Late initiation of antiretroviral therapy: inequalities by educational level despite universal access to care and treatment

Detalhes bibliográficos
Autor(a) principal: Rodrigues, Amanda
Data de Publicação: 2021
Outros Autores: Struchiner, Claudio J., Coelho, Lara E., Veloso, Valdiléa G., Grinsztejn, Beatriz, Luz, Paula M.
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da FIOCRUZ (ARCA)
Texto Completo: https://www.arca.fiocruz.br/handle/icict/46396
Resumo: Inclui errata.
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spelling Rodrigues, AmandaStruchiner, Claudio J.Coelho, Lara E.Veloso, Valdiléa G.Grinsztejn, BeatrizLuz, Paula M.2021-03-23T00:09:48Z2021-03-23T00:09:48Z2021RODRIGUES, Amanda et al. Late initiation of antiretroviral therapy: inequalities by educational level despite universal access to care and treatment. BMC Public Health, v. 21, n. 1, p. 1-9, 2021.1471-2458https://www.arca.fiocruz.br/handle/icict/4639610.1186/s12889-021-10421-8Inclui errata.Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sérgio Arouca. Rio de Janeiro, RJ, Brasil.Fundação Getúlio Vargas. Escola de Matemática Aplicada. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.Background: Late antiretroviral treatment initiation for HIV disease worsens health outcomes and contributes to ongoing transmission. We investigated whether socioeconomic inequalities exist in access to treatment in a setting with universal access to care and treatment. Methods: This study investigated the association of educational level, used as a proxy for socioeconomic status, with late treatment initiation and treatment initiation with advanced disease. Study participants included adults (≥25 years) who started treatment from 2005 to 2018 at Instituto Nacional de Infectologia Evandro Chagas of Fundação Oswaldo Cruz (INI/FIOCRUZ), Rio de Janeiro, Brazil. Educational level was categorized following UNESCO's International Standard Classification of Education: incomplete basic education, basic education, secondary level, and tertiary level. We defined late treatment initiation as those initiating treatment with a CD4 < 350 cells/mL or an AIDS-defining event, and treatment initiation with advanced disease as those initiating treatment with a CD4 < 200 cells/mL or an AIDS-defining event. A directed acyclic graph (DAG) was constructed to represent the theoretical-operational model and to understand the involvement of covariates. Logistic regression models were used to estimate the adjusted odds ratios (aOR) and 95% confidence intervals (95%CI). Multiple imputation using a chained equations approach was used to treat missing values and non-linear terms for continuous variables were tested. Results: In total, 3226 individuals composed the study population: 876 (27.4%) had incomplete basic education, 540 (16.9%) basic, 1251 (39.2%) secondary level, and 525 (16.4%) tertiary level. Late treatment initiation was observed for 2076 (64.4%) while treatment initiation with advanced disease was observed for 1423 (44.1%). Compared to tertiary level of education, incomplete basic, basic and secondary level increased the odds of late treatment initiation by 89% (aOR:1.89 95%CI:1.47-2.43), 61% (aOR:1.61 95%CI:1.23-2.10), and 35% (aOR:1.35 95%CI:1.09-1.67). Likewise, the odds of treatment initiation with advanced disease was 2.5-fold (aOR:2.53 95%CI:1.97-3.26), 2-fold (aOR:2.07 95%CI:1.59-2.71), 1.5-fold (aOR:1.51 95%CI:1.21-1.88) higher for those with incomplete basic, basic and secondary level education compared to tertiary level. Conclusion: Despite universal access to HIV care and antiretroviral treatment, late treatment initiation and social inequalities persist. Lower educational level significantly increased the odds of both outcomes, reinforcing the existence of barriers to "universal" antiretroviral treatment.engBMCLate initiation of antiretroviral therapy: inequalities by educational level despite universal access to care and treatmentinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleART or antiretroviral therapyBrazilHIVLate treatment initiationUniversal careinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da FIOCRUZ (ARCA)instname:Fundação Oswaldo Cruz (FIOCRUZ)instacron:FIOCRUZLICENSElicense.txtlicense.txttext/plain; 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dc.title.pt_BR.fl_str_mv Late initiation of antiretroviral therapy: inequalities by educational level despite universal access to care and treatment
title Late initiation of antiretroviral therapy: inequalities by educational level despite universal access to care and treatment
spellingShingle Late initiation of antiretroviral therapy: inequalities by educational level despite universal access to care and treatment
Rodrigues, Amanda
ART or antiretroviral therapy
Brazil
HIV
Late treatment initiation
Universal care
title_short Late initiation of antiretroviral therapy: inequalities by educational level despite universal access to care and treatment
title_full Late initiation of antiretroviral therapy: inequalities by educational level despite universal access to care and treatment
title_fullStr Late initiation of antiretroviral therapy: inequalities by educational level despite universal access to care and treatment
title_full_unstemmed Late initiation of antiretroviral therapy: inequalities by educational level despite universal access to care and treatment
title_sort Late initiation of antiretroviral therapy: inequalities by educational level despite universal access to care and treatment
author Rodrigues, Amanda
author_facet Rodrigues, Amanda
Struchiner, Claudio J.
Coelho, Lara E.
Veloso, Valdiléa G.
Grinsztejn, Beatriz
Luz, Paula M.
author_role author
author2 Struchiner, Claudio J.
Coelho, Lara E.
Veloso, Valdiléa G.
Grinsztejn, Beatriz
Luz, Paula M.
author2_role author
author
author
author
author
dc.contributor.author.fl_str_mv Rodrigues, Amanda
Struchiner, Claudio J.
Coelho, Lara E.
Veloso, Valdiléa G.
Grinsztejn, Beatriz
Luz, Paula M.
dc.subject.en.pt_BR.fl_str_mv ART or antiretroviral therapy
Brazil
HIV
Late treatment initiation
Universal care
topic ART or antiretroviral therapy
Brazil
HIV
Late treatment initiation
Universal care
description Inclui errata.
publishDate 2021
dc.date.accessioned.fl_str_mv 2021-03-23T00:09:48Z
dc.date.available.fl_str_mv 2021-03-23T00:09:48Z
dc.date.issued.fl_str_mv 2021
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
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status_str publishedVersion
dc.identifier.citation.fl_str_mv RODRIGUES, Amanda et al. Late initiation of antiretroviral therapy: inequalities by educational level despite universal access to care and treatment. BMC Public Health, v. 21, n. 1, p. 1-9, 2021.
dc.identifier.uri.fl_str_mv https://www.arca.fiocruz.br/handle/icict/46396
dc.identifier.issn.pt_BR.fl_str_mv 1471-2458
dc.identifier.doi.none.fl_str_mv 10.1186/s12889-021-10421-8
identifier_str_mv RODRIGUES, Amanda et al. Late initiation of antiretroviral therapy: inequalities by educational level despite universal access to care and treatment. BMC Public Health, v. 21, n. 1, p. 1-9, 2021.
1471-2458
10.1186/s12889-021-10421-8
url https://www.arca.fiocruz.br/handle/icict/46396
dc.language.iso.fl_str_mv eng
language eng
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv BMC
publisher.none.fl_str_mv BMC
dc.source.none.fl_str_mv reponame:Repositório Institucional da FIOCRUZ (ARCA)
instname:Fundação Oswaldo Cruz (FIOCRUZ)
instacron:FIOCRUZ
instname_str Fundação Oswaldo Cruz (FIOCRUZ)
instacron_str FIOCRUZ
institution FIOCRUZ
reponame_str Repositório Institucional da FIOCRUZ (ARCA)
collection Repositório Institucional da FIOCRUZ (ARCA)
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