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Guimar es MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and Ne

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Guimar es MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and Ne

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    1. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    2. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    3. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    4. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    5. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    6. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    7. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    8. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    9. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    10. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    11. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute RATIONALE Increased vulnerability and higher STI prevalence among mentally ill patients [ ? ? ? ] Need to establish prevention and health care strategies for both, AIDS and Mental Health Programs Absence of representative risk behavior or STI seroprevalence data

    12. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    13. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    14. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute PESSOAS PROJECT OBJECTIVES To determine the prevalence of HIV, syphilis, and Hepatitis B and C among mentally ill patients in psychiatric hospitals and CAPS units in Brazil To describe socio-demographic, behavioral, clinical aspects of the study population

    15. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute DIMENSIONS

    16. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute METHODS DESIGN: Cross-sectional national sample POPULATION: Chronic mentally ill patients hospitalized in public hospitals or under care in CAPS units randomly selected Eligibility criteria: Adults (> 18 years old) Hospitalized for at least seven days (Inpatients) OR Under care in CAPS units [ Except CAPS Ad] Capable of answering the questionnaire Written consent to participate

    17. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute PROCEDURES SEMI-STRUCTURED INTERVIEW Socio-demographics, STI perception and knowledge, behavior, risk and vulnerability profiles MEDICAL CHARTS Clinical data (Psychiatric & STI Dx and Treatment) SEROLOGY Hepatitis B Surface Antigen (HBsAg) (ELISA, BioMérieux®) Hepatitis B Total Antibody (Anti-HBc) (ELISA, BioMérieux®) Hepatitis C antibody (Anti-HCV) (ELISA, Adaltis®) HIV (Anti-HIV 1 e 2) (ELISA, Dade Bhering®) & WB (Genelabs Abbott®) Syphilis (VDRL, Wiener Lab®) & Hemaglutinin – HAI, BioMérieux®). HEALTH SERVICE EVALUATION Structural and process aspects: referral system, STI prevention programs, counseling, services offered QUALITATIVE INTERVIEW Ethnographic and social representation aspects

    19. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute ANALYSIS DESCRIPTIVE SEROPREVALENCE Corrected for clustering by Huber/White Sandwich (Rogers, 1993) Weighted by sample size relative to the total population Associations with UNSAFE SEX: Sexually active past six months Not always using condoms in the past six months Multivariate logistic regression Odds Ratio with 95% confidence limits Associations with PREVALENT HIV infection: Multivariate Poisson regression Prevalence ratio with 95% confidence Corrected for clustering by Huber/White Sandwich (Rogers, 1993) Weighted by sample size relative to the total population Database: Paradox / Analysis: SAS, STATA

    20. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    21. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    22. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    23. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute DESCRIPTIVE RESULTS (n=2475), PROJETO PESSOAS Sociodemographics (%) CAPS (64) Women (52) White or mulato (84) Singles/Separated (67) Age > 39 yeas old (56) Didn’t know how to read or write (18) Schooling < 4 years (34) Monthly family income (< US$ 150) (35) No health insurance (90) History of homelessness (18) Currently living in institutional setting (10)

    24. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    25. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    26. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    27. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    28. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    29. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    30. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    31. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    32. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    33. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    34. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    35. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    36. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    37. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    38. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    39. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    40. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    41. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    42. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    43. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    44. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    45. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    46. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    47. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    48. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    49. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

    50. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute Brazilian AIDS Program: CHALLENGES Non-adherence 37% Drop-outs (pharmacy) 30% Irregular pharmacy pick-ups 58% Late ARV therapy start 44-68% Unsafe sex among HIV+ men 25-30% Low general HIV Testing Increasing HIV/AIDS prevalence among women Increasing HIV/AIDS prevalence among young MSM

    53. © Guimarăes MDC. Grand Rounds April 24, 2008. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute

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