Análise da prevalência das doenças infecciosas na população em situação de rua : desafios das equipes do consultório na rua no acesso ao cuidado à saúde.

Abstract

Healthcare is a social right, but the homeless population (PSR) faces access barriers, stigma, and high rates of diseases such as HIV (human immunodeficiency virus), hepatitis, syphilis, and tuberculosis (TB). The overall objective of my dissertation was to analyze the prevalence of emerging infectious diseases among the homeless and the challenges faced by street clinic teams in ensuring access to healthcare. Manuscript 1: This study aimed to map the literature on the prevalence, stigma, and barriers to treatment of infectious diseases such as HIV, syphilis, hepatitis, and tuberculosis among the homeless population (PSR), and the public policies needed to mitigate their impacts with health interventions targeted at this vulnerable group. This is an integrative literature review, with searches in PubMed, Springer Link, Taylor & Francis Online, Google Scholar, Scielo, and Wiley Online Library. A high prevalence of these diseases was found in individuals over 18 years of age, women, drug users, transgender individuals, and individuals with a history of incarceration. Homeless people face barriers to combating infectious diseases due to housing instability, drug use, and limited access to health services. Public policies such as housing stability strategies, targeted vaccination, screening, and early treatment can improve access to health care and reduce inequalities. It is concluded that targeted interventions and inclusive public health policies are essential to address these issues and promote equitable health outcomes. Manuscript 2: Homeless people face extreme poverty, homelessness, serious health problems, difficulties in accessing medical care, and discrimination. This study aimed to analyze the prevalence of infectious diseases, symptoms, risk behaviors, working conditions, and access to health services among homeless people, considering their history of deprivation of liberty, in a municipality in Rio Grande do Sul, Brazil. This is a cross-sectional, exploratory, and descriptive study conducted with homeless people from September to October 2024. Data collection took place at the Street Clinic Program to analyze infectious diseases and staff challenges, using in-person and confidential approaches. The data show that the homeless people analyzed have low age variability, a high prevalence of substance use, and challenges in accessing documents and work. Infectious diseases such as HIV (14.9%; p < 0.001) and syphilis (46%; p = 0.548) were identified. The BCG scar and tuberculosis treatment showed no statistical association with symptoms of cough, shortness of breath, weight loss, decreased appetite, fever, or spitting up blood. Cough was more common among those deprived of liberty (p = 0.004). Homeless people are highly vulnerable, with a high prevalence of HIV and syphilis. The data reinforce the importance of the Street Clinic in providing comprehensive care and access to healthcare. Manuscript 3: This study aimed to map the literature on the strategies and challenges faced by Street Outreach teams in Brazil. This is an integrative literature review, with research in the Scielo and Google Scholar databases, covering papers published within a five-year period (2019-2024). Street Outreach teams face challenges such as low educational levels and chemical dependency among the individuals they serve, which complicate reintegration and treatment. Lack of resources and inadequate infrastructure compromise continuity of care, while resistance to treatment and difficulty maintaining adherence are recurring problems. Social outreach and inclusion strategies range from basic support and socio-educational activities to education and prevention, with some teams utilizing technologies and adapting to local conditions. The study revealed that, although there have been advances in assisting the homeless population, significant challenges persist, such as lack of resources, social stigma, and logistical difficulties. It highlights the need for integrated approaches and more effective public policies to ensure more inclusive and equitable care.