Late entry into HIV care: estimated impact on AIDS mortality rates in Brazil, 2003-2006.
Late entry into HIV care: estimated impact on AIDS mortality rates in Brazil, 2003-2006.
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DOI：
10.1371/journal.pone.0014585
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发表时间：
2011-01-25
期刊：
影响因子：
3.7
通讯作者：
Ayres de Castilho E
中科院分区：
文献类型：
--
作者：
Grangeiro A;Escuder MM;Menezes PR;Alencar R;Ayres de Castilho E
在世界范围内，很高比例的艾滋病毒感染者接受艾滋病毒护理的时间较晚。在这里，我们的目标是评估较晚进入艾滋病毒护理对巴西艾滋病死亡率的影响。我们分析了2003年至2006年期间在巴西公共卫生保健机构寻求治疗的艾滋病毒感染成年人的信息系统数据。我们最初估计了较晚进入艾滋病毒护理的流行率，以及前12个月的死亡概率、可归因于较晚进入的死亡风险的百分比以及可避免的死亡人数。我们随后调整了每年的艾滋病死亡率，排除了这类死亡。在接受评估的115,369名患者中，50,358人(43.6%)进入HIV护理较晚，18,002人在前12个月死亡，前12个月死亡的概率为16.5%(95%CI：16.3-16.7)。通过比较进入HIV护理较晚的患者和及时获得护理的患者，我们发现死亡的风险比为49.5(95%CI：45.1-54.2)。晚入院的死亡风险百分比为95.5%，相当于17,189例潜在可避免的死亡。避免这些死亡本可以将2003-2006年的艾滋病死亡率降低39.5%。将CD4+T细胞计数为200和≤350细胞/mm~3的无症状患者包括在较晚进入艾滋病毒护理的组中，这一比例增加了1.8%。在巴西，抗逆转录病毒药物将艾滋病死亡率降低了43%。及时加入将以类似的比例降低这一比例，并导致艾滋病毒护理方案的有效性增加45.2%。世界卫生组织建议治疗CD4+T细胞计数为≤350个/mm~3的无症状患者，这不会对这种情况产生重大影响。
Worldwide, a high proportion of HIV-infected individuals enter into HIV care late. Here, our objective was to estimate the impact that late entry into HIV care has had on AIDS mortality rates in Brazil. We analyzed data from information systems regarding HIV-infected adults who sought treatment at public health care facilities in Brazil from 2003 to 2006. We initially estimated the prevalence of late entry into HIV care, as well as the probability of death in the first 12 months, the percentage of the risk of death attributable to late entry, and the number of avoidable deaths. We subsequently adjusted the annual AIDS mortality rate by excluding such deaths. Of the 115,369 patients evaluated, 50,358 (43.6%) had entered HIV care late, and 18,002 died in the first 12 months, representing a 16.5% probability of death in the first 12 months (95% CI: 16.3–16.7). By comparing patients who entered HIV care late with those who gained timely access, we found that the risk ratio for death was 49.5 (95% CI: 45.1–54.2). The percentage of the risk of death attributable to late entry was 95.5%, translating to 17,189 potentially avoidable deaths. Averting those deaths would have lowered the 2003–2006 AIDS mortality rate by 39.5%. Including asymptomatic patients with CD4+ T cell counts >200 and ≤350 cells/mm3 in the group who entered HIV care late increased this proportion by 1.8%. In Brazil, antiretroviral drugs reduced AIDS mortality by 43%. Timely entry would reduce that rate by a similar proportion, as well as resulting in a 45.2% increase in the effectiveness of the program for HIV care. The World Health Organization recommendation that asymptomatic patients with CD4+ T cell counts ≤350 cells/mm3 be treated would not have a significant impact on this scenario.
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影响因子：
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作者：
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通讯作者：
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DOI：
10.1097/qai.0b013e3181967602
发表时间：
2009-04-15
影响因子：
3.6
作者：
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通讯作者：
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DOI：
10.1590/s0102-311x2009000900019
发表时间：
2009-09-01
期刊：
Cadernos de Saúde Pública
影响因子：
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作者：
Grangeiro, Alexandre;Escuder, Maria Mercedes;Kayano, Jorge
通讯作者：
Kayano, Jorge