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“RELATIVE”

“RELATIVE”. Adele S chwartz Benzaken UNAIDS/BRAZIL. Fundação Alfredo da Matta , Manaus , Brasil. AMAZON REGION. Biggest Brazilian geographic area, but the lowest demographic density (4 hab /km²) 195 indigenous ethnic groups (90.000 hab ) - 55,7% of the

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“RELATIVE”

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  1. “RELATIVE” Adele Schwartz Benzaken UNAIDS/BRAZIL Fundação Alfredo da Matta, Manaus, Brasil

  2. AMAZON REGION • Biggest Brazilian geographic area, but the lowest • demographic density (4 hab/km²) • 195 indigenous ethnic groups (90.000 hab) - 55,7% of the • indigenous population in Brasil • Difficult access in the indigenous communities and no • laboratory infrastructure for perform Syphilis and HIV • diagnosis despite being national guideline for ANC. • Indigenous infant mortality of 54.5 per 1,000 livebirths • (2004)

  3. FUNASA/SESAI- Indigenous Health Sub-System of Brazil 9 DSEI“Special Indigenous Health Districts” in Amazon *Includes retraining

  4. INCREASING ACCESS TO HIV AND SYPHILIS SCREENING IN REMOTE AREAS USING RAPID TESTS IN THE AMAZON REGION

  5. SYPHILIS AND HIV SCREENING RESULTS Syphilis positivity in sexually active population HIV Prevalence in sexually active population # screened/sexually active population (%) DSEI Syphilis positivity in Pregnant Women HIV Prevalence in Pregnant Women 0.11% 6/424 (1.42%) 0/424 (0.0%) 1.61% 7.122/10.980 64.9% Manaus 0.12% 3/749 (0.40%) 0/749 (0.00%) Yanomami 0.00% 3.400/4.317 78.8% 0.85% 4/789 (0.51%) 1/789 (0.13%) 0.10% Leste Roraima 3.892/ 4.038 96.4% 0.04% 2.04% Alto Solimões 0/1.443 (0.0%) 37/1.443 (2.56%) 19.888/25.322 78.5% 0.35% 0.04% 1/253 (0.40%) 0/253 (0.0%) Parintins 2.308/4.904 47,1% 0.72% 7/893 (0.78%) Alto Rio Negro 0.04% 0/893 (0.0%) 7.256/19.872 36,5% 3.14% Médio Solimões 1/76 (1.32) 573/9.092 6,3% 0.00% 0/76 (0.0%) 0% Médio Purus 0/20 (0.0%) 329/2.950 11,2% 0/20 (0.0%) 0.0% 5.87% 5/149 (3.36%) Vale do Javari 1.875/2.563 73,2% 2/149 (1.34%) 0.16% 46.643/83.311 55.5% 731/46.643 1.57% 51/46.643 0.11% 63/4.639 1.36% 3/4.639 0.06% Total

  6. Quality Control DTS

  7. CHANGING NATIONAL POLICIES • NATIONAL STI PROGRAM AND SESAI- are implementing Syphilis and HIV RT at ANC in all indigenous communities throughout Brasil • STORK INITIATIVE : a national pre and neonatal primary care network , conducted by MoH, will use HIV and Syphilis RT in the public health system (estimated of 2 million pregnant women per year) • PRODUCING RST IN THE COUNTRY • MoH USING RST IN DIFFERENT SCENARIOS AND SPECIFIC POPULATIONS: • NATIONAL LAB TRAINING- Introduction of RST in TELELAB by MoH • NATIONAL MANAGEMENT GUIDELINE- Introduction of RST to the algorithm diagnostic of acquired syphilis by MoH • INTEGRATE QA/QC USING DTS - adopted by MoH in the National VCT clinics; Training others countries in LA founded by CDC

  8. Relative

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