Comprehensiveness and programmatic vulnerability to stds/hiv/aids in
					primary care

Val, Luciane Ferreira do; Nichiata, Lucia Yasuko Izumi

doi:10.1590/S0080-623420140000600021

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Artigo Original • Rev. esc. enferm. USP 48 (spe) • Aug 2014 • https://doi.org/10.1590/S0080-623420140000600021 copy

Comprehensiveness and programmatic vulnerability to stds/hiv/aids in primary care^* * Extracted from the thesis "Construção e validação de marcadores de vulnerabilidade de mulheres às DST/HIV na atenção básica à saúde," School of Nursing, University of São Paulo, 2012

La integralidad y vulnerabilidad programática de las ets/vih/sida en la atención básica

Authorship SCIMAGO INSTITUTIONS RANKINGS

This study aimed to identify programmatic vulnerability to STDs/HIV/AIDS in primary health centers (PHCs). This is a descrip - tive and quantitative study carried out in the city of São Paulo. An online survey was applied (FormSUS platform), involving administrators from 442 PHCs in the city, with responses received from 328 of them (74.2%), of which 53.6% were nurses. At - tention was raised in relation to program - matic vulnerability in the PHCs regarding certain items of infrastructure, prevention, treatment, prenatal care and integration among services on STDs/HIV/AIDS care. It was concluded that in order to reach comprehensiveness of actions for HIV/ AIDS in primary health care, it is necessary to consider programmatic vulnerability, in addition to more investment and reor - ganization of services in a dialogue with the stakeholders (users, multidisciplinary teams, and managers, among others).   

Sexually transmitted diseases; Acquired immunodeficiency syndrome; Health vulnerability; Comprehensiveness in health; Primary health care; Public health nursing

Programmatic vulnerability signs	Affirmative responses to the items (N=328)
Infrastructure for the performance of preventive and STDs/HIV/AIDS care actions (16 items)	Nº	%
A. Exam rooms have visual/auditory privacy for STDs/HIV/AIDS appointments.	275	83.8
B. Room for the performance of educational activity.	267	81.4
C. Availability of basic materials for educational activity.	242	73.8
D. Steady supply of materials for contraception and prevention: Pill.	325	99.1
E. Steady supply of materials for contraception and prevention: Injectable.	297	90.5
F. Steady supply of materials for contraception and prevention: IUD.	254	77.4
G. Steady supply of materials for contraception and prevention: Male condom.	306	93.3
H. Quantity of materials for contraception and prevention: Pill.	322	98.2
I. Quantity of materials for contraception and prevention: Injectable.	294	89.6
J. Quantity of materials for contraception and prevention: IUD.	270	82.3
K. Quantity of materials for contraception and prevention: Male condom.	284	86.6
L. Quantity of laboratory exams: Syphilis.	327	99.7
M. Quantity of laboratory exams: Anti-HIV.	328	100.0
N. Quantity of laboratory exams: Hepatitis B serology.	328	100.0
O. Daily collection of laboratory exams in general.	326	99.4
P. Exams for immediate pregnancy in case of late period.	324	98.8
Responses to necessities of STDs/HIV/AIDS care (7 items)	Nº	%
A. Going through treatment with benzatin penicillin when a pregnant woman is diagnosed with syphilis.	289	88.1
B. Indicate treatment with benzatin penicillin without requisition or exam results from the partner of a pregnant woman with syphilis diagnosis.	213	64.9
C. Going through candidiasis treatment.	328	100.0
D. Going through syphilis treatment.	327	99.7
E. Going through trichomoniasis treatment.	322	98.2
F. Going through chlamydia treatment.	298	90.9
G. Treatment is based on the syndromic approach.	274	83.5
Prenatal and puerperium actions regarding STDs/HIV/AIDS care (11 items)	Nº	%
A. Schedules the first prenatal appointment within two weeks.	308	93.9
B. Offering a pap exam for pregnant women is standard procedure.	306	93.3
C. Offers syphilis test for pregnant women during the 1st and 3rd trimesters of pregnancy.	203	61.9
D. Tested for Hepatitis B in prenatal period.	325	99.1
E. Tested for Hepatitis C during pregnancy.	299	91.2
F. Tested for HIV in prenatal period.	220	67.1
G. Performs consented approach to request HIV test from pregnant women.	256	78.0
H. Notification of HIV diagnosis to pregnant women is performed by a multiprofessional team.	119	36.3
I. Performs active search for the attendance of partners of pregnant women with HIV diagnosis.	322	98.2
J. Notifies pregnant women of the syphilis diagnosis.	327	99.7
K. There is a reference hospital to perform childbirth for HIV-positive pregnant women.	316	96.3
Preventive actions regarding STDs/HIV/AIDS (10 items)	Nº	%
A. Professionals trained to perform syndromic approach care for STDs.	168	51.2
B. Professionals trained to perform counseling when offering HIV test.	119	36.3
C. Performs action for the attendance of the partner in case of STD.	319	97.3
D. Performs action for the attendance of the partner in specific case of HIV.	319	97.3
E. Performs active search for users who carry STDs when they do not come to the center.	318	97.0
F. Multiprofessional team records notifications of positive exams for the detection of syphilis.	182	55.5
G. Performs HIV test for the general population any day of the week.	304	92.6
H. Performs counseling for the HIV exam.	35	10.7
I. The average response time for the results of positive HIV exams to the center is up to seven days.	126	38.4
J. Performs consented approach when requesting HIV exam.	251	76.5
Integration of actions between UBS, CRT/SAE on HIV/STDs/AIDS and maternity hospitals (8 items)	Nº	%
A. There is a continuous stream of notifications for congenital syphilis in the maternity hospital.	295	89.9
B. Notifies pregnant women of the HIV diagnosis.	313	95.4
C. Provides referral forms and registers appointments on the STDs/AIDS CRT and SAE reference services for pregnant women diagnosed with HIV.	206	62.8
D. Information is sent back to the center after referring pregnant women to reference services for STDs/AIDS CRT and SAE.	224	68.3
E. Information is sent back to the center regarding childbirth of referred pregnant women with HIV.	239	72.9
F. Makes an appointment with the reference service for STDs/AIDS when there is a positive result for HIV.	205	62.5
G. There is a stream of references/counter-references for patients referred to special treatment services for STDs/AIDS.	93	28.4
H. Follows up the cases referred to reference service for STDs/AIDS.	279	85.1

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Correspondence: Lucia Yasuko Izumi Nichiata.  Departamento de Enfermagem em Saúde Coletiva, Escola de Enfermagem da USP.  Av. Dr. Enéas de Carvalho Aguiar, 419 – Cerqueira César . CEP 05403-000 – São Paulo, SP, Brazil. izumi@usp.br

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Comprehensiveness and programmatic vulnerability to stds/hiv/aids in primary care* * Extracted from the thesis "Construção e validação de marcadores de vulnerabilidade de mulheres às DST/HIV na atenção básica à saúde," School of Nursing, University of São Paulo, 2012

La integralidad y vulnerabilidad programática de las ets/vih/sida en la atención básica

Comprehensiveness and programmatic vulnerability to stds/hiv/aids in primary care^* * Extracted from the thesis "Construção e validação de marcadores de vulnerabilidade de mulheres às DST/HIV na atenção básica à saúde," School of Nursing, University of São Paulo, 2012