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Background Cutaneous leishmaniasis (CL) is a neglected disease and a public health problem in Latin America. The diagnosis of CL in poor hyperendemic regions relies to large extent on the identification of amastigotes in Giemsa-stained smears. There is an urgent need for a rapid, sensitive and low cost diagnostic method for use in field conditions for CL as current modalities are not readily available. The primary objective of this study was to determine the sensitivity and specificity of the FDA-cleared CL Detect Rapid Test in Peru, using modified test procedures rather than the instructions-for-use, by 1) increasing the extraction time and 2) increasing the volume of the sample added to the test strip. CL Detect Rapid Test results were compared against microscopy and kDNA-PCR, for the diagnosis of CL in ulcerated lesions. In addition, we compared two collection methods the dental broach used and mentioned in the CL Detect insert and the standard less invasive and easier to conduct scrapping method. Methodology Participants were patients who presented for medical consultation due to a suspected CL lesion. Four samples from the index lesion were collected using a dental broach, per package insert, and lancet scraping and tested by the modified CL Detect Rapid Test, microscopy, and PCR. Principal findings A total of 156 subjects were eligible and evaluated. The modified CL Detect sensitivity was higher in specimens obtained by scraping (83.3%) than those from dental broach (64.2%). The specificity was lower in scrapings (77.8%) with a false positive rate of 22.2% compared with dental broach samples (91.7%) with a false positive rate of 8.3%. However, molecular analysis showed that all 8 false negative microscopy scrapings (those positive by modified CL Detect and negative by microscopy) were positive by kDNA-PCR, meaning that the modified CL Detect was more sensitive than microscopy. Conclusions These modifications to the package insert that resulted in a diagnostic sensitivity (83.3%) comparable to microscopy for species found in Peru may enable earlier anti-leishmanial drug treatment decisions based on a positive result from the CL Detect Rapid Test alone until further diagnostic tests like microscopy and PCR can be performed. Trial registration NCT03762070; Clinicaltrials.gov.

Access to safe drinking water is limited in many isolated areas, such as the Amazon where Indigenous peoples frequently reside. Identifying safe forms of drinking water accepted by the communities could have positive health benefits for Indigenous peoples. Many Amazon Indigenous peoples traditionally prepare and consume a fermented beverage called masato, which is frequently the only form of water consumption. Despite its widespread consumption and evidence of the health benefits of fermentation, masato remains poorly investigated. We partnered with a Shawi Indigenous community in the Peruvian Amazon to conduct participatory photography to research masato preparation, and to characterize key cultural features and to assess the presence of total and fecal coliform bacteria by using a membrane filter technique. Pictures show that masato preparation is a key part of cultural practices and that there are clear gender roles in the preparation process. We found that 100% of communal water sources (26/26) were contaminated with coliform bacteria; by contrast, fewer, 18% of masato samples (2/11), were positive for coliform. This exploratory study suggests that fermented beverages like masato merit further investigation as they represent an Indigenous method to improve water quality in Amazonian communities where water safety cannot be assured.

Introduction: Plasmodium vivax malaria causes significant disease burden worldwide, especially in Latin America, Southeast Asia, and Oceania. P. vivax is characterized by the production of liver hypnozoites that cause clinical relapses upon periodic activation. Primaquine, an 8-aminoquinoline drug, has been the standard of care for decades to treat liver-stage P. vivax malaria; however, it requires long treatment regimens (one to two weeks) that lead to poor adherence and thus clinical relapses. Tafenoquine (TFQ), a newly available and efficacious single-dose 8-aminoquinoline, aims to address this challenge. Safe administration is possible when paired with the use of glucose-6-phosphate dehydrogenase (G6PD) diagnostics to prevent 8-aminoquinoline-induced hemolysis in patients with underlying G6PD deficiency (G6PDd). Areas covered: In this review, the authors present the recent literature regarding the pharmacology, efficacy, safety, and tolerability of TFQ and highlight regional differences in these areas. The authors also discuss the potential for TFQ, complemented with primaquine PQ and effective screening for G6PDd, to improve P. vivax clinical management and facilitate targeted mass drug administration in communities to decrease transmission. Expert opinion: Clinical studies show therapeutic efficacy of TFQ as well as a good performance in terms of safety and tolerability. Additional research regarding the effectiveness and safety TFQ in malaria elimination strategies, such as targeted or mass drug administration, are needed.

