Rio De Janeiro Metropolitan Area Research Articles

RdJ detection tests to identify a unique MRSA clone of ST105-SCCmecII lineage and its variants disseminated in the metropolitan region of Rio de Janeiro.

Hospital bloodstream infection (BSI) caused by methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of morbidity and mortality and is frequently related to invasive procedures and medically complex patients. An important feature of MRSA is the clonal structure of its population. Specific MRSA clones may differ in their pathogenic, epidemiological, and antimicrobial resistance profiles. Whole-genome sequencing is currently the most robust and discriminatory technique for tracking hypervirulent/well-adapted MRSA clones. However, it remains an expensive and time-consuming technique that requires specialized personnel. In this work, we describe a pangenome protocol, based on binary matrix (1,0) of open reading frames (ORFs), that can be used to quickly find diagnostic, apomorphic sequence mutations that can serve as biomarkers. We use this technique to create a diagnostic screen for MRSA isolates circulating in the Rio de Janeiro metropolitan area, the RdJ clone, which is prevalent in BSI. The method described here has 100% specificity and sensitivity, eliminating the need to use genomic sequencing for clonal identification. The protocol used is relatively simple and all the steps, formulas and commands used are described in this work, such that this strategy can also be used to identify other MRSA clones and even clones from other bacterial species.

A Peer-Led Digital Intervention to Reduce HIV Prevention and Care Disparities Among Young Brazilian Transgender Women (The BeT Study): Protocol for an Intervention Study.

The HIV epidemic continues to disproportionately burden marginalized populations despite the availability of effective preventive and therapeutic interventions. Transgender women are severely affected by HIV worldwide including in Brazil and other low- and middle-income countries, with evidence of increasing new infections among young people. There is an urgent need for youth-specific HIV prevention and care interventions for young transgender women in Brazil. This study aims to (1) address stigma in the Brazilian public health system and (2) reduce barriers to HIV care and prevention with systems navigation among young transgender women aged 18-24 years in Rio de Janeiro, Brazil. The Brilhar e Transcender (BeT) study is a status-neutral, peer-led, single-arm digital intervention study enrolling 150 young transgender women in Rio de Janeiro, Brazil. The intervention was pilot tested and refined using data from a formative phase. The BeT intervention takes place over 3 months, is delivered remotely via mobile phone and in person by peers, and comprises three components: (1) BeT sessions, (2) digital interactions, and (3) automated messages. Eligibility criteria include identifying as transgender women, being aged 18-24 years, speaking in Portuguese, and living in the Rio de Janeiro metropolitan area in Brazil. The primary outcomes are HIV incidence, pre-exposure prophylaxis uptake, linkage to HIV care, and viral suppression. Primary outcomes were assessed at baseline and quarterly for 12 months. Participants respond to interviewer-based surveys and receive tests for HIV and sexually transmitted infections. The study has been approved by the Brazilian and the US local institutional review boards in accordance with all applicable regulations. Study recruitment began in February 2022 and was completed in early July 2022. Plans are to complete the follow-up assessment of study participants on July 2023, analyze the study data, and disseminate intervention results by December 2023. Interventions to engage a new generation of transgender women in HIV prevention and care are needed to curb the epidemic. The BeT study will evaluate a digital peer-led intervention for young transgender women in Brazil, which builds on ways young people engage in systems and uses peer-led support to empower transgender youth in self-care and health promotion. A promising evaluation of the BeT intervention may lead to the availability of this rapidly scalable status-neutral HIV intervention that can be translated throughout Brazil and other low- and middle-income countries for young transgender women at high risk of or living with HIV. ClinicalTrials.gov NCT05299645; https://clinicaltrials.gov/ct2/show/NCT05299645. DERR1-10.2196/44157.

Assessment of meteorological settings on air quality modeling system-a proposal for UN-SDG and regulatory studies in non-homogeneous regions in Brazil.

