Made available in DSpace on 2015-08-20T17:09:25Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-02-26. Added 1 bitstream(s) on 2015-08-20T17:27:11Z : No. of bitstreams: 1 000840966.pdf: 294356 bytes, checksum: 390fdd32d2ab5b9506a50b66541d14fc (MD5) / A raiva é uma zoonose transmitida aos mamíferos por meio do contato de ferimentos na pele ou mucosa com a saliva de animais infectados e o tratamento profilático pós-exposição tem sido usado como uma forma de se evitá-la. Este tratamentoébaseado nas características da lesão provocada pelo animal agressor, no seu estado de saúde no momento do acidente, na possibilidade de sua observação por dez dias, na procedência e hábitos de vida do animal e naclassificação epidemiológica da região geográfica onde ocorreu o acidente.Foi realizado um estudo retrospectivo dosdados das fichas de atendimento antirrábico humano do Sistema de Informação de Agravos de Notificação (SINAN), referentes ao município de Araçatuba -SP, no período de 1990 a 2010, com o objetivo de avaliar a conduta adotada para as indicações do tratamento antirrábico humano pós-exposição por agressões de cães e gatos, considerando a situação epidemiológica da doença.O cão foi o principal agressor, ocasionando acidentes em sua maioria leves, a dispensa do tratamento foi a conduta mais adotada tanto no período de raiva não controlada (1990-96) quanto no período de raiva controlada (1997-2010), porém na maioria dos casos em que foi indicado algum tratamento, este foi inadequado. Optou-se preferencialmente pelo tratamento completo com soro e vacina e pelo tratamento de até três doses de vacina Fuenzalida e Palácios ou até duas doses de vacina de cultivo celular em dias alternados. Noperíodo de raiva controlada observou-se com uma melhor adoção das condutas frente às recomendações técnicas quando comparadoaos período de raiva não controlada (p<0,0001), mesmo havendo uma aplicação excessiva de soro e vacinaem ambos o períodos / Rabies is a zoonosis transmitted to mammals by contact of saliva from infected animals with injury in the skin or mucous and the post-exposure prophylactic treatment is the only way to prevent this disease. This treatment is based on the characteristics of the injury caused by the aggressor animal, on his state of health at the time of the accident, on the possibility of their observation for ten days, on the origin and habits of the animal and on the epidemiological classification of the geographic region where the accident occurred. By means of a retrospective analysis of data from the records of rabies prophylactic treatment from Information System for Notification of Diseases (SINAN), concerning to Araçatuba - SP the conducts adopted for treatment of aggression by dogs and cats, considering the epidemiological situation of the disease. The dog was the main aggressor, causing mostly minor accidents, remission of treatment was the most adopted conduct in both period of non controlled rabies (1990-96) and controlled rabies (1997-2010), but, in the majority of cases when any treatment was adopted, this was inadequate. It was decided preferably by the full treatment with the serum and the vaccine and by the treatment with up to three doses of Fuenzalida and Palacius vaccine or up to two doses of cell culture vaccine on alternate days. In the period of controlled rabies there was a better adoption of conducts, based on technical recommendations, when compared to the period of uncontrolled rabies (p <0.0001), even with the excessive application of serum and vaccine in both periods

Resumo: A raiva é uma zoonose transmitida aos mamíferos por meio do contato de ferimentos na pele ou mucosa com a saliva de animais infectados e o tratamento profilático pós-exposição tem sido usado como uma forma de se evitá-la. Este tratamentoébaseado nas características da lesão provocada pelo animal agressor, no seu estado de saúde no momento do acidente, na possibilidade de sua observação por dez dias, na procedência e hábitos de vida do animal e naclassificação epidemiológica da região geográfica onde ocorreu o acidente.Foi realizado um estudo retrospectivo dosdados das fichas de atendimento antirrábico humano do Sistema de Informação de Agravos de Notificação (SINAN), referentes ao município de Araçatuba -SP, no período de 1990 a 2010, com o objetivo de avaliar a conduta adotada para as indicações do tratamento antirrábico humano pós-exposição por agressões de cães e gatos, considerando a situação epidemiológica da doença.O cão foi o principal agressor, ocasionando acidentes em sua maioria leves, a dispensa do tratamento foi a conduta mais adotada tanto no período de raiva não controlada (1990-96) quanto no período de raiva controlada (1997-2010), porém na maioria dos casos em que foi indicado algum tratamento, este foi inadequado. Optou-se