Malaria remains endemic in 17 countries in the Americas, where 723,000 cases were reported in 2019. The majority (> 90%) of the regional malaria burden is found within the Amazon Basin, which includes nine countries and territories in South America. Locally generated evidence is critical to provide information to public health decision makers upon which the design of efficient and regionally directed malaria control and elimination programs can be built. Plasmodium vivax is the predominant malaria parasite in the Amazon Basin. This parasite species appears to be more resilient to malaria control strategies worldwide. Asymptomatic Plasmodium infections constitute a potentially infectious reservoir that is typically missed by routine microscopy-based surveillance and often remains untreated. The primary Amazonian malaria vector, Nyssorhynchus (formerly Anopheles) darlingi, has changed its behavior to feed and rest predominantly outdoors, reducing the efficiency of core vector control measures such as indoor residual spraying and distribution of long-lasting insecticide-treated bed nets. We review public health implications of recent field-based research carried out by the Amazonia International Center of Excellence in Malaria Research in Peru and Brazil. We discuss the relative role of traditional and novel tools and strategies for better malaria control and elimination across the Amazon, including improved diagnostic methods, new anti-relapse medicines, and biological larvicides, and emphasize the need to integrate research and public health policymaking.

Cutaneous leishmaniasis (CL) is an infectious and neglected disease caused by parasites of the genus Leishmania, which produces a wide spectrum of cutaneous manifestations. CL research has shown that the innate immune activity of cells such as neutrophils, natural killers, macrophages, dendritic cells, and the complement system are capable of controlling this infection. However, Leishmania can also modulate the immune activity of these cells to promote its own survival and proliferation at the intracellular level. This review discusses the role of the innate immune response in the control and spread of this infection

Low- and middle-income countries (LMICs) face significant challenges in the control of COVID-19, given limited resources, especially for inpatient care. In a parallel effort to that for vaccines, the identification of therapeutics that have near-term potential to be available and easily administered is critical. Using the United States, European Union, and WHO clinical trial registries, we reviewed COVID-19 therapeutic agents currently under investigation. The search was limited to oral or potentially oral agents, with at least a putative anti-SARS-CoV-2 virus mechanism and with at least five registered trials. The search yielded 1,001, 203, and 1,128 trials, in the United States, European Union, and WHO trial registers, respectively. These trials covered 13 oral or potentially oral repurposed agents that are currently used as antimicrobials and immunomodulatory therapeutics with established safety profiles. The available evidence regarding proposed mechanism of actions, potential limitations, and trial status is summarized. The results of the search demonstrate few published studies of high quality, a low proportion of trials completed, and the vast majority with negative results. These findings reflect limited investment in COVID-19 therapeutics development compared with vaccines. We also identified the need for better coordination of trials of accessible agents and their combinations in LMICs. To prevent COVID-19 from becoming a neglected tropical disease, there is critical need for rapid and coordinated effort in the evaluation and deployment of those agents found to be efficacious

Background Climate change is expected to decrease food security globally. Many Indigenous communities have heightened sensitivity to climate change and food insecurity for multifactorial reasons including close relationships with the local environment and socioeconomic inequities which increase exposures and challenge adaptation to climate change. Pregnant women have additional sensitivity to food insecurity, as antenatal undernutrition is linked with poor maternal-infant health. This study examined pathways through which climate change influenced food security during pregnancy among Indigenous and non-Indigenous women in rural Uganda. Specific objectives were to characterize: 1) sensitivities to climate-associated declines in food security for pregnant Indigenous women; 2) women’s perceptions of climate impacts on food security during pregnancy; and 3) changes in food security and maternal-infant health over time, as observed by women. Methods Using a community-based research approach, we conducted eight focus group discussions—four in Indigenous Batwa communities and four in non-Indigenous communities—in Kanungu District, Uganda, on the subject of climate and food security during pregnancy. Thirty-six women with ≥1 pregnancy participated. Data were analysed using a constant comparative method and thematic analysis. Results Women indicated that food insecurity was common during pregnancy and had a bidirectional relationship with antenatal health issues. Food security was thought to be decreasing due to weather changes including extended droughts and unpredictable seasons harming agriculture. Women linked food insecurity with declines in maternal-infant health over time, despite improved antenatal healthcare. While all communities described food security struggles, the challenges Indigenous women identified and described were more severe. Conclusions Programs promoting women’s adaptive capacity to climate change are required to improve food security for pregnant women and maternal-infant health. These interventions are particularly needed in Indigenous communities, which often face underlying health inequities. However, resiliency among mothers was strong and, with supports, they can reduce food security challenges in a changing climate.