Air quality models are essential tools to meet the United Nations Sustainable Development Goals (UN-SDG) because they are effective in guiding public policies for the management of air pollutant emissions and their impacts on the environment and human health. Despite its importance, Brazil still lacks a guide for choosing and setting air quality models for regulatory purposes. Based on this, the current research aims to assess the combined WRF/CALMET/CALPUFF models for representing SO2 dispersion over non-homogeneous regions as a regulatory model for policies in Brazilian Metropolitan Regions to satisfy the UN-SDG. The combined system was applied to the Rio de Janeiro Metropolitan Area (RJMA), which is known for its physiographic complexity. In the first step, the WRF model was evaluated against surface-observed data. The local circulation was underestimated, while the prevailing observational winds were well represented. In the second step, it was verified that all CALMET three meteorological configurations performed better for the most frequent wind speed classes so that the largest SO2 concentrations errors occurred during light winds. Among the meteorological settings in WRF/CALMET/CALPUFF, the joined use of observed and modeled meteorological data yielded the best results for the dispersion of pollutants. This result emphasizes the relevance of meteorological data composition in complex regions with unsatisfactory monitoring given the inherent limitations of prognostic models and the excessive extrapolation of observed data that can generate distortions of reality. This research concludes with the proposal of the WRF/CALMET/CALPUFF air quality regulatory system as a supporting tool for policies in the Brazilian Metropolitan Regions in the framework of the UN-SDG, particularly in non-homogeneous regions where steady-state Gaussian models are not applicable.

Optimization of water allocation networks in highly engineered basins: The case of Guandu River basin, Rio de Janeiro State, Brazil

During the last decades, metropolitan areas with a large population and economic size have mushroomed, modifying the urban geography and natural environment. Along with the rising of megacities, highly engineered basins have been created, providing resource security regarding water and energy. The coastal Guandu River basin in Brazil represents an artificial basin that has been heavily intervened for decades. The basin receives almost ∼80% of the water by transfers from the Paraiba do Sul River Basin System and has an associated hydroelectric complex that generates power for the national network. It is the primary source of water and energy for the Rio de Janeiro Metropolitan Area, home to ∼13 million people. Recently, water availability for this region has been jeopardized by drought conditions due to changing rainfall patterns and competition for water resources with other users such as Sao Paolo Metropolitan Area. This study focuses on the development of an optimization framework (WANAB model) for water resources management at the macroscopic level in the Guandu Basin to guarantee economic viability and water resources sustainability. The model incorporates parameters and equations for hydrological, and engineered water and hydropower processes to determine the optimal water allocation network. Also, a multi-criteria analysis is proposed to evaluate the water availability considering different scenarios. The results show that through optimization, it is possible to have a water availability of up to ∼24 m3/s in the Guandu River basin by integrating elements such as water storage systems, grey and blackwater treatment plants with capacities up to ∼39 m3/s and ∼9 m3/s, respectively. The results show that it is possible to reach a water availability of 21 m3/s in the scenario, considering the reduction of water transfers from outside the basin due to climate change. However, the major impact is observed in the hydropower generation, decreasing from ∼2270 GWh/y to ∼1950 GWh/y. The WANAB model represents a decision-making and policy tool for optimizing water allocation networks and may be adapted for other highly engineered basins.

Multiresistance and endemic status of Corynebacterium striatum associated with nosocomial infections: a critical situation in Intensive Care Units and varied wards of a tertiary care hospital, Rio de Janeiro metropolitan area, Brazil

Nowadays, Corynebacterium striatum has been reported asetiologic agent of mild to severe hospital-acquired infections,including patients undergoing endotracheal intubation withfatal outcome. A continuous survey of infections due multidrug-resistant (MDR) C. striatum in South American countriesremains necessary. This retrospective and prospective studyaimed to analyze clinical-microbiological features of C. striatumclinical isolates from patients attended at a Braziliantertiary care hospital, during a nine-year period. C. striatumstrains (n=130) were isolated from infected patients attended attwenty nosocomial wards, mainly of tracheal aspirate (n=53)and blood and/or intravenous catheter (n=21/n=13). Notably,original cases of nosocomial infections due to C. striatum wereverified in children making use of invasive devices, includingone fatal neonatal case, in addition to a fatal respiratoryinfection in patient with cystic fibrosis, as well as urinarytract infections of kidney transplant recipients. Most of C.striatum strains expressed MDR profiles (88.46%). Emergenceof vancomycin (1.90%) and linezolid (7.41%) resistance wasverified among MDR and non-MDR-strains. In conclusion,endemic condition with wide dissemination among hospitalwards of varied types of infections due to MDR and non-MDRC. striatum strains expressing heterogenic virulence potentialand genetic features may occur in hospital units.

