The HEAL Trafficking Protocol Toolkit was developed to meet an urgent need: to equip primary care (PC) institutions with a structured approach to identify and support victims of human trafficking (HT). HT is a pervasive problem in Brazil, where it intersects with various forms of exploitation, including forced labor and commercial sexual exploitation. The toolkit aims to fill a critical gap in the Brazilian Unified Health System (SUS), where PC settings lack the necessary tools and knowledge to address HT effectively. For trafficking victims, contact with health professionals may be the first—or only—opportunity to seek help.1 Primary care health workers, therefore, need awareness and knowledge to investigate signs and symptoms that already indicate severe conditions.2

The HEAL Trafficking Protocol Toolkit (Supplemental Appendix 1)3 was originally developed by HEAL Trafficking NGO (non-governmental organization) and was translated into Portuguese (Supplemental Appendix 2)4 and adapted to the Brazilian context with a focus on primary health care and the needs of vulnerable groups. This toolkit, already used in over 50 countries and foundational for training nearly 50,000 health care professionals, was tailored to Brazilian PC environments.5 The project was supported by the Work Group for Combating HT in the State of Pernambuco (GTETP-PE), which includes professionals from health care, social assistance, security, justice, civil society organizations, and the public sector.

Pernambuco, a state with a long history of HT, was a strategic location for this initiative. The state has been a pioneer in Brazil’s fight against HT; the first to establish a State Committee for the Prevention of HT. Currently, all efforts are focused on implementing a pilot project in Recife’s primary health units and expanding its use across Brazil via SUS.

To adapt this Toolkit to the Brazilian PC context, a comprehensive and collaborative process was initiated, involving stakeholders from various sectors, beginning with identification of local partners and creation of a multidisciplinary community network, including professionals from primary health care, social assistance, security, justice, civil society organizations, and public sector entities in Pernambuco.

The adaptation was guided by principles of trauma-informed care and focused on understanding the specifics of HT in Brazil within PC settings. Stakeholder engagement was critical and included 50 semistructured interviews with professionals and experts from diverse fields, a technical workshop with the GTETP-PE, and validation workshops with health professionals, social assistance workers, and other involved institutions. The sessions helped ensure the toolkit was culturally relevant and effectively addressed the needs of PC professionals in the Brazilian context.

Since September 2023, the Brazilian Protocol Toolkit page on the HEAL website has received 535 views from 270 users across 17 states and 53 different cities, demonstrating growing interest and engagement. In the US implementation, nearly 87% of Toolkit users considered it very helpful for achieving their respective objectives, including 84.1% who accessed it for educational purposes and 90.5% who used it for protocol development, implementation, or improvement.5

Adapting the Toolkit to SUS is a critical first step in building the capacity of PC to combat HT. Equipping health care professionals with the tools and knowledge to identify and respond to HT cases effectively is contributing to intervention and prevention efforts.

Based on identified groups vulnerable to exploitation and the challenges posed to primary health care professionals in assisting trafficked persons, we demonstrate how the guide can be adapted in the sociocultural context. PC settings must collaborate with social services, justice systems, and other community resources to provide comprehensive support to survivors. Safety protocols for both victims and professionals are crucial in public primary health environments, which are often not equipped to deal with organized crime.

Ultimately, the toolkit aims to provide a practical and actionable framework for PC professionals, bridging the gap between recognition and response in the fight against HT in Brazil. The next crucial step is to train primary care professionals in Recife and expand to combat HT throughout Brazilian SUS. With the extensive network and its unique capillarity, which welcomes all types of patients in various vulnerable situations, the successful implementation of the project in a key city like Recife can become a national primary health care model.