Desigualdades en el consumo de la TARGA y supervivencia diferencial según la categoría de exposición en Río de Janeiro, Brasil

Translated title of the contribution: Inequalities in haart uptake and differential survival according to exposure category in Rio de Janeiro, Brazil

Tatiana de Araujo Lima, Christopher Beyrer, Jonathan E Golub, Jurema Corrêa da Mota, Monica Siqueira Malta, Cosme Marcelo Furtado Passos da Silva, Francisco I. Bastos

Research output: Contribution to journalArticle

Abstract

Despite substantial improvement in prognosis and quality of life among people living with HIV/AIDS (PLWHA) in Brazil, inequalities in access to treatment remain. We assessed the impact of these inequalities on survival in Rio de Janeiro over a 12-year period (2000/11). Data were merged from four databases that comprise the national AIDS monitoring system: SINAN-AIDS (Brazilian Information System for Notificable Diseases; AIDS cases), SISCEL (laboratory tests), SICLOM (electronic dispensing system), and SIM (Brazilian Mortality Information System), using probabilistic linkage. Cox regressions were fitted to assess the impact of HAART (highly active antiretroviral therapy) on AIDS-related mortality among men who have sex with men (MSM), people who inject drugs (PWID), and heterosexuals diagnosed with AIDS, between 2000 and 2011, in the city of Rio de Janeiro, RJ, Brazil. Among 15,420 cases, 60.7% were heterosexuals, 36.1% MSM and 3.2% PWID. There were 2,807 (18.2%) deaths and the median survival time was 6.29. HAART and CD4+ > 200 at baseline were associated with important protective effects. Non-whites had a 33% higher risk of dying in consequence of AIDS than whites. PWID had a 56% higher risk and MSM a 11% lower risk of dying of AIDS than heterosexuals. Non-white individuals, those with less than eight years of formal education, and PWID, were more likely to die of AIDS and less likely to receive HAART. Important inequalities persist in access to treatment, resulting in disparate impacts on mortality among exposure categories. Despite these persistent disparities, mortality decreased significantly during the period for all categories under analysis, and the overall positive impact of HAART on survival has been dramatic.

Original languageSpanish
Article numbere00009617
JournalCadernos de Saude Publica
Volume34
Issue number8
DOIs
StatePublished - Jan 1 2018

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Keywords

  • Acquired immunodeficiency syndrome
  • Differential mortality
  • Hight active antiretroviral therapy
  • Social inequity
  • Survival analysis

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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