Gravity Model Parameter Variation during a Long-Term Study using Mobile Phone Data in the Rio de Janeiro Metropolitan Area

Large-scale events are usually difficult for transportation planners because most survey data are focused on regular workdays. Mobile phone call records are low-cost and valuable data sources for transportation planning and monitoring. This work presents a long-term study of mobile phone call records collected throughout 2014 in the Rio de Janeiro Metropolitan Area. A careful aggregation of antenna coverage areas generated the useful spatial partition of the geographic area of study into geographic units. This spatial partition was used to identify presumed domiciles and to estimate four gravity models per day in four time-shifts. The power law gravity model distribution concerns the home distance of the visitors detected in the studied destination, Copacabana Beach, which was chosen because it is a frequent venue for several large-scale events in the city of Rio de Janeiro. The model results show that the power law parameters vary according to the type of day and the number of visitors. The analysis of parameter values reveals clusters of similar mobility patterns according to the type of day and time shift. The proposed methodology can be used as a first approach to simulate the mobility demand of new events complementing other transport planning approaches at a tactical and strategic levels.

Virulence profile of tigecycline-resistant Gram-negative bacilli isolated from river waters using the Caenorhabditis elegans infection model / Perfil de virulência de bacilos Gram-negativos resistentes à tigeciclina isolados das águas dos rios usando o modelo de infecção por Caenorhabditis elegans

Last-resort antibiotics act as ultimate force to overcome multidrug-resistant strains infections. Cases of tigecycline resistance in gram-negative bacilli in clinical settings are reported worldwide, however, there is no data related to tigecycline resistant strains in river water. This study demonstrates seven tigecycline gram-negative bacilli isolated from river water in Rio de Janeiro metropolitan area, their resistance genes, ability of biofilm formation with/without antibiotics and behavior using the nematode Caenohabidits elegans as infection in vivo model. From 24 gram-negative isolated strains, 16 (66.6%) were classified as multidrug-resistant, however, seven (29.1%) presented resistant to all antimicrobial agents tested, including tigecycline and have been identified by MALDI-TOF as A. baumannii, E. aerogenes and P. agglomerans. All tigecycline-resistant strains presented amplification products for ESBL, AME and PMQR and ability of biofilm formation on hydrophilic and hydro­phobic abiotic surfaces with and without antimicrobial agents. The presence of antimicrobials did not inhibit biofilm formation. Tigecycline-resistant strains differed of OP50 control with P<0,0001 indicating its virulence potential, however, none of them were capable to kill all nematodes during 5 days infection. In conclusion, tigecycline-resistant gram-negative strains have important global public health implications due to the therapeutic problems they pose. Further studies and continuous surveillance of tigecycline-resistant strains in both clinical and aquatic environment remains necessary to track and understand the dissemination of tigecycline resistance.

A territorial embeddedness analysis based on transport flows: Classifying the intra-urban space of the Rio de Janeiro metropolitan area

The way we think about cities is conditioned by the way they have been historically structured: a central business district (CBD) surrounded by suburban housing. Nevertheless, deep urban transformations took place in many cities from the mid-twentieth century onwards, including activity decentralisation and a growing detachment between form and function. Hence, while there still are substantial travel dynamics between core and periphery, socio-spatial interaction patterns within large cities complexify and become more explicit. That is, localities outside the CBD develop ties such as cooperation, complementarity, and mutual influence. Proper identification of those interaction patterns is paramount to identify emergent subcentres and latent synergies that might be fomented, thus aiding better-targeted transport policies. In that context, we proposed a territorial embeddedness analysis (TEA), which consists of two steps implemented in the Rio de Janeiro Metropolitan Area (RJMA). Firstly, we applied graph theory to flow data from the 2013 Household Travel Survey (HTS) to detect the main centralities, which then serve as the basis for calculating the TEA relational indices. Secondly, the k-means algorithm was applied to these indices to organise the HTS traffic zones into seven groups. Our findings allow us to place localities into two opposing categories. The first is that of places that need longer trips to access resources, while in the second category, there are places most associated with shorter trips. Three further situations can be distinguished within this second category: (a) areas near first-order centralities; (b) classical peripheries that access resources either in closer subcentres or on scattered areas nearby; and (c) highly segregated places that are unable to properly access the city’s resources. Overall, we believe this classification allows planners to better understand the complex relations taking place in metropolitan areas, which have evolved far beyond the core-periphery model. It can also foster the implementation of place-specific policies, such as restructuring the transit network based on local specificities and regional goals.

