Author | Malta, Monica Siqueira | |
Author | Bastos, Francisco Inácio Pinkusfeld Monteiro | |
Author | Silva, Cosme Marcelo Furtado Passos da | |
Author | Pereira, Gerson Fernando Mendes | |
Author | Lucena, Francisca de Fátima A. | |
Author | Medeiros, Maria Goretti Pereira Fonseca | |
Author | Strathdee, Steffanie Anne | |
Access date | 2010-11-04T17:52:55Z | |
Available date | 2010-11-04T17:52:55Z | |
Document date | 2009 | |
Citation | MALTA, Monica Siqueira et al. Differential Survival Benefit of Universal HAART Access in Brazil: A Nation-Wide Comparison of Injecting Drug Users Versus Men Who Have Sex With Men. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, v. 52, n. 5, p. 629-635, Dec. 15, 2009. | pt_BR |
ISSN | 1077-9450 | |
URI | https://www.arca.fiocruz.br/handle/icict/1258 | |
Language | eng | pt_BR |
Publisher | Lippincott Williams & Wilkins, Inc. | pt_BR |
Rights | open access | pt_BR |
Title | Differential Survival Benefit of Universal HAART Access in Brazil: A Nation-Wide Comparison of Injecting Drug Users Versus Men Who Have Sex With Men | pt_BR |
Type | Article | |
DOI | 10.1097/QAI.0b013e3181b31b8a | pt_BR |
Abstract | Objective: Brazil accounts for ;70% of injection drug users (IDUs) receiving highly active antiretroviral therapy (HAART) in low-income/middle-income countries. We evaluated the impact of HAART availability/access on AIDS-related mortality among IDUs versus men who have sex with men (MSM).
Design: Nation-wide analysis on Brazilian IDU and MSM diagnosed with AIDS in 2000–2006. Methods: Four national information systems were linked, and Cox regression was used to assess impact of HAART availability/access on differential AIDS-related mortality. Results: Among 28,426 patients, 6777 died during 87,792 personyears of follow-up. Compared with MSM, IDU were significantly less likely to be receiving HAART, to have ever had determinations for CD4 or viral load. After controlling for confounders, IDU had a significantly higher risk of death (adjusted hazard ratio: 1.94; 95% confidence interval: 1.84 to 2.05). Among the subset that had at least 1 CD4 and viral load determination, higher risk of death among IDU persisted (hazard ratio: 1.82; 95% confidence interval: 1.58 to 2.11). Nonwhite ethnicity significantly increased this risk, whereas prompt HAART uptake after AIDS diagnosis reduced the risk of death. After controlling for spatially correlated survival data, AIDS-related mortality remained higher in IDU than in MSM. Conclusions: Despite free/universal HAART access, differential AIDS-related mortality exists in Brazil. Efforts are needed to identify and eliminate these health disparities. | pt_BR |
Affilliation | Oswaldo Cruz Foundation. Sergio Arouca School of Public Health. Social Science Department. Rio de Janeiro, RJ, Brazil. | pt_BR |
Affilliation | Oswaldo Cruz Foundation. Health Information Department, Center for Scientific and Technological Information. Rio de Janeiro, RJ, Brazil. | pt_BR |
Affilliation | Oswaldo Cruz Foundation. Sergio Arouca School of Public Health. Department of Epidemiology and Quantitative Methods. Rio de Janeiro, RJ, Brazil. | pt_BR |
Affilliation | Brazilian National STD/AIDS Program. Surveillance Unit. Brasilia, DF, Brazil. | pt_BR |
Affilliation | Brazilian National STD/AIDS Program. Surveillance Unit. Brasilia, DF, Brazil. | pt_BR |
Affilliation | Oswaldo Cruz Foundation. Evandro Chagas Clinical Research Institute. Rio de Janeiro, RJ, Brazil. | pt_BR |
Affilliation | University of California. School of Medicine. Department of Family and Preventive Medicine. Division of International Health and Cross Cultural Medicine. San Diego, CA, USA. | pt_BR |
Subject | AIDS | pt_BR |
Subject | Drug user | pt_BR |
Subject | HAART | pt_BR |
Subject | HIV | pt_BR |
Subject | Survival | pt_BR |