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Table 1 Strengths, weaknesses, opportunities, and threats (SWOT) analysis of the screening programme for HIV and syphilis in Alto Solimões

From: Point-of-care screening for syphilis and HIV in the borderlands: challenges in implementation in the Brazilian Amazon

Strengths Weaknesses
▪ Screenings considered easy to offer
▪ Screenings implemented with support from FUAM, FUNASA, and the coordinators of Alto Solimões DSEI
▪ Nurse technicians mostly indigenous and have a low turnover rate
▪ CHWs with previous experience in working with indigenous people
▪ Rapid testing not requiring laboratory infrastructure or highly trained health care workers
▪ Integration of screening activities into existing health services
▪ Difficulty in reaching remote areas and transporting RT and other consumables due to long distances and having only fluvial or air transport available
▪ Underperforming health services
▪ Need to maintain cold chain for rapid HIV testing
▪ Communication problems and cultural barriers between health care workers and indigenous people
▪ Lack of commitment of CHWs to screening indigenous people
▪ Need to screen adolescents due to early sexual initiation
Opportunities Threats
▪ Brazilian Ministry of Health committed to screening programme
▪ Screening programme prioritised by FUNASA
▪ Rapid testing delivered by WHO and Ministry of Health using existing logistics
▪ Health services decentralised and free of charge
▪ Existing outreach activities to screen communities
▪ Funding available from Bill & Melinda Gates Foundation and the WHO
▪ Lack of trained health care workers
▪ Lack of treatment for syphilis- and HIV-positive individuals and lack of disposable protective products
▪ Uncertainty about testing acceptance by indigenous people
▪ Inconsistent support from DSEI coordinators
▪ Strikes