Factors associated with HIV care and treatment cascade in Rio Grande do Sul, Brazil, 2014–2017: A cross-sectional study

Abstract

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.

The Impact of COVID-19 on HIV Care in Rio de Janeiro, Brazil 2019–2021: Disparities by Age and Gender

“…This highlights the potential disproportionate impact of social vulnerability on disruption to HIV care continuum. Despite prior studies demonstrating racial disparities in retention in care for PLWH by race/skin color in Brazil [ 6 ], the prevalence of adequate care by each indicator were relatively equivalent among race/skin color groups in both periods in this study. However, each race/skin color group experienced significant decreases in care visits and viral load monitoring and an increase in MPR.…”

“…In our study, younger PLWH had lower odds of having adequate care visits. In addition, younger age has been linked to higher attrition rates [ 6 ], not being on ART and not being virologically suppressed [ 5 ]. With COVID-19 onset, younger PLWH may have been less able to adhere to social distancing requirements and more likely to need to go to work.…”

“…On the other hand, older PLWH were more at risk of COVID-19 related mortality [ 10 ] and less likely to adopt alternatives to in-person care events [ 43 ]. While the literature has suggested that those with lower education have worse health outcomes for HIV (linkage to care, ART uptake, viral suppression, retention in care, mortality [ 5 , 6 , 42 , 43 ]) and COVID-19 (exposure and severity [ 44 ], mortality [ 10 ]), our results did not show statistically significant lower odds of adequate care visits among those with less than 8 years of schooling compared to those with 9 or more years of schooling. Finally, we found that those who were on ART for less than or equal to 12 months by the start of the pre-pandemic year had a higher odds of adequate care visits.…”

“…A 2016 study of sociodemographic factors associated with gaps in the HIV care continuum in Brazil found that non-white individuals and those of lower educational attainment, black/indigenous, or brown race/skin color had worse access to HIV testing, ART treatment initiation and virologic suppression; younger age was strongly associated with lack of ART use and virologic suppression [ 5 ]. Furthermore, a 2018 study of HIV care in Rio Grande do Sul, Brazil found that younger, non-white, and lower educated individuals had the greatest attrition rates and that, while cisgender women were more likely to achieve viral suppression, they were less likely to be retained in care [ 6 ].…”