Browsing by Author "Shivaji, Tara"
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- As características dos indivíduos com idade acima de 50 anos e diagnosticados com infeção VIH em Portugal no período 1983-2013Publication . Shivaji, Tara; Cortes Martins, Helena; Diniz, AntónioIntrodução Nos últimos anos a nível mundial, o número de indivíduos com idade acima de 50 anos e diagnosticados com infecção VIH, tem aumentado. A população portuguesa está a envelhecer e, por este facto, precisamos de compreender as características da epidemia do VIH nesta faixa etária, de modo a prevenir a infeção e facilitar o acesso a cuidados médicos. Material e Métodos Foi realizada uma análise descritiva dos casos de VIH em indivíduos de 50 ou mais anos no momento do diagnóstico e com notificação ao Núcleo de Vigilância Laboratorial de Doenças Infecciosas do INSA, entre 1983 e 31 de Dezembro de 2013. Resultados No período do estudo foram notificados 6782 casos de infeção VIH, dos quais 2653 indivíduos (39%) desenvolveram SIDA. A análise da distribuição por sexo revela um ratio homem: mulher de 2.5. A maioria dos casos (4987;77%) registou-se em indivíduos nativos de Portugal e reportando a categoria de transmissão “heterossexual” (5509; 81%). Em 2013, os indivíduos da faixa etária em estudo foram responsáveis por 26% dos casos de infeção VIH registados neste ano, correspondendo a uma taxa de 8,4 casos de infeção VIH /100.000 indivíduos. Discussão e Conclusões O perfil epidemiológico da infecção VIH evoluiu ao longo dos 30 anos da epidemia e actualmente os indivíduos com idade acima de 50 anos representam um quarto de todos os novos diagnósticos de VIH feitos em Portugal. O conhecimento desta evolução é da maior importância para o desenho e optimização dos programas de prevenção e intervenção.
- Characteristics of late presentation of HIV infection in MSM and heterosexual adults in Portugal 2011-2013Publication . Shivaji, Tara; Diniz, António; Cortes Martins, HelenaBackground: It is estimated that over half of newly diagnosed HIV infections in Europe present late. An HIV positive individual presenting late to care represents a missed opportunity to benefit from treatment, increasing the risk of morbidity and mortality at an individual level, and onward disease transmission at population level. Reducing late presentation is a strategic priority of the Portuguese HIV/AIDS program. We set out to describe the characteristics of late presentation in the two largest transmission risk groups currently in Portugal to inform HIV prevention and treatment. Methods: We extracted details of all notified cases from individuals over 15 years with a laboratory confirmed HIV diagnosis made between January 2011 and December 2013 from the Portuguese HIV surveillance database and selected cases from heterosexuals and men who have sex with men (MSM). We defined late presentation as an initial CD4 count <350 cells/mm3 or presence of AIDS-defining disease at time of HIV diagnosis. We calculated adjusted odds ratios (aOR) with 95% confidence intervals (CI) for characteristics associated with late presentation in separate logistic regression for heterosexuals and MSM. Results: Of 4219 HIV positive cases notified, 2589 (61%) were heterosexuals and 1220 (29%) were MSM. 1586 (38%) cases presented late of which 1037 (40%) were heterosexual and 328 (27%) were MSM. The median age at late presentation was 40 in heterosexual women, 46 in heterosexual men and 35 in MSM.1446 (55%) of heterosexual HIV positive adults were unaware of having had a high risk sexual contact. Late presentation among heterosexuals was associated with being male (aOR= 1.58 95% CI: 1.29-1.93), not knowing a partners’ HIV status (OR=1.59 95% CI: 1.35-1.87) and age, increasing the odds of late presentation by a factor of 1.02 per year (95% CI: 1.01-1.03). Among MSM, only age was associated with late presentation, increasing by 1.04 (95% CI 1.03-1.05) per year. Conclusion: Portuguese HIV prevention programs need to increase the risk awareness of heterosexuals, particularly men, to reduce missed opportunities for early diagnosis. As half of all cases presenting late are aged 40 and over, we recommend that general HIV outreach services and specialist services for MSM review their accessibility and acceptability to both middle and older-aged clients.
