Diapositiva 1

RELATIVE

Fundao Alfredo da Matta, Manaus, Brasil

Adele Schwartz BenzakenUNAIDS/BRAZILI would like to thank the opportunity to be here telling the history of how Rapid tests project among indigenous was transform into policy in my country and save indigenous lives.

19 DSEISpecial Indigenous Health Districts in AmazonFUNASA/SESAI- Indigenous Health Sub-System of Brazil

DSEIPOLO BASEN. OF HEALTH PROFESSIONALSTRAINEDDATE6-ALTO SOLIMOES1153May 0918-MANAUS *1269Mar 09/Mar 1024-PARINTINS *1455Feb 09/May 1021-PURUS935Mar 104-ALTO RIO NEGRO25112Oct 09/ Apr 10/May1022-MEDIO SOLIMOES1235May 1034-YANOMAMI *3760Aug 09/Dec 09/Dec 1016-LESTE RORAIMA*3360Aug 09/Dec 09/Dec 1031-VALE DO JAVARI730Dec 09TOTAL160509*Includes retrainingTo contribute to Syphilis and Congenital Syphilis control in indigenous population in the State of Amazonas, BrazilSpecific:To screen the sexually active indigenous population in 9 (nine) DSEIs in Amazon for syphilis and HIV with Rapid Tests (RT) To implement RT syphilis screening with Quality Assurance in the nine DSEIs To model the cost-effectiveness of introducing syphilis RT in remote areas in Brazil. To integrate syphilis RT in the National Indigenous Health Care Policy in order to improve the coverage of syphilis screening for pregnant indigenous womenTrain the trainers

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INCREASING ACCESS TO HIV AND SYPHILIS SCREENING IN REMOTE AREAS USING RAPID TESTS IN THE AMAZON REGION

The health indigenous system has a capilarity to go where the people are!! The 160 polo base has a health unit in the polo base, but they also travel by boat, helicopter, small planes4

6SYPHILIS AND HIV SCREENING RESULTSDSEI Syphilis positivity in Pregnant Women# screened/sexually active population(%)Manaus

6/424(1.42%)

7.122/10.98064.9%Yanomami3/749 (0.40%)3.400/4.31778.8%Leste Roraima4/789(0.51%)3.892/ 4.03896.4%Alto Solimes37/1.443(2.56%)19.888/25.32278.5%Parintins1/253(0.40%)

2.308/4.90447,1%Alto Rio NegroMdio SolimesMdio PurusVale do JavariTotal63/4.6391.36%5/149(3.36%)1.875/2.56373,2%7/893(0.78%)1/76(1.32)

7.256/19.87236,5%573/9.0926,3%329/2.95011,2%0/20(0.0%)

Syphilis positivity in sexually active population1.61% 0.12%0.85% 2.04%0.35%731/46.6431.57%5.87%0.72%3.14%0%

HIV Prevalencein sexually active population0.11% 0.00%0.10%0.04%0.04%

51/46.6430.11%0.16%

0.04%0.00%

0.0%

HIV Prevalence in Pregnant Women0/424(0.0%)0/749(0.00%)1/789(0.13%)

0/1.443(0.0%)

0/253(0.0%)

3/4.6390.06%2/149(1.34%)0/893(0.0%)

0/76(0.0%)

0/20(0.0%)

46.643/83.311 55.5%

Engagement of FUNASA the institution responsible for indigenous health we screen enough to get a representive sample. FUAM and FUNASA, the government organization responsible for indigenous peoples health services, implementing RT project in remotely located indigenous communities in Brazils Amazon regionThe districts with low performance are related to management

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Quality Control DTSNATIONAL STI PROGRAM AND SESAI- are implementing Syphilis and HIV RT at ANC in all indigenous communities throughout Brasil STORK INITIATIVE : a national pre and neonatal primary care network , conducted by MoH, will use HIV and Syphilis RT in the public health system (estimated of 2 million pregnant women per year) PRODUCING RST IN THE COUNTRYMoH USING RST IN DIFFERENT SCENARIOS AND SPECIFIC POPULATIONS:NATIONAL LAB TRAINING- Introduction of RST in TELELAB by MoHNATIONAL MANAGEMENT GUIDELINE- Introduction of RST to the algorithm diagnostic of acquired syphilis by MoH INTEGRATE QA/QC USING DTS - adopted by MoH in the National VCT clinics; Training others countries in LA founded by CDC

CHANGING NATIONAL POLICIES

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