Point-of-care screening for syphilis and HIV in the borderlands: challenges in implementation in the Brazilian Amazon.

Carole Zen Ruffinen,Ximena Pamela Díaz-Bermúdez,David Mabey,Rosanna W Peeling,Adele Schwartz Benzaken,Marcus Lacerda,Meritxell Sabidó

doi:10.1186/s12913-015-1155-y

Abstract

BackgroundPoint-of-care (POC) screening for HIV and syphilis using rapid testing was implemented in indigenous communities in the triple-border area of the Brazilian Amazon. We describe the context of the early introduction of POC screening, explore hindering and enabling factors for POC implementation, and recommend strategies for feasible, viable, and sustainable syphilis and HIV screening interventions.MethodsThis was a qualitative study based on grounded theory methodology. Data were collected using in-depth interviews, semi-structured questionnaires, and field observations and were analysed using the framework approach. Qualitative information was complemented by quantitative data for descriptive purposes.ResultsAn overall high score for vulnerability to acquiring HIV and syphilis was observed among the indigenous communities. Health professionals reported satisfactory rapid testing acceptance, although concerns were raised about the pain of the fingerprick. Counselling-related challenges included ensuring the accuracy of translations, collaborating with translators and communicating positive test results. Over 3 months, 86.7 % of the syphilis-positive individuals began treatment, and all of them notified their partners. Accessibility, measured as travel time via the local transportation network, was a barrier to health care access. A lack of gasoline for boats and other transportation was also a hindering factor at all levels of implementation.ConclusionsThe recommendations address the preparation phase at the coordination level as well as at the training level. Tools such as strengths, weaknesses, opportunities, and threats (SWOT) analyses; checklists; context-adapted protocols; and fact sheets are very simple methods to facilitate implementation. The findings of this study are important because they may inform the implementation of new health technologies in low-resource national disease control programmes in remote communities.

Highlights

Point-of-care (POC) screening for HIV and syphilis using rapid testing was implemented in indigenous communities in the triple-border area of the Brazilian Amazon
The current study was conducted in the Alto Solimões DSEI, which is located in northern Brazil at the triple border with Colombia and Peru, during the first three months of the implementation process for community-based POC screening for HIV and syphilis
Demographics and vulnerability to acquiring HIV and syphilis among the indigenous people The Alto Solimões DSEI is located in the triple-border area and has 43,259 indigenous inhabitants, [18] 25,322 of whom are of reproductive age (58 %)

Summary

Introduction

Point-of-care (POC) screening for HIV and syphilis using rapid testing was implemented in indigenous communities in the triple-border area of the Brazilian Amazon. The Brazilian Amazon region is characterised by scattered and isolated communities, a fragile physical infrastructure, and a shortage and high rotation of health staff, all of which hinder efforts to implement point-ofcare (POC) testing for syphilis and HIV. From 2008 to 2010, a consortium of institutions introduced community-based POC screenings for syphilis and HIV among remote indigenous groups in the Brazilian Amazon. The current study was conducted in the Alto Solimões DSEI, which is located in northern Brazil at the triple border with Colombia and Peru, during the first three months of the implementation process for community-based POC screening for HIV and syphilis

Methods

Results

Conclusion