TY - JOUR
T1 - Inequalities in haart uptake and differential survival according to exposure category in Rio de Janeiro, Brazil
AU - Lima, Tatiana de Araujo
AU - Beyrer, Chris
AU - Golub, Jonathan E.
AU - da Mota, Jurema Corrêa
AU - Malta, Monica Siqueira
AU - da Silva, Cosme Marcelo Furtado Passos
AU - Bastos, Francisco I.
N1 - Funding Information:
The authors wish to thank the Department of STDs, AIDS, and Viral Hepatitis of the Health Department of the city of Rio de Janeiro for generously allowing use of the data for this article. We also wish to thank the Graduate Studies Program from Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation (ENSP/Fiocruz) and from Johns Hopkins Bloomberg School of Public Health for the learning and professional growth opportunities provided by the doctoral course in Epidemiology. Scholarship provided by the Brazilian Ministry of Science and Technology (Science Without Borders Program).
Publisher Copyright:
© 2018, Fundacao Oswaldo Cruz. All rights reserved.
PY - 2018
Y1 - 2018
N2 - 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.
AB - 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.
KW - Acquired immunodeficiency syndrome
KW - Differential mortality
KW - Hight active antiretroviral therapy
KW - Social inequity
KW - Survival analysis
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U2 - 10.1590/0102-311x00009617
DO - 10.1590/0102-311x00009617
M3 - Article
C2 - 30133651
AN - SCOPUS:85052247360
SN - 0102-311X
VL - 34
JO - Cadernos de saude publica
JF - Cadernos de saude publica
IS - 8
M1 - e00009617
ER -