outreach programme attracted persons with high risk practices who had never been tested. Our findings suggest that transvestites and transgender people (particularly those who sell sex) constitute a high risk population for HIV in urgent need of enhanced prevention, treatment and care services.

Objective To describe the antiretroviral therapy status of people living with HIV (PLHIV) who died of AIDS-related causes between 2009 and 2013. Methods We conducted a cross-sectional population-based study. Data were obtained by linking the mortality information system and the national ART dispensing database. Trends were modelled using linear regression analysis. Results A total of 61 425 AIDS-related deaths were registered in Brazil between 2009 and 2013. Median age at death was 41 years (IQR: 33-49) and 65.7% (40 337) of deaths were among men; 47.2% (29 004) of PLHIV who died during the study period had never started treatment 7.0% (4274) had discontinued it 15.9% (9775) were on ART for 6 months or less and 29.9% (18 372) were on ART for more than 6 months. Only 1.3% of PLHIV were on third-line ARV regimens when they died. Conclusions AIDS-related mortality remains a challenge even in a context of sustained universal access to antiretroviral treatment due to failure of service provision not to therapy failure. Robust health policies closing gaps in the HIV continuum of care are crucial to further reduce mortality.

Introduction Men who have sex with men (MSM) and transgender women (TGW) in Brazil experience high rates of HIV infection. We examined the clinical and economic outcomes of implementing a pre‐exposure prophylaxis (PrEP) programme in these populations. Methods We used the Cost‐Effectiveness of Preventing AIDS Complications (CEPAC)‐International model of HIV prevention and treatment to evaluate two strategies: the current standard of care (SOC) in Brazil, including universal ART access (No PrEP strategy); and the current SOC plus daily tenofovir/emtracitabine PrEP (PrEP strategy) until age 50. Mean age (31 years, SD 8.4 years), age‐stratified annual HIV incidence (age ≤ 40 years: 4.3/100 PY; age > 40 years: 1.0/100 PY), PrEP effectiveness (43% HIV incidence reduction) and PrEP drug costs ($23/month) were from Brazil‐based sources. The analysis focused on direct medical costs of HIV care. We measured the comparative value of PrEP in 2015 United States dollars (USD) per year of life saved (YLS). Willingness‐to‐pay threshold was based on Brazil's annual per capita gross domestic product (GDP; 2015: $8540 USD). Results Lifetime HIV infection risk among high‐risk MSM and TGW was 50.5% with No PrEP and decreased to 40.1% with PrEP. PrEP increased per‐person undiscounted (discounted) life expectancy from 36.8 (20.7) years to 41.0 (22.4) years and lifetime discounted HIV‐related medical costs from $4100 to $8420, which led to an incremental cost‐effectiveness ratio (ICER) of $2530/YLS. PrEP remained cost‐effective (

The network of HIV counseling and testing centers in São Paulo, Brazil is a major source of data used to build epidemiological profiles of the client population. We examined HIV-1 incidence from November 2000 to April 2001, comparing epidemiological and socio-behavioral data of recently-infected individuals with those with long-standing infection. A less sensitive ELISA was employed to identify recent infection. The overall incidence of HIV-1 infection was 0.53/100/year (95% CI: 0.31-0.85/100/year): 0.77/100/year for males (95% CI: 0.42-1.27/100/year) and 0.22/100/ year (95% CI: 0.05-0.59/100/year) for females. Overall HIV-1 prevalence was 3.2% (95% CI: 2.8-3.7%), being 4.0% among males (95% CI: 3.3-4.7%) and 2.1% among females (95% CI: 1.6-2.8%). Recent infections accounted for 15% of the total (95% CI: 10.2-20.8%). Recent infection correlated with being younger and male (p = 0.019). Therefore, recent infection was more common among younger males and older females. Secretaria Municipal de Saúde de São Paulo Universidade de São Paulo Faculdade de Saúde Pública Departamento de Epidemiologia Santa Casa de São Paulo Faculdade de Ciências Médicas Departamento de Medicina Social Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Laboratório de Retrovirologia UNIFESP, EPM, Laboratório de Retrovirologia SciELO

The network of HIV counseling and testing centers in Sao Paulo, Brazil is a major source of data used to build epidemiological profiles of the client population. In this study, HIV-1 incidence from November of 2000 to April of 2001 was estimated, comparing recently infected individuals to those with long-standing infection in terms of epidemiological and socio-behavioral aspects. To identify recent infection, less sensitive ELISA was employed. The overall incidence of HIV-1 infection among the clients was 0.53/100/year (95% CI: 0.31-0.85/100/year): 0.77/100/year for males (95% CI: 0.42-1.27/100/year) and 0.22/100/year (95% CI: 0.05-0.59/100/year) for females. Overall HIV-1 prevalence was 3.2% (95% CI: 2.8-3.7%), being 4.0% among males (95% CI: 3.3-4.7%) and 2.1% among females (95% CI: 1.6-2.8%). Recent infections accounted for 15% of the total (95% CI: 10.2-20.8%). Recent infection correlated with being younger and male (p = 0.019). Therefore, recent infection was more common among younger males and older females.

