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Healthcare challenges and interventions in pre-trial detention centers in Venezuela
In Venezuela, pre-trial detention centers, originally intended for brief holding periods, often detain individuals far beyond the normative 48 hours, with some awaiting trial for up to 10 years. This prolonged detention, in facilities not designed for long-term occupancy, leads to severe overcrowding and deteriorating physical conditions for detainees. From January 2021 to October 2023, healthcare was provided to 3975 detainees in 60 such centers, focused on providing healthcare to detainees, who were the primary population of interest, without considering other high-risk groups.
Universal HIV detection strategies in emergency services in Venezuela
HIV diagnosis is a critical public health priority and a vital step in the continuum of care. Early HIV diagnosis remains a challenge in Venezuela, where individuals unaware of their infection cannot benefit from antiretroviral therapy (ART), leading to significantly increased morbidity and mortality, as well as high viral loads that elevate the likelihood of transmission. The Centers for Disease Control and Prevention (CDC), UNAIDS, and WHO recommend routine, non-selective HIV screening in most medical settings, including emergency services, advocating for the use of rapid HIV tests in specific contexts as a useful strategy to facilitate and enhance early diagnosis of the infection. Institutional barriers can hinder efforts to increase HIV testing among the most vulnerable populations. Therefore, offering this tool for free, voluntarily, and confidentially to all individuals admitted to hospital emergency services can greatly aid in identifying new cases and linking them to the national public health system for treatment initiation.
Efficacy of TLD regimen in viral suppression among HIV patients in Venezuela: the «Plan Maestro» initiative.
Universal free distribution of antiretrovirals (ARVs) has long been a public policy in Venezuela, with most ARVs acquired through the PAHO/WHO Strategic Fund. However, the economic crisis since 2017 led to significant challenges in ARV procurement, culminating in a near-total shortage of ARVs by 2018. This shortage severely impacted the health outcomes of people living with HIV, increasing the risk of HIV transmission and AIDS-related complications.
To address this crisis, the “Plan Maestro para el fortalecimiento de la respuesta al VIH, la tuberculosis y la malaria desde una perspectiva de salud pública” (Master Plan for Strengthening the Response to HIV, Tuberculosis, and Malaria from a Public Health Perspective), known as «Plan Maestro,» was developed in June 2018. This plan secured resources from the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM), entirely allocated for ARV procurement and social monitoring. The Tenofovir/Lamivudine/Dolutegravir (TLD) formulation was acquired to meet at least 85% of the active population’s needs registered with the National AIDS Program (PNSIDA/ITS) in 2019. This initiative marked a significant step toward stabilizing HIV treatment and ensuring continuous access to comprehensive healthcare for affected individuals.