Banca de DEFESA: Pâmela Cristina Gaspar

Uma banca de DEFESA de DOUTORADO foi cadastrada pelo programa.
STUDENT : Pâmela Cristina Gaspar
DATE: 25/08/2023
TIME: 14:00
LOCAL: plataforma teams - link disponível na página do programa
TITLE:

“__Sexually transmitted infections that cause urethral discharge in men: etiological approach as a strategy of public health policy in Brazil ”

KEY WORDS:

“_Sexually Transmitted Infections; Urethral discharge in men; Syndromic approach; Etiological approach; Public health policy"

PAGES: 1000
BIG AREA: Ciências da Saúde
AREA: Saúde Coletiva
SUMMARY:

“Male urethral discharge is characterized as one of the symptoms of urethral inflammation, also known as urethritis. When caused by Sexually Transmitted Infections (STIs), urethritis is classically divided into gonococcal, caused by Neisseria gonorrhoeae, and non-gonococcal. The main etiological agents of non-gonococcal urethritis are Chlamydia trachomatis, Mycoplasma genitalium, Ureaplasma urealyticum, and Trichomonas vaginalis. The syndromic approach involves using clinical algorithms to identify groups of easily recognized signs and symptoms that characterize a syndrome and initiating treatment according to the syndrome. Despite being a very useful and necessary practice in the past, the World Health Organization (WHO) has been discouraging its use due to a series of limitations. Therefore, the replacement of the syndromic approach with the etiological approach, which involves identifying the causative pathogen of the infection through testing and managing the case accordingly, is urgently needed worldwide. The objective of this study was to analyze scenarios, actors, and components aiming to incorporate the etiological approach as a strategy of public health policy in Brazil for the clinical management of sexually transmitted infections causing urethral discharge in men within the scope of the Unified Health System (SUS). It is a descriptive-exploratory study using a qualitative and quantitative approach supported by method triangulation. Thus, the study included the analysis of the quality of the national protocol for the management of male urethral discharge using the AgreeII instrument; analysis of secondary data from questionnaires answered by management professionals and laboratories participating in the pilot network for the molecular detection of Chlamydia trachomatis and Neisseria gonorrhoeae in the SUS and their perception of the process; determination of the detection rate of CT and/or NG infection among patients tested in the pilot network, as well as the analysis of factors associated with the presence of CT and/or NG infection in this population. Finally, semi-structured interviews were conducted with professionals from state management of STIs, laboratories, and healthcare providers (doctors or nurses), aiming to systematize, from the perspective of these professionals, the notion of the problem, challenges, and strengths related to the implementation of the etiological approach. The analysis of the national protocol highlighted important points for modification, particularly regarding the algorithm of diagnosis, and treatment, which require changes based on gonococcal resistance data in the country and WHO recommendations. The results of the pilot implementation of molecular biology tests for CT/NG detection within the SUS emphasized the importance of making testing available, especially for populations most vulnerable to STIs, while considering the weaknesses and strengths identified in the pilot network. Lastly, the qualitative analysis of the interviews revealed the need for national data availability on non-notifiable STIs and raising awareness among management professionals about implementing the etiological approach for the management of urethral discharge. Workflow change, the culture of the syndromic approach, and the unavailability of rapid diagnostic tests are weaknesses mentioned by clinical professionals, who showed more awareness than management professionals. Finally, the statements of laboratory experts highlight the need for more advanced technologies, especially for surveillance purposes. At the same time, they consider decentralization of testing for healthcare assistance crucial for expanding access to diagnosis and guiding clinical management based on results. In conclusion, Brazil has made progress in strategies and actions for implementing the etiological approach for managing urethral discharge in men. However, the results of this study suggest the need for changes and strategic actions to ensure successful implementation within the scope of the SUS.”

COMMITTEE MEMBERS:
Externa à Instituição - MARA CRISTINA SCHEFFER - UFSC
Presidente - ***.478.802-** - ADELE SCHWARTZ BENZAKEN - ENSP
Externa à Instituição - ANGELICA ESPINOSA BARBOSA MIRANDA - UFES
Interno - 1225317 - EDGAR MERCHAN HAMANN