The Ministry of Health, in partnership with states, municipalities and civil society, will carry out a national mobilization for testing for syphilis , HIV and viral hepatitis (B and C). For 10 days, all people who wish to know their condition can look for public network units and Testing and Counseling Centers – CTA, throughout the country. The strategy is part of the actions that mark World AIDS Day, celebrated on December 1st, and which was presented this Tuesday (20th) by Health Minister Alexandre Padilha.
Among the actions is the launch of the new epidemiological bulletin, which brings, as a novelty, the inclusion of information on clinical monitoring of patients, viral load, CD4 count (situation of the immune system) and treatment. The expansion of prenatal testing is one of the highlights. A study by the Ministry of Health with pregnant women indicates that, in 2004, 63% of pregnant women underwent the test. Between 2010 and 2011, this index was 84%, an increase of 21 percentage points.
The bulletin also shows a 12% drop in the standardized mortality rate (number of deaths per 100,000 inhabitants using a standard population). The rate of 6.3 deaths per 100,000 inhabitants in 2000 dropped to 5.6 in 2011.
About 70% of patients living with AIDS in Brazil, who are on antiretroviral therapy, have undetectable viral loads. This means that people who have the infection and receive medication through the Unified Health System (SUS) are living longer. “The Ministry of Health considered it a priority to work, not only on the day to combat AIDS, but also on this mobilization action. The campaign serves to raise awareness of the importance of early diagnosis, expanding the population’s access to rapid tests in basic health units”, stressed Health Minister Alexandre Padilha.
FIQUE SABENDO – From this Thursday until December 1st – the units of the “Fique Sabendo” mobilization strategy will be in all states of the country, offering testing for HIV/AIDS , syphilis and hepatitis B and hepatitis C. With just a drop of blood taken, the result of the quick test comes out in 30 minutes. The person receives counseling before and after the test, and if so, is referred to the specialized service.
“Early diagnosis produces two positive impacts: the individual and the collective. First, it is important for the patient to know that he is infected, this enables effective and faster treatment, reducing risks and improving quality of life. Second, it reduces the negative viral load. Living with HIV is not simple, but knowing is much better”, said the Secretary of Health Surveillance, Jarbas Barbosa.
QUICK TEST – Since its implementation in 2005, there has been a 340% increase in the number of tests offered (from 528 thousand in 2005 to 2.3 million in 2011). From January to September this year, 2.1 million test units have already been distributed. The expectation is to close 2012 with the shipment of around 2.9 million, just for HIV detection.
For the National Mobilization, the Ministry of Health sent to the capitals, 386,890 rapid tests for HIV, 182,500 for syphilis, 93 thousand for hepatitis B and 93 thousand for C. In total, there were 755,390 units of inputs, as requested by each state . Rapid tests for diagnosing HIV/AIDS, viral hepatitis and syphilis are available free of charge throughout the Public Health Network.
“The test access policy has shown to be on the right track. According to the Survey of Behaviors, Attitudes and Practices of the Brazilian Population (PCAP), HIV testing rose from 20% in 1998 to almost 40% in the Brazilian adult population in 2008”, observes the director of the STD Department, AIDS and Viral Hepatitis from the Ministry of Health, Dirceu Greco.
The test is recommended for the entire population, especially for some population groups in situations of greater vulnerability to HIV infection, such as men who have sex with men (MSM) (54%), female sex workers (65.1 %) and illicit drug users (44.3%). This is because the epidemic in Brazil is concentrated and the country focuses, as a priority, on the prevention actions of the federal government in these populations.
EPIDEMIOLOGICAL DATA – The AIDS incidence rate in Brazil has remained at the same levels in recent years, although it shows regional differences. These and other epidemiological data on AIDS will be highlighted in the Epidemiological Bulletin that will be released on December 1, with numbers updated until June 2012. The data indicate that the incidence rate of AIDS in Brazil, in 2011, was 20.2 per 100,000 inhabitants. That year, 38,800 new cases of the disease were registered. The largest volume of cases remains concentrated in large urban centers.
The Southeast region shows a reduction in AIDS incidence rates from 27.5 cases (for every 100,000) – in 2002 – to 21.0 in 2011. In the South, North and Northeast regions, there is a slight upward trend. The Midwest has a similar behavior to Brazil, that is, the epidemic continues at the same level.
The prevalence rate (percentage of people infected with HIV) in 2010 was estimated at 0.42%. Regarding AIDS mortality, the country had an average of 11,300 deaths per year in the last decade. The standardized mortality rate (number of deaths per 100,000 inhabitants using a standard population) has been falling. While in 2000 it was 6.3, in 2011 the registered number was 5.6, which represents a reduction of 12%. Early diagnosis followed by timely access to antiretroviral therapy explains the drop in deaths from AIDS.
MONITORING – The increase in diagnosis has been reflected in the growth in the proportion of HIV-positive individuals who are identified early. In 2006, 32% of patients arrived at the health service with a CD4 count greater than 500 cells per mm3, which indicates that the patient’s immune system is not yet compromised. In 2010, this percentage rose to 37%.
The incorporation of new drugs in the treatment of AIDS has also contributed to reducing the statistics of deaths as a result of the infection. In 2010, etravirine began to be offered in the SUS for patients with resistance to other antiretrovirals. Tipranavir has been included in the list of drugs available in the country since last year. It is the first therapeutic rescue antiretroviral that can be used by children from 2 to 6 years old.
In October of that year, the Ministry of Health signed an agreement with the laboratories Farmanguinhos, Fundação Ezequiel Dias and Laboratório Farmacêutico do Estado de Pernambuco for the manufacture of a fixed combined dose (a single pill) of the antiretrovirals tenofovir, lamivudine and efavirenz, the so-called 2.0 treatment . The initiative will facilitate patient adherence to AIDS treatment, following the global trend of simplifying therapy schemes. The expectation is that the single pill will already be available in the SUS in 2013.
The Ministry is also incorporating, as part of the therapeutic arsenal of third-line drugs (rescue schemes for patients who do not respond satisfactorily to first- and second-line drugs), maraviroc. The antiretroviral belongs to a new class of drugs and, initially, will benefit 300 patients in the country, starting next year. It will be the fifth third-line antiretroviral made available by the government.
CAMPAIGN – The campaign theme for this year’s World AIDS Day will highlight the importance of testing, with people living with HIV/AIDS as spokespersons. The strategy provides for the dissemination of messages promoting the diagnosis of HIV, based on human rights and the fight against stigma and prejudice. National disclosure will be made on TV, radio, movie theaters and internet.
The messages will show that the test is a safe, confidential and accessible process on the public network. The protagonists of the campaign, who live with HIV and discovered their serology through the test, will encourage the test to be carried out. The campaign will take the following approach: “I live with HIV and I know it. The difference between us is that you can have the virus and not know it. Go to the health unit and get tested for AIDS”.
Of the 530,000 people currently living with HIV in Brazil, 135,000 are unaware of their status and about 30% of patients still arrive at the health service late.
The target audience is the general population, especially those living in more vulnerable situations, such as men who have sex with men (MSM), transvestites and sex workers. The campaign also encourages health professionals to recommend testing to patients, regardless of gender, sexual orientation, behavior or contexts of greater vulnerability.
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