INTRODUCCIÓN: La leishmaniasis mucosa (LM) afecta la mucosa nasal, el tabique, el paladar, la faringe y la laringe. La LM causa desfiguración, dificultad para hablar y comer, y una alta morbilidad y mortalidad en general. Aproximadamente el 1-5% de los pacientes con leishmaniasis cutánea desarrollarán LM más adelante. Leishmania (Viannia) braziliensis es el agente etiológico principal, el cual es endémico en Perú y otras regiones tropicales de las Américas. El fracaso al tratamiento con antimoniales en LM ocurre en aproximadamente 7 a 30% de los pacientes (1), y probablemente depende de la severidad de la enfermedad mucosa y de las comorbilidades asociadas. La pentoxifilina es un inhibidor de la xantina oxidasa utilizada en el tratamiento de leishmanaisis cutánea por sus efectos antiinflamatorios. La adición de la pentoxifilina a los antimoniales podría mejorar la eficacia de la terapia en LM. 2019-09-05

Background: Climate change is affecting food systems globally, with implications for food security, nutrition, and the health of human populations. There are limited data characterizing the current and future consequences of climate change on local food security for populations already experiencing poor nutritional indicators. Indigenous Amazonian populations have a high reported prevalence of nutritional deficiencies. This paper characterizes the food system of the Shawi of the Peruvian Amazon, climatic and non-climatic drivers of their food security vulnerability to climate change, and identifies potential maladaptation trajectories. Methods and findings: Semi-structured interviews with key informants (n = 24), three photovoice workshops (n = 17 individuals), transect walks (n = 2), a food calendar exercise, and two community dissemination meetings (n = 30 individuals), were conducted within two Shawi communities in Balsapuerto District in the Peruvian Loreto region between June and September of 2014. The Shawi food system was based on three main food sub-systems (forest, farming and externally-sourced). Shawi reported collective, gendered, and emotional notions related to their food system activities. Climatic and non-climatic drivers of food security vulnerability among Shawi participants acted at proximal and distal levels, and mutually reinforced key maladaptation trajectories, including: 1) a growing population and natural resource degradation coupled with limited opportunities to increase incomes, and 2) a desire for education and deforestation reinforced by governmental social and food interventions. Conclusion: A series of maladaptive trajectories have the potential to increase social and nutritional inequities for the Shawi. Transformational food security adaptation should include consideration of Indigenous perceptions and priorities, and should be part of Peruvian food and socioeconomic development policies.

Climate change adaptation is increasingly considered an urgent priority for policy action. Billions of dollars have been pledged for adaptation finance, with many donor agencies requiring that adaptation is distinct from baseline development. However, practitioners and academics continue to question what adaptation looks like on the ground, especially in a developing country. This study examines the current framing of planned adaptation amidst low socioeconomic development and considers the practical implications of this framing for adaptation planning. Three overarching approaches to planned adaptation in a developing country context emerged in a systematic review of 30 peer-reviewed articles published between 2010 and 2015, including: (1) technocratic risk management, which treats adaptation as additional to development, (2) pro-poor vulnerability reduction, which acknowledges the ability of conventional development to foster and act as adaptation, and (3) sustainable adaptation, which suggests that adaptation should only be integrated into a type of development that is socially and environmentally sustainable. Over half of sustainable adaptation' articles in this review took a critical adaptation approach, drawing primarily from political ecology and postdevelopment studies, and emphasizing the malleability of adaptation. The reviewed articles highlight how the different framings of the relationship between adaptation and development result in diverse and sometimes contradictory messages regarding adaptation design, implementation, funding, monitoring, and evaluation. This review illustrates the need to continually interrogate the multiple framings of adaptation and development and to foster a pragmatic and pluralistic dialogue regarding planned adaptation and transformative change in developing countries.

