Adaptação de protocolo clínico para manejo de infecções sexualmente transmissíveis em população privada de liberdade: HPV, Mycoplasma genitalium e Tricomoníase

Abstract

This study aimed to adapt clinical protocol for the management of HPV, Mycoplasma genitalium, and trichomoniasis for the incarcerated population. This is a methodological study on the adaptation of clinical protocols related to Sustainable Development Goals (SDGs) 3, 10, and 16. The study was conducted from May 2024 to December 2025, guided by the ADAPTE methodological framework, for implementation in prison units in the state of Ceará. The Configuration and Adaptation phases were carried out. In the configuration phase, the feasibility of adapting sexually transmitted infection (STI) guidelines to the prison context was verified, and working groups were formed, composed of health professionals from different areas, members of the prison primary care team, researchers with experience in prison health, and prison health managers. During the adaptation phase, a literature review was conducted to search for source guidelines and other materials relevant to the adaptation. This research was approved by the Research Ethics Committee of the Federal University of Ceará, under opinion 6.745.715. Nineteen materials, published predominantly in English in 2022 and 2024, were adapted, mainly from the World Health Organisation (WHO), Canada, and Brazil. The evaluations of the included guidelines, carried out by AGREE II, showed scores ranging from four to seven. Among the included guidelines, those from the WHO received the best evaluations. The recommendations extracted were analysed by the panel group in April 2025 with suggestions for adaptations. The result of this work was a preliminary version of the adapted protocol, organised into 13 chapters with specific sections devoted to recommendations for STI care in general, STI investigation and risk assessment consultations, communication of sexual partnerships, STI prevention strategies, individual chapters on HPV, Mycoplasma genitalium, and trichomoniasis, as well as information on the development and implementation of the clinical protocol. The main changes made were in relation to screening and diagnosis due to the reality of the prison context, in addition to the exclusion of treatments not available in the context of the Unified Health System. In addition, changes were made in relation to the disclosure of sexual partners, due to the limitations of extramural communication resulting from the deprivation of liberty. The main limitation encountered was the scarcity of recommendations directed at prisoners in the literature.