- Improving data management practices in the Portuguese HIV/AIDS surveillance system during a time of public sector austerityPublication . Shivaji, Tara; Cortes Martins, HelenaIn a climate of public sector austerity, the demand for accurate information about disease epidemiology rises as health program managers try to align spending to health needs. A policy of case re-notification to improve HIV information quality resulted in a nine-fold increase in the number of case reports received in 2013 by the Portuguese HIV surveillance office. We used value stream mapping to introduce improvements to data processing practices, identify and reduce waste. Two cycles of improvement were trialled. Before intervention, processing time was nine minutes and 28 seconds (95%CI 8:53-10:58) per report. Two months post intervention, it was six minutes and 34 seconds (95% CI 6:25-6:43). One year after the start of the project, processing time was five minutes and 20 seconds (95% CI 1:46-8:52).
- Infeção VIH/SIDA em Portugal: o rosto atual de uma epidemia com três décadasPublication . Cortes Martins, Helena; Shivaji, TaraIntrodução e Objetivos: Portugal apresenta a maior taxa de novos casos de infeção VIH na Europa Ocidental e ascendia a 47390 o total de casos de infeção VIH notificados até 31 de Dezembro de 2013. Nos 30 anos que decorreram desde que o primeiro caso de infeção por VIH foi diagnosticado em Portugal a epidemia sofreu evolução, pelo que se afigura importante apresentar as suas características atuais. Métodos: Foi efetuada análise descritiva dos casos de infeção VIH e SIDA diagnosticados em 2013 e análise de tendências dos casos notificados ao INSA entre 1985 e 31 de Dezembro de 2013 usando o programa Joinpoint (versão 4.1.1). Resultados: Entre 2000-2012 a taxa de novos diagnósticos notificados apresenta um decréscimo lento. Em 2013, foram diagnosticadas e notificadas 1093 novas infeções, o que sugere uma taxa de 10,5 novas infeções por 100000 habitantes. O ratio H/M foi de 2,4. A mediana das idades à data do diagnóstico revela um aumento temporal ao longo da epidemia, em 2013 metade dos casos referentes a adultos correspondiam a indivíduos com idade ≥40 anos. O modo de transmissão mais frequente em 2013 foi o contacto heterossexual (61%). Contudo, regista-se um aumento temporal no número de casos na categoria “Homo/bissexual” e, em 2013, 43% dos novos casos de infeção em indivíduos do sexo masculino correspondem a homens que têm relações sexuais com homens (HSH). Os HSH tendem a ser mais jovens que os heterossexuais à data de diagnóstico, metade têm idade ≤32anos Os casos associados ao consumo de drogas representaram 7% dos novos diagnósticos em 2013. Dos 70% de novos casos com diagnóstico em 2013 e informação sobre valores de CD4 da primeira avaliação clínica, 58% referem valores <350 células/mm3. Durante o ano 2013 foram diagnosticados e comunicados ao INSA 322 novos casos de SIDA, sendo a pneumonia por Pneumocystis a doença definidora de SIDA mais comummente referida. Conclusões: A infeção por VIH continua a representar um desafio importante para a Saúde Pública de Portugal. Atualmente a transmissão é maioritariamente sexual em contraste com o verificado em décadas anteriores. O aumento do número de novos diagnósticos de infeção por VIH em jovens do sexo masculino que têm sexo com homens e a elevada percentagem de diagnósticos tardios em heterossexuais de meia-idade são tendências recentes que urge compreender e reverter.
