Inequalities in HAART uptake and differential survival according to exposure category in Rio de Janeiro, Brazil
Autor(a) principal: | |
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Data de Publicação: | 2018 |
Outros Autores: | , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Cadernos de Saúde Pública |
Texto Completo: | http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2018000805010 |
Resumo: | 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. |
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Inequalities in HAART uptake and differential survival according to exposure category in Rio de Janeiro, BrazilAcquired Immunodeficiency SyndromeSurvival AnalysisDifferential MortalitySocial InequityHight Active Antiretroviral TherapyAbstract: 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.Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz2018-01-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2018000805010Cadernos de Saúde Pública v.34 n.8 2018reponame:Cadernos de Saúde Públicainstname:Fundação Oswaldo Cruz (FIOCRUZ)instacron:FIOCRUZ10.1590/0102-311x00009617info:eu-repo/semantics/openAccessLima,Tatiana de AraujoBeyrer,ChrisGolub,Jonathan E.Mota,Jurema Corrêa daMalta,Monica SiqueiraSilva,Cosme Marcelo Furtado Passos daBastos,Francisco I.eng2018-08-20T00:00:00Zoai:scielo:S0102-311X2018000805010Revistahttp://cadernos.ensp.fiocruz.br/csp/https://old.scielo.br/oai/scielo-oai.phpcadernos@ensp.fiocruz.br||cadernos@ensp.fiocruz.br1678-44640102-311Xopendoar:2018-08-20T00:00Cadernos de Saúde Pública - Fundação Oswaldo Cruz (FIOCRUZ)false |
dc.title.none.fl_str_mv |
Inequalities in HAART uptake and differential survival according to exposure category in Rio de Janeiro, Brazil |
title |
Inequalities in HAART uptake and differential survival according to exposure category in Rio de Janeiro, Brazil |
spellingShingle |
Inequalities in HAART uptake and differential survival according to exposure category in Rio de Janeiro, Brazil Lima,Tatiana de Araujo Acquired Immunodeficiency Syndrome Survival Analysis Differential Mortality Social Inequity Hight Active Antiretroviral Therapy |
title_short |
Inequalities in HAART uptake and differential survival according to exposure category in Rio de Janeiro, Brazil |
title_full |
Inequalities in HAART uptake and differential survival according to exposure category in Rio de Janeiro, Brazil |
title_fullStr |
Inequalities in HAART uptake and differential survival according to exposure category in Rio de Janeiro, Brazil |
title_full_unstemmed |
Inequalities in HAART uptake and differential survival according to exposure category in Rio de Janeiro, Brazil |
title_sort |
Inequalities in HAART uptake and differential survival according to exposure category in Rio de Janeiro, Brazil |
author |
Lima,Tatiana de Araujo |
author_facet |
Lima,Tatiana de Araujo Beyrer,Chris Golub,Jonathan E. Mota,Jurema Corrêa da Malta,Monica Siqueira Silva,Cosme Marcelo Furtado Passos da Bastos,Francisco I. |
author_role |
author |
author2 |
Beyrer,Chris Golub,Jonathan E. Mota,Jurema Corrêa da Malta,Monica Siqueira Silva,Cosme Marcelo Furtado Passos da Bastos,Francisco I. |
author2_role |
author author author author author author |
dc.contributor.author.fl_str_mv |
Lima,Tatiana de Araujo Beyrer,Chris Golub,Jonathan E. Mota,Jurema Corrêa da Malta,Monica Siqueira Silva,Cosme Marcelo Furtado Passos da Bastos,Francisco I. |
dc.subject.por.fl_str_mv |
Acquired Immunodeficiency Syndrome Survival Analysis Differential Mortality Social Inequity Hight Active Antiretroviral Therapy |
topic |
Acquired Immunodeficiency Syndrome Survival Analysis Differential Mortality Social Inequity Hight Active Antiretroviral Therapy |
description |
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. |
publishDate |
2018 |
dc.date.none.fl_str_mv |
2018-01-01 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2018000805010 |
url |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2018000805010 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
10.1590/0102-311x00009617 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/html |
dc.publisher.none.fl_str_mv |
Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz |
publisher.none.fl_str_mv |
Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz |
dc.source.none.fl_str_mv |
Cadernos de Saúde Pública v.34 n.8 2018 reponame:Cadernos de Saúde Pública instname:Fundação Oswaldo Cruz (FIOCRUZ) instacron:FIOCRUZ |
instname_str |
Fundação Oswaldo Cruz (FIOCRUZ) |
instacron_str |
FIOCRUZ |
institution |
FIOCRUZ |
reponame_str |
Cadernos de Saúde Pública |
collection |
Cadernos de Saúde Pública |
repository.name.fl_str_mv |
Cadernos de Saúde Pública - Fundação Oswaldo Cruz (FIOCRUZ) |
repository.mail.fl_str_mv |
cadernos@ensp.fiocruz.br||cadernos@ensp.fiocruz.br |
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1754115738950434816 |