Background. Health research knowledge translation (KT) is important to improve population health outcomes. Considering social, geographical and cultural contexts, KT in Inuit communities often requires different methods than those commonly used in non-Inuit populations. Objectives. To examine the extent, range and nature of literature about health-related KT in Inuit communities. Design. A scoping review was conducted. A search string was used to search 2 English aggregator databases, ProQuest and EBSCOhost, on 12 March 2015. Study selection was conducted by 2 independent reviewers using inclusion and exclusion criteria. To be included, studies had to explicitly state that KT approaches were used to share human health research results in Inuit communities in the Circumpolar North. Articles that evaluated or assessed KT approaches were thematically analysed to identify and characterize elements that contributed to KT success or challenges. Results. From 680 unique records identified in the initial search, 39 met the inclusion criteria and were retained for analysis. Of these 39 articles, 17 evaluated the KT approach used; thematic analysis identified 3 themes within these 17 articles: the value of community stakeholders as active members in the research process; the importance of local context in tailoring KT strategies and messaging; and the challenges with varying and contradictory health messaging in KT. A crosscutting gap in the literature, however, included a lack of critical assessment of community involvement in research. The review also identified a gap in assessments of KT in the literature. Research primarily focused on whether KT methods reflected the local culture and needs of the community. Assessments rarely focused on whether KT had successfully elicited its intended action. Conclusions. This review synthesized a small but burgeoning area of research. Community engagement was important for successful KT; however, more discussion and discourse on the tensions, challenges and opportunities for improvement are necessary.

Rainfall variability and related hydrological disasters are serious threats to agricultural production in developing countries. Since projections of climate change indicate an increase in the frequency and intensity of climatic hazards such as flooding and droughts, it is important to understand communities’ adaptive capacity to extreme hydrological events. This research uses a case study approach to characterize the current vulnerability and adaptive capacity of the food system to hydrological hazards in Panaillo, a flood-prone indigenous community in the Peruvian Amazon. Participatory methods were utilized to examine how biophysical and socioeconomic factors constrain or enable local adaptive capacity to climatic hazards over time. Seasonal flooding was shown to strongly influence agriculture and fishing cycles. Panaillo residents have developed several adaptive strategies to adjust to hydrological extremes, such as food-sharing and the cultivation of fast-growing crops on riverbeds. However, Panaillo residents generally lack the necessary human, physical, social, and natural resources to effectively employ their adaptive mechanisms as a result of major social and environmental changes in the area. Economic development, low institutional capacity, climate variability, and the assimilation social model in Peru all have profound effects on the food system and health by affecting the ways in which adaptive strategies and traditional livelihoods are practiced. Climate change has the potential to exacerbate these socioeconomic and biophysical drivers and further compromise community food systems in the Peruvian Amazon in the future.

Although malnutrition and malaria co-occur among individuals and populations globally, effects of nutritional status on risk for parasitemia and clinical illness remain poorly understood. We investigated associations between Plasmodium falciparum infection, nutrition, and food security in a cross-sectional survey of 365 Batwa pygmies in Kanungu District, Uganda in January of 2013. We identified 4.1% parasite prevalence among individuals over 5 years old. Severe food insecurity was associated with increased risk for positive rapid immunochromatographic test outcome (adjusted relative risk [ARR] = 13.09; 95% confidence interval [95% CI] = 2.23–76.79). High age/sex-adjusted mid-upper arm circumference was associated with decreased risk for positive test among individuals who were not severely food-insecure (ARR = 0.37; 95% CI = 0.19–0.69). Within Batwa pygmy communities, where malnutrition and food insecurity are common, individuals who are particularly undernourished or severely food-insecure may have elevated risk for P. falciparum parasitemia. This finding may motivate integrated control of malaria and malnutrition in low-transmission settings.

