ABSTRACT
OBJECTIVE
To build an integrated database of individual and service data from the cohort of people who started antiretroviral therapy (ART), from 2015 to 2018, in Brazil.
METHODS
Open cohort study that includes people aged 15 years or older who started ART from 2015 to 2018, with follow-up in services of the Brazilian Unified Health System (SUS), and who responded to the 2016/2017 Qualiaids national survey. The source of individual data was the related HIV database, derived from the probabilistic linkage between data from the SUS systems of diagnostic information, medication, tests, and deaths. The data source for the services was the services’ response database to the Qualiaids survey. After analysis of consistency and exclusions, the database of individuals was deterministically related to the database of services.
RESULTS
The cohort comprised 132,540 people monitored in 941 SUS services. Of these services, 59% are located in the Southeast region and 49% followed 51 to 500 cohort participants. The average performance of organization and management of patient care ranged from 29% to 75%. Most of the cohort participants are male, black and mixed, aged between 20 and 39 years old, and have between 4 and 11 years of schooling. Median baseline T-CD4 was 419 cells/mm3, 6% had an episode of tuberculosis, and 2% died of HIV disease.
CONCLUSION
For the first time in Brazil, this cohort provides the opportunity for a joint analysis of individual factors and services in the production of positive and negative clinical outcomes of HIV treatment.
HIV; Cohort Studies; Brazilian Unified Health System; Health Services Research; Tuberculosis
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Sinan: Sistema de Informação de Agravos de Notificação (Informatiom System for Notifiable Diseases); Siclom: Sistema de Controle Logístico de Medicamentos (Medication Logistic Control System) ; Siscel: Sistema de Controle de Exames Laboratoriais de CD4+/CD8+ e Carga Viral do HIV (CD4+/CD8+ and HIV Viral Load Laboratory Test Control System); SIM: Sistema de Informação sobre Mortalidade (Mortality Information System); ART: antiretroviral therapy; PLWHA: people living with HIV/aids; VL: viral load.a Incompatibility of Sinan data (n = 593), dispensing after death (n = 300), deaths prior to treatment initiation (n = 649), notification of tuberculosis after death (n = 67), duplicate CD4 test results (n = 2), duplicate VL test results (n = 261), duplicate dispensing records (n = 257), incorrect registration of ART initiation (5,073), interruption of ART and subsequent VL result undetectable (n = 160).b Record of first undetectable VL result (n = 19,081).
ART: antiretroviral therapy; PLWHA: people living with HIV/aids.a Services were classified based on the response to the question about the type of service in the Qualiaids questionnaire. “Outpatient type” for the answers: exclusive outpatient clinic for specialized care for patients with HIV/AIDS, STD, and viral hepatitis outpatient clinic; outpatient clinic specializing in infectious diseases; specialized assistance team included in a primary care service; outpatient care for various specialties and hospital outpatient clinic; “Type of primary care” for the answers: basic health unit, health center, family health.b The services’ infrastructure was calculated based on the answers to 45 questions in the Qualiaids questionnaire on the availability of: initial assessment and follow-up tests, complementary tests for evaluation of additional clinical conditions common in HIV/AIDS patients, referrals to specialist physicians, assistance modalities and other health professionals, and availability of medicines and supplies for prevention and diagnosis. Services with up to 49% of the expected infrastructure were classified as “insufficient,” those with infrastructure between 50% and 64% were defined as “acceptable” and those with more than 65% of available infrastructure were classified as “sufficient.”