SARS-CoV-2 testing disparities across geographical regions from a large metropolitan area in Brazil: Results from a web-based survey among individuals interested in clinical trials for COVID-19 vaccines

After more than a year since the novel coronavirus (SARS-CoV-2) disease 2019 or COVID-19 has reached the status of a global pandemic, the number of COVID-19 cases continues to rise in Brazil. As no effective treatment been approved yet, only mass vaccination can stop the spread of SARS-CoV-2 and end the COVID-19 pandemic. Multiple COVID-19 vaccine candidates are under development and some are currently in use. This study aims to describe the characteristics of individuals who have registered in an online platform to participate in clinical trials for COVID-19 vaccines. Additionally, participants’ characteristics according to age and presence of comorbidities associated with severe COVID-19 and differences of SARS-CoV-2 testing across different geographical areas/neighborhoods are provided. This was a cross-sectional web-based study conducted between September and December/2020, aiming to reach individuals aged ≥18 years who live in Rio de Janeiro metropolitan area, Brazil. Among 21,210 individuals who completed the survey, 20,587 (97.1%) were willing to participate in clinical trials for COVID-19 vaccines. Among those willing to participate, 57.8% individuals were aged 18–59 years and had no comorbidity, 33.7% were aged 18–59 years and had at least one comorbidity, and 8.6% were aged ≥ 60 years regardless the presence of any comorbidity. Almost half (42.6%) reported ever testing for COVID-19, and this proportion was lower among those aged ≥ 60 years (p < 0.001). Prevalence of positive PCR results was 16.0%, higher among those aged 18–59 years (p < 0.009). Prevalence of positive antibody result was 10.0%, with no difference across age and comorbidity groups. Participants from areas/neighborhoods with higher Human Development Index (HDI) reported ever testing for SARS-CoV-2 more frequently than those from lower HDI areas. Interest to participate in clinical trials for COVID-19 vaccines candidates in Rio de Janeiro was significantly high. The online registry successfully reached out a large number of individuals with diverse sociodemographic, economic and clinical backgrounds.

Abordagem da Violência Contra a Mulher nos Cursos de Graduação em Odontologia do Rio de Janeiro

Objective: the aim of this paper was to verify knowledgement senior undergraduate dental students’ of Rio de Janeiro Universities on how to proceed when facing violence against women. Material and Methods: a cross-sectional study was conducted, using an on-line Google Form containing 17 objective questions. Last year undergraduate dental students from Rio de Janeiro metropolitan area and close campi answered the survey, coming to a total of 237 answers, with 95% confiability. This research was approved by the number 4.105.142 CEP-HUFF/UFRJ technical report. Results: only 26,6% of the students claimed to have received orientation on how to conduct a case of violence against women. Moreover, 67,1% don’t feel ready to guide victims of domestic violence, claiming to have none/phew/insufficient knowledge of the topic. Most of the students, 92,4%, said that they didn’t receive any information about the notification and grievances file and, 76,7% of those that did, said that they wouldn’t be able to fill it. Over 71% know a woman who has been a victim of domestic violence, who were mostly hit on head/neck/face. The undergraduate students reported that they would provide dental care, orientate the victim and report the domestic violence scenario to the responsible entities. Conclusion: thus, it was observed a knowledge deficit concerning violence against women protocols in undergraduate dentistry courses in Rio de Janeiro, since this topic isn’t approached or is taught using inefficient methods