Leishmaniasis is a spectral disease, caused by obligate intracellular protozoa of the species Leishmania. There are multiple reported instances where neurological manifestations, whether central or peripheral, are described. In this review we describe neurological manifestations seen during infection with Leishmania spp. Taken together, the material discussed here suggests that in patients from Leishmania-endemic areas, when observing neurological symptoms, causation secondary to infection with Leishmania spp. may be considered.

Antecedentes: Los antimoniales pentavalentes aún son el tratamiento de primera línea para leishmaniasis tegumentaria, a pesar de ser cardiotóxicos. Existen pocos estudios sobre alteraciones electrocardiográficas en pacientes mayores de 40 años, considerándolos grupo de riesgo para el desarrollo de cardiotoxicidad. Objetivo: Describir las alteraciones electrocardiográficas en pacientes mayores de 40 años con leishmaniasis tegumentaria tratados con antimoniales pentavalentes. Material y métodos: Serie de casos. 1,057 pacientes con leishmaniasis tegumentaria fueron tratados entre los años 2015-2019 en el Programa de Leishmaniasis, seleccionando 150 pacientes mayores de 40 años que contaban con electrocardiograma previo y al término del tratamiento. Resultados: El ratio hombre/mujer fue de 2,2, 37/150 pacientes tenían 65 años a más, 24/150 tuvieron leishmaniasis mucosa. 30/150 tuvieron comorbilidades (hipertensión arterial, diabetes mellitus tipo 2, obesidad, hipotiroidismo o tabaquismo), 117/150 usaron dosis de 20mgSb5+/kg/día. La frecuencia ECGs con evidencia de intervalo QT prolongado aumentó (7/150 vs 13/150). El intervalo QTc se incrementó en 12,06ms (IC95% 6,35 a 17,77ms) al final del tratamiento. La frecuencia de alteraciones de la onda T aumentó (51/150 vs 74/150). La amplitud de la onda T disminuyó en 0,35mV (IC95% 0,25 a 0,45mV). No hubo alteraciones en cuanto al intervalo PR ni complejo QRS. No se reportaron arritmias ventriculares, ni muertes. Conclusiones: Se concluye que los antimoniales pentavalentes producen cardiotoxicidad, evidenciado por un incremento del intervalo QTc y una disminución en la amplitud de la onda T en pacientes mayores de 40 años. Background: Pentavalent antimonials still are the first-line treatment for tegumentary leishmaniasis, despite being cardiotoxic. There are few studies on electrocardiographic alterations in patients over 40 years old, being a risk group for the development of cardiotoxicity. Objective: To describe electrocardiographic alterations in patients over 40 years old with tegumentary leishmaniasis treated with pentavalent antimonials. Material and methods: Case series. 1.057 patients with tegumentary leishmaniasis were treated from 2015 to 2019 in the Leishmaniasis Programme, selecting 150 patients over 40 years old with an electrocardiogram at the beginning and the end of treatment. Results: The ratio male/female was 2.2, 37/150 patients were over 65 years old, 24/150 had mucocutaneous disease, 30/150 had comorbidities associated with QT interval prolongation (arterial hypertension, type 2 diabetes mellitus, obesity, hypothyroidism or smoking history), 117/150 used dose of 20mgSb5+/kg/day. There was an increase in the frequency of prolonged QTc intervals (7/150 vs 13/150). QTc interval increased by 12.06ms (95% CI 6.35 to 17.77ms). The frequency of T wave alterations increased (51/150 vs 74/150). T wave amplitude decreased by 0.35mV (95% CI 0.25 to 0.45mV). There were no alterations in terms of the PR interval or QRS complex. Ventricular arrhythmias or deaths were not reported. Conclusions: Pentavalent antimonials cause cardiotoxicity, evidenced by an increase of QT interval and decrease in the T wave amplitude in patients over 40 years old.