preferencialmente pelo tratamento completo com soro e vacina e pelo tratamento de até três doses de vacina Fuenzalida e Palácios ou até duas doses de vacina de cultivo celular em dias alternados. Noperíodo de raiva controlada observou-se com uma melhor adoção das condutas frente às recomendações técnicas quando comparadoaos período de raiva não controlada (p<0,0001), mesmo havendo uma aplicação excessiva de soro e vacinaem ambos o períodos / Abstract: Rabies is a zoonosis transmitted to mammals by contact of saliva from infected animals with injury in the skin or mucous and the post-exposure prophylactic treatment is the only way to prevent this disease. This treatment is based on the characteristics of the injury caused by the aggressor animal, on his state of health at the time of the accident, on the possibility of their observation for ten days, on the origin and habits of the animal and on the epidemiological classification of the geographic region where the accident occurred. By means of a retrospective analysis of data from the records of rabies prophylactic treatment from Information System for Notification of Diseases (SINAN), concerning to Araçatuba - SP the conducts adopted for treatment of aggression by dogs and cats, considering the epidemiological situation of the disease. The dog was the main aggressor, causing mostly minor accidents, remission of treatment was the most adopted conduct in both period of non controlled rabies (1990-96) and controlled rabies (1997-2010), but, in the majority of cases when any treatment was adopted, this was inadequate. It was decided preferably by the full treatment with the serum and the vaccine and by the treatment with up to three doses of Fuenzalida and Palacius vaccine or up to two doses of cell culture vaccine on alternate days. In the period of controlled rabies there was a better adoption of conducts, based on technical recommendations, when compared to the period of uncontrolled rabies (p <0.0001), even with the excessive application of serum and vaccine in both periods / Orientador: Luzia Helena Queiroz / Banca: Cáris Maroni Nunes / Banca: Adolorata Aparecida Bianco Carvalho / Mestre

It is estimated that 50,000 individuals become newly infected with human immunodeficiency virus (HIV) every year in the United States. HIV is a lentivirus that is primarily spread through sexual contact. If left untreated, this viral infection can lead to decreased CD4+ T cells, increased susceptibility to opportunistic infections, and eventually progression to acquired immunodeficiency syndrome (AIDS) and death. HIV viral loads can be decreased to undetectable levels with the use of combination antiretroviral therapy (cART). In 2012 the Food and Drug Administration approved cART therapy, Truvada (tenofovir/emtricitabine), for safe use as pre-exposure prophylaxis (PrEP). When detectable levels of drug are present in the blood stream of patients, there is up to a 92% relative risk reduction in HIV infection compared to placebo. The implementation of PrEP has the potential to decrease the incidence of new HIV infections in at-risk populations worldwide. Because PrEP treatment is relatively new (2012), there are many barriers to administration to patients. Increased risky sexual behavior, known as risk compensation, is one of the concerns providers cite as a reason against prescribing PrEP. Most publications on PrEP have described randomized controlled trials that focused on safety, efficacy, and to a lesser extent, risk compensation behaviors. Now that Truvada is widely available, researchers are starting to elucidate patients’ sexual habits while using PrEP in the outpatient settings. However, there is a need for more longitudinal research regarding the behaviors of individuals using PrEP, specifically to determine how often risk compensation occurs and under what conditions. This study will initiate a PrEP clinic at Boston Medical Center and run a 3 year, open-label randomized controlled trial of eligible men who have sex with men (MSM) patients, who either start PrEP immediately or are delayed by one year. It is hypothesized that condom usage will decrease among immediate PrEP participants compared to the delayed participants. The study aims to determine if risk compensation occurs in these patients by following condom usage, development of sexually transmitted infections, number of sexual partners, and number/type of sexual encounter. Secondary outcomes will include measurements of medication adherence and number of HIV-seroconverters. These data will be collected through surveys and laboratory testing. The resulting information will help medical professionals better understand the risks and benefits of PrEP and also how to implement it most effectively in the fight to reduce the worldwide HIV burden.