Hepatitis C is considered one of the most neglected diseases in world. Worldwide about 150 million people are chronically infected by hepatitis C virus (HCV), and 60% to 70% of them will develop severe liver disease. This article describes Brazil’s response to hepatitis C, from the first steps in 1993 to a national program in 2002. We reviewed the available literature, most of it in Brazilian Portuguese, and compiled them in order to share this experience with those seeking some pragmatic solutions. After 12 years, the national program has achieved universal coverage of treatment, resulting in saved lives and resources for the health system. There is abundant evidence that the HCV epidemic deserves attention. The overall consequence of long-term HCV infection is a negative impact on the health care economy. The Brazilian experience can be adapted to many countries in the world, in compliance with the 2010 World Health Organization World Health Assembly Resolution.

Supplemental Digital Content is Available in the Text., Background: Few studies have assessed the effects of antiretroviral therapy (ART) to prevent HIV transmission in Asian HIV epidemics. Vietnam has a concentrated HIV epidemic with the highest prevalence among people who inject drugs. We investigated the impact of expanded HIV testing and counseling (HTC) and early ART, combined with other prevention interventions on HIV transmission. Methods: A deterministic mathematical model was developed using HIV prevalence trends in Can Tho province, Vietnam. Scenarios included offering periodic HTC and immediate ART with and without targeting subpopulations and examining combined strategies with methadone maintenance therapy and condom use. Results: From 2011 to 2050, maintaining current interventions will incur an estimated 18,115 new HIV infections and will cost US $22.1 million (reference scenario). Annual HTC and immediate treatment, if offered to all adults, will reduce new HIV infections by 14,513 (80%) and will cost US $76.9 million. Annual HTC and immediate treatment offered only to people who inject drugs will reduce new infections by 13,578 (75%) and will cost only US $23.6 million. Annual HTC and immediate treatment for key populations, combined with scale-up of methadone maintenance therapy and condom use, will reduce new infections by 14,723 (81%) with similar costs (US $22.7 million). This combination prevention scenario will reduce the incidence to less than 1 per 100,000 in 14 years and will result in a relative cost saving after 19 years. Conclusions: Targeted periodic HTC and immediate ART combined with other interventions is cost-effective and could lead to potential elimination of HIV in Can Tho.

Viral hepatitis is a disease of great concern to public health that is now met by a favorable momentum to combat the global epidemic. This article is intended to highlight the importance of viral hepatitis in the Vietnam population as well in the group of people living with HIV/AIDS (PLWHA). We reviewed available data on epidemiology and response on hepatitis B virus (HBV) and hepatitis C virus (HCV) and HIV coinfection in Vietnam. The hepatitis B surface antigen (HBsAg) prevalence in the general population ranged from 5.7% to 24.7%. The anti-HCV prevalence ranged from 0.38% to 4.3% in the general population, while among people who inject drugs (PWIDs) it ranged from 31% to 97.2%. The HBV prevalence among PLWHA is similar to the general population, while HCV/HIV coinfection is concentrated in some groups. Anti-HCV prevalence among HIV-infected PWIDs can be as high as 98.5%. Developing policies for diagnosis and treatment of chronic HBV and HCV infections are critical priorities in order to prevent clinical progression to cirrhosis and liver cancer.

Introduction : The World Health Organization recently released guidelines on the use of pre-exposure prophylaxis (PrEP) for prevention of HIV infection among men and transgender women (TGW) who have sex with men based on results of randomized clinical trials. The aim of this commentary is to discuss the opportunities and challenges of incorporating PrEP into the Brazilian continuum of HIV care and prevention for men who have sex with men (MSM) and TGW. Discussion : Key aspects of the AIDS epidemic among MSM and TGW in Brazil and the comprehensive Brazilian response to the epidemic are presented. The universal access to health care provided through the Brazilian Unified Health System (SUS) and the range of prevention and care services already available countrywide to HIV-positive individuals and at-risk MSM and TGW are identified as the main facilitators for the implementation of PrEP. Limited PrEP awareness among MSM, TGW and health care providers, low HIV testing frequency and low HIV risk perception among MSM and TGW represent the core challenges to be addressed. Data generated by demonstration projects in Brazil will provide an important contribution to PrEP rollout in Brazil. Conclusions : The implementation of PrEP in Brazil is feasible. A synergistic rollout of treatment as prevention and PrEP will maximize public health and individual benefits of the country’s comprehensive response to the AIDS epidemic. Keywords: pre-exposure prophylaxis; MSM; TGW; prevention; Brazil; resource-limited setting; health system (Published: 20 July 2015) Citation: Veloso VG et al. Journal of the International AIDS Society 2015, 18 (Suppl 3):20010 http://www.jiasociety.org/index.php/jias/article/view/20010 | http://dx.doi.org/10.7448/IAS.18.4.20010

