Late Entry into HIV Care: Estimated Impact on AIDS Mortality Rates in Brazil, 2003-2006

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dc.contributor Sistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.author GRANGEIRO, Alexandre FMUSP-HC
ESCUDER, Maria Mercedes
MENEZES, Paulo Rossi FMUSP-HC
ALENCAR, Rosa
CASTILHO, Euclides Ayres de FMUSP-HC
dc.date.issued 2011
dc.identifier.citation PLOS ONE, v.6, n.1, article ID e14585, 11p, 2011
dc.identifier.issn 1932-6203
dc.identifier.uri http://observatorio.fm.usp.br/handle/OPI/23362
dc.description.abstract Background: Worldwide, a high proportion of HIV-infected individuals enter into HIV care late. Here, our objective was to estimate the impact that late entry into HIV care has had on AIDS mortality rates in Brazil. Methodology/Principal Findings: We analyzed data from information systems regarding HIV-infected adults who sought treatment at public health care facilities in Brazil from 2003 to 2006. We initially estimated the prevalence of late entry into HIV care, as well as the probability of death in the first 12 months, the percentage of the risk of death attributable to late entry, and the number of avoidable deaths. We subsequently adjusted the annual AIDS mortality rate by excluding such deaths. Of the 115,369 patients evaluated, 50,358 (43.6%) had entered HIV care late, and 18,002 died in the first 12 months, representing a 16.5% probability of death in the first 12 months (95% CI: 16.3-16.7). By comparing patients who entered HIV care late with those who gained timely access, we found that the risk ratio for death was 49.5 (95% CI: 45.1-54.2). The percentage of the risk of death attributable to late entry was 95.5%, translating to 17,189 potentially avoidable deaths. Averting those deaths would have lowered the 2003-2006 AIDS mortality rate by 39.5%. Including asymptomatic patients with CD4(+) T cell counts >200 and <= 350 cells/mm(3) in the group who entered HIV care late increased this proportion by 1.8%. Conclusions/Significance: In Brazil, antiretroviral drugs reduced AIDS mortality by 43%. Timely entry would reduce that rate by a similar proportion, as well as resulting in a 45.2% increase in the effectiveness of the program for HIV care. The World Health Organization recommendation that asymptomatic patients with CD4(+) T cell counts <= 350 cells/mm(3) be treated would not have a significant impact on this scenario.
dc.description.sponsorship · Brazilian National Ministry of Health
· Deutsche Gesellschaft fur Technische Zusammenarbeit (GTZ, German Agency for Technical Cooperation) in Brazil
· Brazilian Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq, National Council for Scientific and Technological Development)
dc.language.iso eng
dc.publisher PUBLIC LIBRARY SCIENCE
dc.relation.ispartof Plos One
dc.rights openAccess
dc.subject.other antiretroviral therapy; hiv-1-infected patients; united-states; gender-differences; infected patients; medical-care; sao-paulo; 1st year; diagnosis; settings
dc.title Late Entry into HIV Care: Estimated Impact on AIDS Mortality Rates in Brazil, 2003-2006
dc.type article
dc.rights.holder Copyright PUBLIC LIBRARY SCIENCE
dc.description.group LIM/39
dc.identifier.doi 10.1371/journal.pone.0014585
dc.identifier.pmid 21283618
dc.type.category original article
dc.type.version publishedVersion
hcfmusp.author GRANGEIRO, Alexandre:HC:LIM/39
hcfmusp.author MENEZES, Paulo Rossi:FM:MPR
hcfmusp.author CASTILHO, Euclides Ayres de:FM:MPR
hcfmusp.author.external · ESCUDER, Maria Mercedes:Secretaria Estado Saude Sao Paulo, Inst Saude, Sao Paulo, Brazil
· ALENCAR, Rosa:Secretaria Estado Saude Sao Paulo, Ctr Referencia & Treinamento DST Aids, Sao Paulo, Brazil
hcfmusp.origem.id WOS:000286661400003
hcfmusp.origem.id 2-s2.0-79551537508
hcfmusp.publisher.city SAN FRANCISCO
hcfmusp.publisher.country USA
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dc.description.index MEDLINE
hcfmusp.citation.scopus 43
hcfmusp.affiliation.country Brasil
hcfmusp.scopus.lastupdate 2021-08-27


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