Impactos da pandemia de covid-19 na educação infantil em São Gonçalo/RJ

O presente artigo busca problematizar e provocar reflexões acerca dos impactos da pandemia do coronavírus na Educação Infantil destinada às crianças pequenas das classes populares que vivem em periferias urbanas da cidade de São Gonçalo, na Região Metropolitana do Rio de Janeiro (RMRJ). Diante do cenário pandêmico e do isolamento social decretado, que implicou no fechamento de creches e pré-escolas, urge interrogar sobre a presença (in)visível de crianças pequenas em São Gonçalo. Do ponto de vista metodológico, trazemos a dúvida como método (GARCIA, 2009) a partir de questões que se intensificam num tempo de incertezas e rompimento de vínculos. Acreditamos que problematizar os impactos da pandemia na vida de crianças pequenas, nos remete ao desafio de investigar que potenciais conhecimentos decorrentes da pandemia do coronavírus podem mobilizar reflexões e práticas favoráveis à educação e ao cuidado das referidas crianças, trazendo questões e ponderações que possam contribuir para um melhor acolhimento e educação das crianças pequenas nas creches e pré-escolas públicas do município.

Multidrug-Resistant Methicillin-Resistant Staphylococcus aureus Associated with Bacteremia and Monocyte Evasion, Rio de Janeiro, Brazil.

We typed 600 methicillin-resistant Staphylococcus aureus (MRSA) isolates collected in 51 hospitals in the Rio de Janeiro, Brazil, metropolitan area during 2014–2017. We found that multiple new clonal complex (CC) 5 sequence types had replaced previously dominant MRSA lineages in hospitals. Whole-genome analysis of 208 isolates revealed an emerging sublineage of multidrug-resistant MRSA, sequence type 105, staphylococcal cassette chromosome mec II, spa t002, which we designated the Rio de Janeiro (RdJ) clone. Using molecular clock analysis, we hypothesized that this lineage began to expand in the Rio de Janeiro metropolitan area in 2009. Multivariate analysis supported an association between bloodstream infections and the CC5 lineage that includes the RdJ clone. Compared with other closely related isolates, representative isolates of the RdJ clone more effectively evaded immune function related to monocytic cells, as evidenced by decreased phagocytosis rate and increased numbers of viable unphagocytosed (free) bacteria after in vitro exposure to monocytes.

The spotted zebra: Cohabitation between informal solutions and public-owned infrastructures for water supply in the Rio de Janeiro Metropolitan Region

Abstract In many emerging and developing countries hybrid systems, not completely public nor private, have become a regrettable unstandardized ‘standard’ for water and sanitation service (WSS) provisions. These spotted zebras deserve the attention of both the scientific community and policymakers being ambiguous solutions. On the one hand, the hybrid systems allow broadening the access to the water supply service in face of the challenge to manage, maintain and adapt large infrastructures in a time of increasing climate change impacts, water-supply demand and drinking water scarcity. On the other hand, by embodying informal artefacts and unregulated behaviours to use natural resources, the hybrid systems enhance the vulnerability and precariousness of the population that is normally not reached by the formal public infrastructure. The paper presents findings of research conducted in Queimados, in the Rio de Janeiro Metropolitan Area. Our study suggests that grassroots solutions, albeit being an opportunity when integrated, represent a threat when standing alone, and it is critical to further discuss ways to promote such integration within a structured institutional public framework. Conclusions stress the need to rethink the grassroots engagement within socio-technical transition emphasizing the nexus between political culture, civic education and infrastructural solutions.

Analysis of urban - industrial expansion and increasing level of ozone concentration as subsiding an environmental management plan for the east of Rio de Janeiro metropolitan area – Brazil

