Incidência de sífilis e HIV e avaliação do tratamento em indivíduos privados de liberdade do Estado do Mato Grosso do Sul, Brasil

Abstract

Sexually transmitted infections (STIs) have increased in several countries, including Brazil, mainly in groups with risk behaviors such as private individuals of freedom. To assist in the implementation of public health strategies to control syphilis and HIV, a transversal cohort study was conducted to evaluate the efficacy of treatment of these infections in prisons in Mato Grosso do Sul, Brazil. In 2013, we conducted a cross-sectional study that estimated the prevalence of STIs in 3,363 individuals in twelve prisons of Mato Grosso do Sul. In 2014, a cohort study was conducted with 1,614 individuals who participated in the cross-sectional study. The prisoners were interviewed using a standardized questionnaire and blood samples for serological tests for syphilis and HIV were collected. In addition, individuals with infection by Treponema pallidum or HIV in the first year, were assessed for treatment carried out during incarceration, through data contained in the medical records of prisons, comparing the serologic results (VDRL, viral load and CD4 contain) between 2013 and 2014, and the information contained in national information systems of HIV patients (SISCEL and SICLOM). Active syphilis was identified in 5.8% (n= 95) of patients in the first year and 74% (n= 70) of those showed treatment failure. Multivariate analysis revealed that drugs user in last year was a risk factor for failure in the syphilis treatment. However, having a stable partner and piercing were a protective factor. HIV prevalence was 1.5% (n= 25), 52% (n= 13) of those had high viral load (> 200 copies/ml) and six had regular withdrawing medication, which may reveal a low adherence of treatment or virologic failure. The incidence of syphilis and HIV was 0.5% (n= 9) and coinfection of 0.2% (n= 4). Therapeutic failures encountered demonstrate the fragility of public health programs, showing the importance to implement treatment programs of STIs in Brazilian prisons. In addition, the low incidence of syphilis and HIV during incarceration period reinforces the importance of STI screening programs in prisons admission for early detection and treatment.