- A large outbreak of Legionnaires’ Disease in an industrial town in PortugalPublication . George, Francisco; Shivaji, Tara; Pinto, Catia Sousa; Serra, Luis Antonio Oliveira; Valente, João; Albuquerque, Maria João; Vicêncio, Paula Cristina Olivença; San-Bento, Ana; Diegues, Paulo; Nogueira, Paulo Jorge; Marques, Teresa; Rebelo, Helena; Costa, Filipa; Rodrigues, Raquel; Nunes, Alexandra; Borges, Vitor; Gomes, João Paulo; Sampaio, Daniel; Barreiro, Paula; Duarte, Silvia; Carpinteiro, Dina; Mendonça, Joana; Silva, Catarina; Vieira, Luís; Simões, Maria Joao; Gonçalves, Paulo; Nunes, Baltazar; Dias, Carlos; Machado, Jorge; Almeida, Fernando; Goncalves, Elsa A; Carvalho, Lucilia; Viterbo, Pedro; Jardim, Dilia; Lacasta, Nuno; Boavida, Filomena; Perez, Ana; Santana, Isabel; Matias, Paula; Banza, Nuno; Rabacal, CarlosBackground: We describe the investigation and control of an outbreak of Legionnaires’ disease in Portugal in October, November and December 2014. Methods: Confirmed cases were individuals with pneumonia, laboratory evidence of Legionella pneumophila serogroup 1 and exposure, by residence, occupational or leisure to the affected municipalities. 49 possible sources were reduced to four potential sources, all industries with wet cooling system, following risk assessment. We geo-referenced cases’ residences and the location of cooling towers defining four study areas 10km buffer centered on each cooling tower system. We compared the number of cases with expected numbers, calculated from the outbreak's attack rates applied to 2011 census population. Using Stones’ Test, we tested observed to expected ratios for decline in risk, with distance up to 10km four directions. Isolates of Legionella pneumophila were compared using molecular methods. Results: We identified 403 cases, 377 of which were confirmed, 14 patients died. Patients became ill between 14 October and 2 December. A NE wind and thermal inversion were recorded during the estimated period of exposure. Disease risk was highest in people living south west from all of the industries identified and decreased with distance (p<0.001). 71 clinical isolates demonstrated an identical SBT profile to an isolate from a cooling tower. Whole genome sequencing identified an unusual L. pneumophila subsp. fraseri serogroup 1 as the outbreak causative strain, and confirmed isolates’ relatedness. Conclusions: Industrial wet cooling systems, bacteria with enhanced survival characteristics and a combination of climatic conditions contributed to the second largest outbreak of Legionnaires’ disease recorded internationally.
- Surveillance in the time of austerity; Portuguese HIV/AIDS Surveillance achieves a 30% improvement in efficiency after LEAN inspired changes to processingPublication . Shivaji, Tara; Cortes Martins, Helena; Diniz, Antonio; Nogueira, Paulo J; Vasconcelos, Paula; Silva, AndreiaBackground In 2013, following reminders about statutory notification of HIV/AIDS, Portuguese clinicians notified all cases, irrespective of previous notification. At the same time, hospitals introduced electronic records that automatically generated additional paper notification reports. No supplemental resources were available to process the 10-fold increase in notifications. The ensuing backlog caused delays in providing timely information for HIV program planning and evaluation. We investigated whether management principles from the automobile industry (LEAN) could improve data management efficiency. Methods Efficiency was defined as the time spent processing the paper report into electronic surveillance information. We used value stream mapping to understand the process and employed focus groups to identify areas for improvement (LEAN methodology). We recorded the time taken to complete this process for randomly selected batches of reports and calculated the average time per report. Results When consulted, stakeholders expressed the need for information about recent HIV/AIDS diagnoses. We prioritized processing cases diagnosed between 2011-2013. We reduced data-entry errors and transcribing time by inserting drop-down menus and automatic variable calculators. We implemented auto-search during data entry to prevent duplication. We redesigned the data entry mask to match the paper report. Before intervention, processing time was 9 minutes and 28 seconds (95%CI 8:53-10:58) per report. Two months post-intervention, this was 6 minutes and 34 seconds (95% CI 6:25-6:43), reducing the time to process the remaining backlog (10,000 reports) by 54 days. Conclusion Applying LEAN techniques to HIV/AIDS surveillance in Portugal enabled delivery of crucial information to national and international HIV stakeholders through a 30% reduction in data processing time and optimization of data quality. Public health practitioners should consider LEAN techniques to improve data quality and efficiency of surveillance systems.