The disorderly growth of metropolitan regions, combined with the lack of efficient air quality management strategies, contributes to the potential increase in O3. That impact might undoubtedly cause harmful and immediate and continuous effects on living organisms. In this sense, the primary objective of this research work is to identify and evaluate the threshold values of the O3 concentration pattern in the expanded region of the Rio de Janeiro Metropolitan Area (RJMA). Landsat images were retrieved and showed that there was an expansion to the east and west of the RJMA at an average rate of 32 km2. year−1. After analyzing the air quality data in the region for the period between 2010 and 2018, excess concentrations of O3 were registered to occur every month and across all weather seasons, mainly from October to March (spring and summer), concerning air quality standards, There are significant differences in ozone violations between Paquetá weather station (t = 184 days, 53.2 %) and Porto das Caxias weather station (t = 105 days, 30.2 %). The annual time series of O3 violations during the study period was highly variable, with peaks in the years 2012 (14.3 ± 20.1 violations), 2013 (12.3 ± 15.7 violations), and 2015 (23 ± 15.7 violations). Furthermore, there was an increase in the value of surpluses of O3 along 2016, marked by a longer period of excess concentration from August to March. Despite advances in environmental legislation, air quality management protocols still lack effective measures to mitigate the impacts of O3 on the environment, which highlights the need for developing timely and additional interdisciplinary investigations in the coming future.

Impact on ground-level ozone formation by emission characterization of volatile organic compounds from a flex-fuel light-duty vehicle fleet in a traffic tunnel in Rio de Janeiro, Brazil

The present study aimed to evaluate the contribution of mobile source emissions from, in particular, light-duty vehicles (LDVs) to tropospheric ozone formation in the Rio de Janeiro Metropolitan Area (RJMA), by quantifying the volatile organic compounds (VOCs) in a representative urban road tunnel of the city. The importance of having this type of study in Brazil is because this country has a unique vehicle emission scenario that passenger cars can use different percentages of bioethanol mixed in gasoline. The concentration of speciated VOCs in Reboucas tunnel in Rio de Janeiro, Brazil, was measured in two campaigns, total period of eight weekdays, and the VOC determination was used to calculate the average composition of the emissions of Rio de Janeiro’s LDV fleet. The United States Environmental Protection Agency (US EPA) method TO-15 was applied to determine the concentrations of VOCs C3–C12. It was found that the vehicles circulating through the tunnel were predominantly light-duty flex-fuel cars (99%). The VOC profile was constant in the monitored period. The most abundant compounds were, in order, propane, iso-pentane, n-pentane, propene, and n-butane. In addition, mono-aromatic compounds were found to be the VOC class with the highest ozone-forming potential (OFP), while propene was the main VOC contributor to ozone formation, being responsible for 27% of the troposphere ozone formed by the total VOCs monitored in the present study.

Entropy as a Measure of Attractiveness and Socioeconomic Complexity in Rio de Janeiro Metropolitan Area.

Defining and measuring spatial inequalities across the urban environment remains a complex and elusive task which has been facilitated by the increasing availability of large geolocated databases. In this study, we rely on a mobile phone dataset and an entropy-based metric to measure the attractiveness of a location in the Rio de Janeiro Metropolitan Area (Brazil) as the diversity of visitors’ location of residence. The results show that the attractiveness of a given location measured by entropy is an important descriptor of the socioeconomic status of the location, and can thus be used as a proxy for complex socioeconomic indicators.

Nonparametric spatiotemporal analysis of violent crime. A case study in the Rio de Janeiro metropolitan area

This paper analyzes the spatiotemporal pattern of gunfire reports collected by the collaborative mobile app Fogo Cruzado in the Rio de Janeiro metropolitan area (Brazil). We apply nonparametric first and second-order inference tools to characterize gunfire behavior, and test whether gunfire patterns meet the assumptions of crime prediction models, such as kernel hotspot maps or self-exciting point process. The kernel intensity estimator describes the spatial distribution of gunfire and identifies chronic hotspots. The nonparametric test for comparison of first-order intensities found differences between gunfires with and without fatalities or police presence. The recently developed log-ratio based first-order separability test found that the spatial distribution of gunfire, fatalities and police presence varied over time. Finally, spatiotemporal inhomogeneous K-tests detected clustering between gunfire events, fatalities and police presence. These results suggest that a self-exciting point process with nonseparable background component is an acceptable model for future development of a suitable approach to forecast gunfire hotspots in Rio de Janeiro.

