Brazil is home to the highest absolute number of human T-cell lymphotropic virus type-1 (HTLV-1)-infected individuals worldwide; the city of Salvador, Bahia, has the highest prevalence of HTLV-1 infection in Brazil. Due to the complex nature of several diseases associated with this retrovirus, a multidisciplinary health care approach is necessary to care for people living with HTLV-1. The Bahia School of Medicine and Public Health’s Integrative Multidisciplinary HTLV Center (CHTLV) has been providing support to people living with HTLV and their families since 2002, striving to ensure physical and mental well-being by addressing biopsychosocial aspects, providing clinical care and follow-up, including to pregnant/postpartum women, as well as comprehensive laboratory diagnostics, psychological therapy, and counseling to family members. To date, CHTLV has served a total of 2,169 HTLV-infected patients. The average patient age is 49.8 (SD 15.9) years, 70.3% are female, most are considered low-income and have low levels of education. The majority (98.9%) are HTLV-1 cases, and approximately 10% have been diagnosed with tropical spastic paraparesis/HTLV-1-associated myelopathy (TSP/HAM), while 2.2% have infective dermatitis and 1.1% have adult T-cell lymphoma. In all, 178 pregnant/postpartum women [mean age: 32.7 (±6.5) years] have received care at CHTLV. Regarding vertical transmission, 53% of breastfed infants screened for HTLV tested positive in their second year of life, nearly 18 times the rate found in non-breastfed infants. This article documents 20 years of experience in implementing an integrative and multidisciplinary care center for people living with HTLV in Bahia, Brazil. Still, significant challenges remain regarding infection control, and HTLV-infected individuals continue to struggle with the obtainment of equitable and efficient healthcare.

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The COVID-19 pandemic disrupted health systems worldwide, mobilizing most of its resources to COVID-19 care. In Portugal, since mid-March 2020, the scheduled assistance activity of the primary health care services has been altered or interrupted, to respond to the needs of users with suspected or diagnosed SARS-CoV-2 infection. This study intends aims to assess the impact of the COVID-19 pandemic in terms of access to primary health care during 2020 in Portugal. Primary Health Care accessibility data were extracted from the national data transparency portal. Data were aggregated by the 5 health regions and compared to homologous periods for years 2019 and 2020. In Portugal, in 2020 the number of primary health care consultations decreased in the regions of Alentejo (-5%), Algarve (-1%) and Centre (-1%) but increased in both North (+6%) and Lisbon and the Tagus Valley regions (+7%). The number of scheduled appointments decreased in the 5 regions (-16%), increasing the unscheduled appointments (+24%). Those differences were higher during the first lockdown (-42% schedule appointments vs + 13% unscheduled appointments). Presential consultations decreased by 38%, non-presential increased by 101%, and domiciliary consultations were reduced by 37%. Changes to regular activity of primary health care units compromised the access to presential health care by the non-COVID-19 population. After the first pandemic wave, the resumption of scheduled activity changed from face-to-face to non-presential consultation. The adoption of new technologies and telemedicine increased the total of registered consultations, compared to previous year. However, not all non-presential consultation is in fact patient-facing teleconsultation, with some of them being just for prescription renewal or to prescribe complementary exams. Predominantly urban regions were less affected by the suspension of presential activity, maintaining their assistance by non-presential provision of care and telework. Key messages Amidst the COVID-19 pandemic, the Portuguese primary health care services ensured the assistance to their population by non-presential provision of care. Predominantly rural regions were most affected by the suspension of presential consultation.