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Orientador: Cáris Maroni Nunes / Coorientador: Luzia Helena Queiroz / Banca: Adolorata Aparecida Bianco Carvalho / Banca: Rafael Silva Cipriano / Resumo: A raiva é uma zoonose globalmente distribuída que apresenta alta letalidade, constituindo grande problema em saúde pública. A persistência do vírus da raiva nas populações é mantida devido sua capacidade de se replicar em diversas espécies de mamíferos, incluindo os humanos. O controle da raiva urbana tem se baseado na vacinação de cães e gatos, reservatórios importantes no ciclo urbano, bem como no atendimento de indivíduos após exposição ao vírus da raiva. Adicionalmente, a profilaxia pré-exposição (PrPE) tem sido aplicada em indivíduos que podem ser expostos à infecção, por atividade ocupacional. Objetivando proteger os estudantes ingressantes do Curso de Medicina Veterinária, grupo de risco em potencial para a raiva, a Faculdade de Medicina Veterinária (FMVA) da Unesp, Câmpus Araçatuba, promove anualmente a vacinação em esquema PrPE, seguida de avaliação sorológica, a fim de habituá-los a anualmente verificarem a resposta de anticorpos. Assim, a presente pesquisa teve como objetivo avaliar, por meio de levantamento de dados de PrPE dos arquivos do Serviço de Vigilância Epidemiológica da Secretaria de Saúde da Prefeitura Municipal de Araçatuba, SP, Brasil a adesão à PrPE, a proteção conferida e a dinâmica dos anticorpos (IgG) neutralizantes contra o vírus da raiva, nos estudantes da FMVA durante o período de 2000 a 2017. Foram avaliados 2.404 registros, 86,4% dos quais apresentaram título protetor contra o vírus da raiva (≥0,5UI/mL). A PrPE teve boa adesão pelos estudantes... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Rabies is a globally distributed zoonosis that shows high lethality and is also a major public health problem. Persistence of rabies virus in populations is maintained due to its ability to replicate in several mammals species, including humans. Rabies control has been based on dogs and cats' vaccination, the most important reservoirs in the urban cycle, as well as on the treatment of individuals after exposure to the rabies virus. In addition, pre-exposure prophylaxis (PEPr) has been applied in individuals who might be exposed to infection due to their occupational activities. In order to protect the incoming students of the veterinary medicine course, a group of potential risk for rabies, the School of Veterinary Medicine (FMVA) of Unesp, Araçatuba, SP, Brazil, promotes annual vaccination in a PEPr scheme, followed by a serological evaluation, in order to habituate them to annually check their antibody response. Thus, by analyzing the PEPr data from the archives of the Epidemiological Surveillance Service of the Health Department of Araçatuba, SP, Brazil, during the period from 2000 to 2017, the present study aimed at evaluating the adhesion of the students to the rabies PEPr, the protection conferred by it and the dynamics of the neutralizing IgG antibodies against rabies virus. A total of 2,404 records were evaluated, 86.4% of which presented protective titers against rabies (≥0.5 IU/mL). PEPr had good adhesion by the students, has proved to be effective for generating an... (Complete abstract click electronic access below) / Mestre

Orientador: Cristina Maria Garcia de Lima Parada / Resumo: Introdução: A raiva é uma antropozoonose e sua transmissão se dá pela inoculação do vírus presente na saliva de animais mamíferos raivosos, principalmente por mordidas ou, mais raramente, arranhões e lambedura de mucosa ou em lesões na pele. A profilaxia pós-exposição está indicada para pessoas após mordedura, arranhadura e/ou lambedura por mamífero com potencial rábico. O uso da vacina antirrábica e do soro homólogo ou soro heterólogo é parte do programa de profilaxia da raiva e a indicação depende das características da lesão e do animal agressor. Objetivo Geral: Analisar a adequação das condutas indicadas e desenvolver tecnologia de apoio à tomada de decisão para profilaxia da raiva humana pós-exposição na Rede de Atenção à Saúde. Método: Trata-se de estudo transversal e retrospectivo, baseado na análise dos dados secundários das fichas de notificação de atendimento antirrábico humano inseridas no Sistema de Informação de Agravos de Notificação do município de Bauru-SP, no ano de 2017. A análise da adequabilidade do tratamento foi guiada pelos protocolos do Ministério da Saúde e Instituto Pasteur. Para cálculo do número de inadequações, considerou-se o tratamento realizado e o tratamento adequado, sendo a proporção de inadequação obtida a partir da subtração do total de tratamento adequado do total de tratamento indicado, dividido pelo total de tratamento adequado e multiplicado por 100. O desenvolvimento do aplicativo móvel foi realizado em parceria com a equipe do Núcleo... