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