Please use this identifier to cite or link to this item: https://www.arca.fiocruz.br/handle/icict/25473
Title: Evaluating the care cascade after antiretroviral therapy initiation in Latin America
Authors: Wolff, Marcelo J.
Cortes, Claudia P.
Mejìa, Fernando A.
Padgett, Denis
Belaunzarán-Zamudio, Pablo
Grinsztejn, Beatriz
Giganti, Mark J.
McGowan, Catherine C.
Rebeiro, Peter F
Affilliation: University of Chile. Fundacion Arriaran. School of Medicine. Santiago, Chile.
University of Chile. Fundacion Arriaran. School of Medicine. Santiago, Chile.
Universidad Peruana Cayetano Heredia. Instituto de Medicina Tropical Alexander von Humboldt. Lima, Peru.
Instituto Hondureño de Seguridad Social and Hospital Escuela Universitario. Tegucigalpa, Honduras.
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Mexico City, Mexico / Universidad Nacional Autónoma de México. División de Investigación de Facultad de Medicina. Mexico City, Mexico.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brasil.
Vanderbilt University School of Medicine. Nashville, TN, USA.
Vanderbilt University School of Medicine. Nashville, TN, USA.
Vanderbilt University School of Medicine. Nashville, TN, USA.
Abstract: Accelerating antiretroviral therapy (ART) administration, improving retention, and achieving viral suppression in low- and middle-income countries must be prioritized. We evaluated trends and disparities in these milestones in a large Latin American cohort. Adults starting ART (ARTstart) from 2003 to 2014 at Caribbean, Central, and South America network for HIV epidemiology sites were assessed for care cascade outcomes: CD4 cell count >200 cells/mm3at ARTstart; retention (≥1 visit at one year after ARTstart); viral suppression (≥1 HIV-1 RNA <200 copies/ml at one year after ARTstart). Modified Poisson regression provided adjusted prevalence ratios by age, gender, and HIV transmission risk, accounting for site and year of ARTstart. Proportions achieving ARTstartand suppression improved over time (p < 0.05). Older age was associated with better retention and viral suppression, but not ARTstartat CD4 cell count >200 cells/mm3. Females and men who have sex with men (MSM) were more likely to have CD4 cell count >200 cells/mm3at ARTstart. Injection drug users (IDUs) were less likely to be retained while MSM were more likely to achieve viral suppression (all p < 0.05). Despite improvements in these outcomes over the course of a decade in this cohort, significant disparities existed, disadvantaging younger patients, men, and IDUs. These gaps indicate continued progress in providing early diagnosis and ARTstartremain critical.
Keywords: HIV
South America
AIDS
Epidemiology
ART
Homosexual
DeCS: Minorias Sexuais
Síndrome de Imunodeficiência Adquirida
Epidemiologia
América do Sul
Issue Date: 2018
Publisher: SAGE
Citation: WOLFF, Marcelo J. et al. Evaluating the care cascade after antiretroviral therapy initiation in Latin America. International Journal of STD and AIDS, v. 29, n. 1, p. 4-12, Jan. 2018.
DOI: 10.1177/0956462417714094
ISSN: 0956-4624
Copyright: restricted access
Appears in Collections:INI - Artigos de Periódicos

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