Almeida Nilza, Melo Mariana, Soares Isabel, Carvalho Helena
Agência Piaget para o Desenvolvimento. Porto. Portugal.
Acta Med Port. 2020 Mar 2;33(3):166-173. doi: 10.20344/amp.11687.
Early diagnosis is a crucial tool for containing the human immunodeficiency virus and other sexually transmitted infections, particularly in key populations such as sex workers. Despite its relevance, there is a gap considering epidemiological studies and interventions aimed at the monitoring and diagnosis of sexually transmitted infections in Portugal. The objectives of this study are: (i) to contribute to a better understanding of the epidemiology of sexually transmitted infections; and (ii) to evaluate the transfer of screening methods from clinical settings to the outreach context in hidden populations such as sex workers.
The screening of sexually transmitted infections (human immunodeficiency virus 1/2, hepatitis B virus, hepatitis C virus, syphilis, chlamydia and gonorrhea) were carried out in a sample of 100 sex workers during the Porto G outreach intervention in the Metropolitan area of Porto, from September 2015 to September 2016.
Six reactive cases for human immunodeficiency virus were identified, five of syphilis, eight of chlamydia and two of gonorrhea. No positive results were detected for hepatitis B virus and hepatitis C virus. The results were discussed considering the risk gradient and sexually transmitted infections vulnerability in the different sex workers' subgroups.
The results of this study corroborate the need to promote comprehensive responses to populations most affected by the human immunodeficiency virus and other sexually transmitted infections, such as sex workers. Also, in this group, men who have sex with men and trans women have a higher prevalence than cis women. Intervention strategies should be informed by rigorous epidemiological studies.
The adaptation of the screening methodology performed in a clinical setting to the proximity context has shown to be an innovative response in Portugal, especially in sentinel populations.
早期诊断是控制人类免疫缺陷病毒及其他性传播感染的关键手段，在性工作者等重点人群中尤为如此。尽管其具有重要意义，但在葡萄牙，针对性传播感染监测与诊断的流行病学研究及干预措施仍存在差距。本研究的目的是：（i）有助于更好地理解性传播感染的流行病学；（ii）评估在性工作者等隐匿人群中，筛查方法从临床环境向外展环境的转移情况。
2015年9月至2016年9月期间，在波尔图都会区的波尔图G外展干预活动中，对100名性工作者进行了性传播感染（人类免疫缺陷病毒1/2型、乙型肝炎病毒、丙型肝炎病毒、梅毒、衣原体和淋病）筛查。
共发现6例人类免疫缺陷病毒反应性病例，5例梅毒，8例衣原体和2例淋病。未检测到乙型肝炎病毒和丙型肝炎病毒的阳性结果。结合不同性工作者亚组中的风险梯度和性传播感染易感性对结果进行了讨论。
本研究结果证实，有必要针对受人类免疫缺陷病毒及其他性传播感染影响最严重的人群，如性工作者，采取全面应对措施。此外，在该群体中，男男性行为者和跨性别女性的患病率高于顺性别女性。干预策略应以严谨的流行病学研究为依据。
在葡萄牙，将临床环境中实施的筛查方法适用于外展环境已被证明是一种创新举措，尤其是在哨点人群中。