Antecedentes: La leishmaniasis cutánea (LC) es una enfermedad infecciosa endémica en Perú. En áreas rurales es común la manipulación de las lesiones y el uso de tratamientos tradicionales como primera opción terapéutica. Lamentablemente, se desconoce la frecuencia y efectos de la manipulación en hospitales de referencia. Se seleccionó el Programa de Leishmaniasis del Hospital Cayetano Heredia, Lima. Objetivo: Describir la prevalencia y potenciales efectos de la manipulación de lesiones de LC en un hospital de referencia. Material y métodos: Se realizó un estudio observacional descriptivo, retrospectivo (serie de casos), utilizando registros clínicos de pacientes que acudieron al Programa de Leishmaniasis del Hospital Cayetano Heredia, centro de referencia nacional, durante junio – diciembre 2017. Resultados: Se trabajó con 124 pacientes con LC de los cuales el 54% (67/124) manipularon sus lesiones; un 92.54% (62/67) de ellos empleó productos químicos y un 43.25% (29/67), plantas. El efecto en la lesión más frecuentemente reportado por los pacientes fue “aumento de tamaño”, en un 35.82% (24/67) e “incremento de inflamación”, en un 28.36% (19/67). La manipulación disminuyó significativamente la positividad del diagnóstico parasitológico en aquellos con lesiones ulcerativas, a través del frotis; 85% (40/47) en los que no se manipularon versus 66.03% (35/53) en los que sí (p=0.0287). En el análisis global de lesiones no se observó el efecto de dicha manipulación (p=0.198). Conclusiones: En esta serie hospitalaria, la manipulación de lesiones de LC por los pacientes es una práctica frecuente (54%) que reduce significativamente el diagnóstico parasitológico a través del frotis en lesiones ulcerativas.

Se realizó un estudio transversal y retrospectivo, con el objetivo de determinar los factores socioculturales que influyen en el abandono de la lactancia materna exclusiva antes de que el bebé cumpla seis meses, en mujeres del Distrito de Piura. Para tal fin, se realizó una encuesta a 169 madres que acudieron a los establecimientos de salud públicos en busca de atención para sus niños de 6 a 8 meses de edad. También se realizó entrevistas en profundidad a madres con diferentes tipos de ocupación y grupos focales a mujeres residentes en zonas rurales, urbanas y urbano – marginales. Mediante regresión logística se pudo determinar que el abandono de la lactancia materna está asociado a la insuficiente producción de leche referida por la madre (p=0.001, OR=36.401), llanto del niño/a (p=0.24. OR=6.914), trabajar como profesional o ser estudiante (p=0.001, OR=6.199) e inicio de la lactancia materna después de la primera hora del nacimiento (p=0.002, OR=3.870). El estudio cualitativo permitió conocer algunas deficiencias en la atención de los profesionales de la salud, por lo cual, es necesario mayor capacitación y supervisión para asegurar la adecuada consejería a las madres y sus familias, para satisfacer sus necesidades y las del lactante.

Introducción: A medida que la transmisión de malaria se vuelve más focalizada en lugares de baja transmisión, resulta crucial la identificación precisa de las zonas con mayor transmisión ó hotspots de malaria que permita el desafío e implementación de intervenciones de control. Este estudio tuvo como objetivo determinar si los hotspots de malaria detectados utilizando marcadores serológicos e incidencia reportada de malaria estuvieron asociados con la incidencia de la malaria por P. vivax en el año siguiente en una zona de baja endemicidad de la costa norte peruana. Métodos: Después del censo poblacional y geo-referenciación de todos los episodios por P. vivax reportados entre junio de 2009 y mayo de 2010 (año 1), se llevó a cabo una encuesta serológica y parasitológica (junio de 2010). Mediante ELISA se detectaron anticuerpos IgG específicos a la proteína de superficie del merozoito 1-19 (PvMSP-119) y al antígeno de membrana apical-1 (PvAMA-1) de P. vivax. Después de la encuesta, una detección pasiva de casos (PCD) optimizada entre junio de 2010 y mayo de 2011 (año 2), permitió la detección de nuevos episodios por P. vivax en el área de estudio. Tanto el análisis espacial de la incidencia acumulada de P. vivax en el año 1, como el análisis espacial de la seropositividad a P. vivax al momento de la encuesta permitieron la identificación retrospectiva de hotspots. Se utilizó regresión logística para evaluar la asociación entre los hotspots y la incidencia de la malaria en el año siguiente. Resultados: La incidencia de malaria por P. vivax se redujo notablemente del año 1 (416 episodios) al año 2 (32 episodios). A pesar de esta reducción, la regresión logística encontró que los hogares (HH) ubicados dentro de los hotspots (identificados usando tanto marcadores serológicos como incidencia en el año 1) se asociaron significativamente con la aparición de episodios por P. vivax en HH en el año 2 (p