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Rabies is an anthropozoonosis which is transmitted by inoculation of the virus that is present in the saliva of rabid mammals, mainly through biting or less often by scratching and licking of mucosa or skin lesions. Post-exposure prophylaxis is indicated for patients after being bitten, scratched or licked by potentially rabid mammals. The use of antirabic vaccine and homologous or heterologous serum is part of the rabies prophylaxis program and their indication depends on the characteristics of the lesion and the kind of attacker animal. General goal: To analyze the adequacy of the measures taken and to develop a technological tool for supporting decision making on post-exposure prophylaxis at the healthcare network. Methods: This study is a crosssectional study and retrospective, based on data analysis of notification files on antirabic treatment on humans within the Notification of Injury Information System in the city of Bauru-SP in 2017. The analysis of the suitability of the treatment was guided by the protocols of the Ministry of Health and Instituto Pasteur. For the calculation of the number of inadequacies, the treatment performed and the appropriate treatment were considered, with the proportion of inadequacy obtained by subtracting the appropriate total treatment from the indicated total treatment, divided by the appropriate total treatment and multiplied by 100. The development of a mobile application was carried out in partnership with the team of t... (Complete abstract click electronic access below) / Mestre

This thesis is based on the use of mathematical theories, modelling, and simulations to study the transmission dynamics of HIV/AIDS in the presence of PrEP (pre-exposure prophylaxis) in the MSM (men who have sex with men) population in the United States. A new deterministic model for HIV/AIDS that incorporates PrEP is designed and used to assess the population-level impact of the use of PrEP on the transmission dynamics within an MSM population. Conditions for the effective control (or elimination) and persistence of HIV/AIDS in the MSM population are determined by rigorously analyzing this model. Uncertainty and sensitivity analysis is carried out to determine the effect of the uncertainties in the parameter values on the response variable (the associated reproduction number) and to identify the top-five parameters that have the most effect on the disease transmission dynamics. Numerical simulations show that HIV burden decreases with increasing PrEP coverage. / October 2015

Orientadora: Adolorata Aparecida Bianco Carvalho / Coorientador: Antonio Sergio Ferraudo / Banca: Angela Cleusa de Fátima Banzatto de Carvalho / Banca: Sonia Regina Pinheiro / Resumo: Um elevado número de tratamentos anti-rábicos profiláticos são efetuados, anualmente, em pessoas envolvidas em agravos com animais. Assim, este trabalho objetivou avaliar os registros e a conduta de profilaxia anti-rábica humana no Município de Jaboticabal, de 2000 a 2006, analisando as informações das fichas de atendimento e a distribuição geográfica dos agravos. Os dados foram tabulados em Excel e analisados com softwares EpiInfo e MapInfo. Também foi calculado o custo direto com as vacinas anti-rábicas humanas. Em 3056 fichas analisadas, computou-se um agravo para cada 160 habitantes, com maior ocorrência em residências e nos bairros da região central da cidade, e incremento de casos nos meses de janeiro, julho, agosto e dezembro. A faixa etária mais atingida foi de 0 a 15 anos, destacando-se o sexo masculino. Com relação à espécie animal envolvida, a canina foi a responsável pela maioria dos agravos, sendo 67,5% dos cães e 22,2% dos gatos declarados vacinados; os cães estavam sadios em 77,8% dos casos. Das pessoas agredidas, 81,6% receberam profilaxia pós-exposição, num total de 7.108 doses de vacina e a um custo aproximado de R$179.105,14. A análise detalhada dos dados, aliada ao fato de Jaboticabal ser considerada região controlada para a raiva, permitem questionar que 1.720 pessoas podem ter recebido vacina sem necessidade. Uma maior atenção deve ser dispensada aos registros de atendimento a agravos por animais, e uma análise acurada e mais criteriosa destes deve ser feita para que os tratamentos sejam instituídos adequadamente. Como a maioria dos acidentes ocorre em residências, portanto com cães e gatos domiciliados e vacinados, recomendam-se programas educativos para promoverem a posse responsável e o conhecimento dos cuidados que as pessoas devem ter com seus animais de estimação. / Abstract: A large number of rabies post-exposure treatment is annually given to humans attacked by animals. This study was aimed to evaluate the records and the conduct of rabies prophylaxis in humans, in the municipality of Jaboticabal, from 2000 to 2006, through the analysis of patients' records and geographic distribution of the accidents. The data were arranged in Excel® spreadsheets and were further analysed by EpiInfo® and MapInfo®. Also, the direct costs of given vaccines were calculated. From 3,056 patient's cards, it was observed 1 animal attack per 160 inhabitants, with higher occurence in residences, central neighborhoods and concentration of attacks in the months of January, July, August and December. The most affected age group was that of 0-15 years old, with predominance in males. As to animal species, dogs were responsible for causing the majority of accidents. 67.5% of dogs and 22.2% of cats had already been vaccinated before attacking. In 77.8% of occurences, the dogs were healthy. As to attacked humans, 81.6% of them received post-exposure prophylaxis, totalizing 7,108 antirabies vaccine doses at an approximate cost of R$179.105,14. Thorough data analysis and the fact that Jaboticabal lies in a rabies controlled region allow to question the administration of post-exposure vaccination in 1,720 persons. More attention should be payed to filling out and interpreting patient's records correctly, so that treatments can be properly established. As most attacks happen in the residences, where cats and dogs are usually domiciled and vaccinated, it is essencial to develop educational programs that promote responsible pet ownership and adequate pet handling and care. / Mestre

