37906University of Vale do Rio dos Sinos - UNISINOS, São Leopoldo, Rio Grande do Sul, Brazil.
8785University of California, San Francisco - UCSF, San Francisco, CA, USA.
Int J STD AIDS. 2021 Apr;32(5):462-469. doi: 10.1177/0956462420975947. Epub 2021 Feb 11.
In 2018, Rio Grande do Sul (RS) had some of the highest HIV/AIDS rates in Brazil, and we did not find any studies about the HIV care and treatment cascade (HCTC) related to this state. We aimed to estimate the indicators of HCTC of RS, Brazil, and associated factors. A cross-sectional study with all people living with HIV (PLWH) in RS between 1 January 2014 and 31 December 2017 was conducted using a national database which registers all HIV notifications, CD4 and viral load laboratory data and antiretroviral therapy (ART) usage in the public health system. We considered sex, age, education, race, year of HIV diagnosis, and health region as predictor factors, and defined linkage to care, retention to care, being on ART, and having undetectable viral load as the HCTC indicators. Descriptive analysis and multivariable logistic regression were performed using Stata 15.2. A total of 116,121 PLWH were diagnosed, 79,959 were linked to care, 72,117 retained in care, 69,219 on ART, and 54,857 had undetectable viral load from 2014 to 2017. We observed greatest attrition for younger age, non-white, and lower education in all HCTC indicators. Women are more likely to have undetectable viral load (OR = 1.04, 95% CI: 1.01-1.07), even though they are less likely to be retained to care (OR = 0.92; 95% CI: 0.89-0.96) and on ART (OR = 0.82; 95% CI: 0.78-0.86). Although all HCTC indicators have increased over the period and the "test and treat" policy indicates improvements in ART and in undetectable viral load outcomes, evidence suggests specific attrition and disparities such as those related to HIV healthcare facilities should be addressed. These findings may be used by researchers, health professionals, and policymakers in order to investigate and implement interventions to better engage PLWH across the HCTC.
2018 年，南里奥格兰德州（RS）的艾滋病毒/艾滋病发病率在巴西居首位，我们没有发现任何与该州相关的艾滋病毒护理和治疗级联（HCTC）的研究。我们旨在估计巴西南里奥格兰德州的 HCTC 指标及其相关因素。这是一项使用国家数据库进行的横断面研究，该数据库记录了 2014 年 1 月 1 日至 2017 年 12 月 31 日期间南里奥格兰德州所有艾滋病毒感染者（PLWH）的所有 HIV 通知、CD4 和病毒载量实验室数据以及公共卫生系统中抗逆转录病毒治疗（ART）的使用情况。我们将性别、年龄、教育程度、种族、艾滋病毒诊断年份和卫生区域作为预测因素，并将与护理的衔接、护理的保留、接受 ART 和无法检测到的病毒载量定义为 HCTC 指标。使用 Stata 15.2 进行描述性分析和多变量逻辑回归。2014 年至 2017 年期间，共诊断出 116121 名 PLWH，其中 79959 人已与护理机构衔接，72117 人得到保留，69219 人接受了 ART 治疗，54857 人病毒载量无法检测。我们观察到所有 HCTC 指标中，年龄较小、非白人以及教育程度较低的人失访率更高。尽管女性更有可能病毒载量无法检测（OR=1.04，95%CI：1.01-1.07），但她们更有可能得不到护理保留（OR=0.92；95%CI：0.89-0.96）和接受 ART（OR=0.82；95%CI：0.78-0.86）。尽管所有 HCTC 指标在此期间都有所增加，而且“检测即治疗”政策表明 ART 和无法检测到的病毒载量结果有所改善，但有证据表明，应解决特定的失访和差异问题，例如与艾滋病毒保健设施相关的问题。这些发现可被研究人员、卫生专业人员和决策者用于调查和实施干预措施，以更好地使整个 HCTC 中的 PLWH 参与其中。