Submitted by Edileide Reis (leyde-landy@hotmail.com) on 2013-12-09T14:13:13Z No. of bitstreams: 1 Tarcísio Andrade.pdf: 99112 bytes, checksum: 1908ebbe9c418a0aa938bb4b875a4dd1 (MD5) Approved for entry into archive by Flávia Ferreira (flaviaccf@yahoo.com.br) on 2014-01-13T13:20:14Z (GMT) No. of bitstreams: 1 Tarcísio Andrade.pdf: 99112 bytes, checksum: 1908ebbe9c418a0aa938bb4b875a4dd1 (MD5) Made available in DSpace on 2014-01-13T13:20:14Z (GMT). No. of bitstreams: 1 Tarcísio Andrade.pdf: 99112 bytes, checksum: 1908ebbe9c418a0aa938bb4b875a4dd1 (MD5) Previous issue date: 2003 The Brazilian response to the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) epidemic is being observed all over the world because of its success. Understanding the role of injection drug users (IDUs) in the epidemic and the political response thereto is a key factor in the control of the epidemic in Brazil. This paper summarizes some of the most important analyses of the Brazilian response to the HIV/AIDS epidemic among and from IDUs. Key elements of the response include the support of the Brazilian Universal Public Health System, the provision of universal access to highly active antiretroviral therapy, and the creation of harm reduction projects that are politically and financially supported by the federal government. The response among and from IDUs is a key element in overall control of the HIV/AIDS epidemic. The response to the epidemic among and from IDUs has been headed in the correct direction since its beginning and is now being intensively expanded.

Santos Metropolitan Region (SMR), State of Sao Paulo, historically is well known as being one of the areas with the largest number of AIDS cases in Brazil, especially among injection drug users (IDUs). The main objective of this study was to assess the effects of changes in drug-using patterns among IDUs on trends in HIV infection among IDUs in the 1990s.During 1991 through 1992 (wave 1; n = 214), 1994 through 1996 (wave 2; n = 135), and 1999 (wave 3; n = 108), we conducted three cross-sectional studies of IDUs. All participants were interviewed and tested for antibodies to HIV.The overall sample population was 69% male, and 87% of the sample population was under 40 years old. Eighty-four percent of the population had less than 9 years of education. HIV seroprevalence was 63% in wave 1, 65% in wave 2, and 42% in wave 3 ( p.001). Smoking of crack cocaine increased from 11% in wave 1 to 60% in wave 2 and 67% in wave 3 ( p.001). The prevalence of frequent injections (5 per day) decreased from 42% in wave 1 to 30% in wave 2 and 15% in wave 3 ( p.001).HIV prevalence decreased as injection frequency decreased and crack cocaine use increased. In SMR, patterns of drug use have been affecting the HIV epidemic more than scant public health intervention.

Several strategies aim at characterizing the AIDS epidemic in different parts of the world. Among these, the identification of recent HIV-1 infections using the recently described serologic testing algorithm for recent human immunodeficiency virus (HIV) seroconversion (STARHS) strategy was employed in four testing sites of the City of Sao Paulo Public Health Department (CSPPHD). Those identified as recently infected were invited to participate in a prospective clinical and laboratory evaluation study. We describe the establishment of the patient identification network and the success in enrolling the participants, as well as their clinical and laboratory characteristics. From May to December 2002, 6,443 persons were tested for HIV in the four participating sites, of whom 384 (5.96%) tested HIV-1 positive; 43 (11.2%) of them were identified as recently infected. Twenty-two were successfully enrolled in the follow-up study, but three of them did not meet clinical and/or laboratory criteria for recent HIV-1 infection. After these exclusions, the laboratory findings revealed a median CD4+ T lymphocyte count of 585 cells/microL (inter-quartile range 25-75% [IQR], 372-754), a CD8+ T lymphocyte count of 886 cells/microL (IQR, 553-1098), a viral load of 11,000 HIV-RNA copies/mL (IQR, 3,650-78,150), log10 of 4.04 (IQR 3.56-4.88). The identification of recent HIV infections is an extremely valuable way to evaluate the spread of the virus in a given population, especially when cohort studies, considered the gold standard method to evaluate incidence, are not available. This work demonstrated that establishing a network to identify such patients is a feasible task, even considering the difficulties in a large, resource-limited country or city.