BACKGROUND: Although the total number of new documented HIV diagnoses annually decreased from 2008-2018, the rate of decrease started to slow in 2013, and substantial variation exists across at-risk groups. People who inject drugs (PWID) account for 9% of new diagnoses annually, with increasing incidence in this population starting in 2015. Among PWID, 34% of new HIV diagnoses occurred in individuals who were also classified as men who have sex with men (MSM), indicating that MSM-PWID have elevated HIV risk. Data on MSM-PWID are scarce, and programmatic and advocacy efforts in HIV prevention do not specifically target MSM-PWID, with no CDC-recommended interventions existing for this population. OBJECTIVE: We sought to characterize the complex, intersecting and unique HIV risks faced by MSM-PWID, including perceptions of HIV risk and attitudes toward antiretroviral pre-exposure prophylaxis (PrEP) among MSM-PWID in urban and non-urban areas of Massachusetts and Rhode Island. METHODS: We recruited PWID through community-based organizations (CBOs; e.g. syringe service programs) in 18 urban centers and smaller cities and towns across Massachusetts and Rhode Island. Participants completed semi-structured interviews exploring substance use behaviors and HIV prevention needs. This in-depth analysis focused on describing the experiences and HIV prevention needs and attitudes of nine participants in the sample who reported a sexual orientation other than “heterosexual.” RESULTS: Most participants identified as cisgender, bisexual men. However, the context of their sexual behaviors varied, with some participants only engaging in same-sex behavior during sex work. The relationship between identity and behavior is explored in the context of reported risk behavior. All participants engaged in at least one behavior that increased risk of HIV acquisition, including syringe sharing, inconsistent condom use, and sex work. Participants also described heightened risk when these behaviors overlapped, particularly within contexts of “sex parties” that some individuals described. At the same time, experiences of isolation and exclusion were common in the sample, indicating a potential vulnerability in this population. HIV risk perception varied among participants, but was not consistently aligned with the behaviors described. Many participants did not perceive needing HIV prevention services “yet,” indicating that they did not view their risk to be high enough to warrant prevention services. Alternatively, some described needing to prioritize daily survival and mental health over HIV prevention efforts. Although knowledge of PrEP was low, acceptability of PrEP was high in this sample, and several participants provided specific suggestions for improving the feasibility of PrEP. CONCLUSION: Data from this study illustrate the HIV risks and prevention needs of this at-risk population and highlight mechanisms to engage them in preventative care. Our main findings are (1) participants had low knowledge of PrEP, but were largely enthusiastic after learning about it from interviewers, (2) varying identity related to same-sex behavior among men who have sex with men and inject drugs may play a role in shaping HIV risk and prevention needs, (3) specific healthcare and prevention service needs of this population emerged, including reducing risk at sex parties and improving access to non-stigmatizing mental health services. An in-depth understanding of the ways in which sexual orientation and gender identity shape HIV risk and prevention needs remains crucial in providing treatment and prevention services to MSM-PWID.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Pre-exposure prophylaxis (PrEP) has limited availability across Latin America, though access is increasing. We explored PrEP uptake in Mexico via an online survey completed by Spanish-speaking, Hornet geosocial networking application (GSN app) users without HIV (n = 2020). Most (81.3%) had heard of PrEP, 3.5% were current users, and 34.2% intended to take PrEP within six months. Current PrEP use was associated with PrEP eligibility (aOR 26.07 [95%CI 13.05–52.09], p < 0.001), recent STI testing (aOR 3.79 [95%CI 1.10–13.11], p = 0.035), and recent chemsex (aOR 3.02 [95%CI 1.02–8.93], p = 0.046). Recent STI testing was associated with hearing about PrEP from a doctor (aOR 3.26 [95%CI 1.98–5.36], p < 0.001), and those who lived in large cities were less likely to have learned about PrEP via Hornet (aOR 0.52 [95%CI 0.32–0.85], p = 0.009). Interventions to increase PrEP uptake in Mexico should build upon existing health networks and utilize GSN apps for PrEP information dissemination, particularly in less populated areas. / University of California / Revisión por pares