Para conocer las características del inicio sexual de hombres que tienen sexo con hombres (HSH) y mujeres transgénero (MTG) de alto riesgo y su asociación con el comportamiento sexual actual en cinco ciudades del Perú, se analizó la base de datos del módulo sobre inicio sexual obtenida de 4,401 HSH y 710 MTG participantes en un estudio transversal de vigilancia centinela de VIH del 2011. En los HSH, la mediana de edad del inicio sexual fue 15.0 años y 16 años para la primera relación sexual anal (PRSA). El 44.2% tuvo su inicio sexual con una mujer. Una PRSA no protegida (Odds ratio ajustado por grupo de edad, nivel educativo y ciudad =AOR: 1.47) y una pareja de identidad desconocida (AOR: 1.61) estuvieron asociados a tener >5 parejas en los 6 meses previos al estudio. El recibir dinero (AOR: 2.61) en la PRSA estuvo asociada con trabajo sexual actual; el tener una pareja desconocida (AOR: 1.64) con el diagnóstico de ITS; mientras una PRSA no protegida (AOR: 2.56) con la última relación sexual anal no protegida. En las MTG la mediana de edad de inicio sexual fue 14.0 años, y 15.0 años para la PRSA. El 93.9% tuvo su inicio sexual con un hombre. Una PRSA no protegida (AOR: 1.64) y una pareja de edad 4-7 años mayor (AOR: 1.79) estuvieron asociados con >5 parejas. Una pareja de edad 1-3 años mayor (AOR: 2.82) en la PRSA estuvo asociada con trabajo sexual; y una PRSA no protegida (AOR: 2.54) con la última relación sexual anal no protegida. Un inicio sexual seguro en HSH y MTG podría disminuir el comportamiento sexual de riesgo futuro.

Introducción. Debido a los riesgos y externalidades económico-sociales producido por la Bartonellosis Humana, así como las graves repercusiones en la Salud Pública de la región y del país, se hace necesario investigar, los conocimientos, las actitudes y las prácticas de la población del distrito de Las Pirias. La finalidad es aportar al diseño de políticas y estrategias educativo comunicacionales para su control. Objetivo. Determinar el nivel de Conocimientos, actitudes y Prácticas acerca de la enfermedad de la Bartonellosis. Material y métodos. Estudio poblacional descriptivo transversal desarrollado entre Enero 2004 y Marzo del 2005 en el Distrito de Las Pirias, provincia de Jaén departamento de Cajamarca. El universo fue de 2,699 personas iguales o mayores a 18 años, distribuidas en 23 localidades. El muestreo fue en forma aleatoria, por conglomerado bietápico y se entrevistó a 391 personas. Los datos fueron obtenidos mediante la aplicación de tres instrumentos: 14 preguntas de conocimientos, 16 de actitudes y 06 de prácticas con p= a 0.05 y 95% de confianza RESULTADOS: Los resultados extendidos a una población de 2699 personas mayores o igual a 18 años de edad mostraron que: un 24,8% tenían conocimientos suficientes, el 97,5% actitudes favorables pero sólo el 12,25% presentaba prácticas saludables en relación a la Bartonellosis. CONCLUSIONES: La población de Las Pirias tiene conocimientos básicos, actitudes favorables y prácticas no saludables en relación a la Bartonellosis, lo cual sugiere un pobre aporte de la población al control de esta enfermedad.