The urban river restoration index (URRIX) - A supportive tool to assess fluvial environment improvement in urban flood control projects

Abstract River restoration is a strategy for controlling floods and restoring fluvial environmental quality. Urban river restoration is a challenge and involves a complex discussion, which needs to focus on the whole watershed and to recognize practical limits for restoration, balancing nature and city needs as much as possible. In this context, aiming to provide a practical tool to assess environmental effects in the flood control design process, the Urban River Restoration Index (URRIx) is proposed to quantify the effects of design alternatives, considering river restoration concepts in an urban watershed, giving an objective measure to help in decision making. Additionally, the URRIx can also be used to continuously monitor the river restoration successfulness over time, after a design alternative is implemented. The URRIx presents a multi-criteria formulation and ranges between 0 (the most negative result) and 1 (the most positive). A case study in the Rio de Janeiro metropolitan area (Brazil) was conducted to exemplify this discussion. The URRIx was applied to assess urban river improvement, through an integrated evaluation of flood reduction, urban revitalization, and river improvement. Outputs present a relevant space for considering urban river restoration - under given constraints - as a viable and valuable approach even in complex and fragile contexts.

Retrospective analysis of risk factors and gaps in prevention strategies for mother-to-child HIV transmission in Rio de Janeiro, Brazil

BackgroundDespite great progress made in methods to prevent mother-to-child transmission of HIV (MTCT), delivery and uptake of these measures remains a challenge in many countries. Although the Brazilian Ministry of Health aimed to eliminate MTCT by 2015, infection still occured in 15–24% of infants born to HIV-infected mothers. We sought to identify remaining factors that constrain MTCT elimination.MethodsWe conducted a retrospective, matched case-control study by reviewing hospital charts of infants born to HIV-infected mothers between 1997 and 2014 at three MTCT reference hospitals in the Rio de Janeiro metropolitan area. Cases were defined as HIV-exposed children with two positive HIV tests before 18 months of age; controls were defined as HIV-exposed children with two negative HIV tests before 18 months of age. We performed bivariate and MTCT cascade analyses to identify risk factors for MTCT and gaps in prevention services.ResultsWe included 435 infants and their mothers (145 cases, 290 controls). Bivariate analyses of MTCT preventative care (PMTCT) indicated that cases were less likely to complete all individual measures in the antenatal, delivery, and postnatal period (p < 0.05). Assessing completion of the PMTCT cascade, the sequential steps of PMTCT interventions, we found inadequate retention in care among both cases and controls, and cases were significantly less likely than controls to continue receiving care throughout the cascade (p < 0.05). Motives for incompletion of PMTCT measures included infrastructural issues, such as HIV test results not being returned, but were most often due to lack of care-seeking. Over the course of the study period, PMTCT completion improved, although it remained below the 95% target for antenatal care, HIV testing, and antenatal ART set by the WHO. Adding concern, evaluation of co-infections indicated that case infants were also more likely to have congenital syphilis (OR: 4.29; 95% CI: 1.66 to 11.11).ConclusionsWhile PMTCT coverage has improved over the years, completion of services remains insufficient. Along with interventions to promote care-seeking behaviour, increased infrastructural support for PMTCT services is needed to meet the HIV MTCT elimination goal in Brazil as well as address rising national rates of congenital syphilis.

HIGH PREVALENCE OF HBV CARRIERS AMONG WASTE COLLECTORS IN THE LARGEST LANDFILL IN LATIN AMERICA

Hepatitis B virus (HBV) is a serious public health problem. Some professions are at an increased risk for HBV infection, such as recyclable waste collectors. In this study, the aim was to evaluate the prevalence of HBV carriers and vaccination coverage among waste collectors in the largest landfill in the Rio de Janeiro metropolitan area, as well as to determine the association between risk factors and HBV infection in the studied population. In this study 73 participants answered a questionnaire on their socio-demographic variables and occupational exposure to waste. All of the subjects in the study were tested for HBsAg and their vaccination cards were evaluated in order to assess their HBV vaccination status. The vaccination coverage among the individuals who had a vaccination card was 57.4%. The overa ll prevalence of HBsAg was 12.3%. The prevalence of HBsAg was significantly higher among men (p = 0.002). However, no statistical differences were found in the prevalence of HBsAg between individuals with a history of occupational accidents involving sharp edges and non-injured individuals (p = 0.267). The results of this study demonstrate the need to strengthen prevention measures and increase HBV vaccination among waste collectors.