Abstract
BackgroundTo evaluate the trends in AIDS detection and the AIDS-attributed death rate in Brazil between 2007 and 2015 and to determine the population characteristics associated with AIDS detection.MethodsSurveillance data including demographics, mode of HIV transmission, AIDS cases, and AIDS-attributed deaths were analysed. A logistic regression model was fitted to assess the trends in AIDS cases by mode of HIV transmission throughout the study period. A segmented Poisson regression model was used to assess changes in the trends of AIDS detection and mortality rates before (2007–2014) and after (2015) the introduction of the Test and Treat Initiative.ResultsIn the segmented Poisson regression, the decline in the AIDS detection rate from 2007 to 2014 was 2.0% annually (i.e., the odds ratio (OR) for annual decline was 0.98 (95% [CI: 0.98–1.00, p-value < 0.001). The observed AIDS detection rate in 2015 was 7.7 cases per 100,000, which was 60% lower than the regression estimate of 19.8 for the hypothetical absence of the Test and Treat Initiative. The reduction in AIDS-attributed deaths from 2007 to 2014 was 8.0% annually (i.e., the OR for annual decline was 0.92 (95% [CI: 0.91–0.95, p-value < 0.001). The observed AIDS mortality rate in 2015 was 0.49 cases per 100,000, which was 73% lower than the regression estimate of 2.1 for the hypothetical absence of the Test and Treat Initiative in 2015.ConclusionsOur results reveal a fairly stable AIDS detection rate from 2007 to 2014, with a sudden significant drop in 2015. This drop may be related to the increasing trends in rapid testing, the number of new HIV diagnoses, the number of patients on antiretroviral therapy (ART), and a median CD4 count at ART enrolment. Further evaluation of the effects of the Test and Treat Initiative on AIDS diagnosis and mortality is needed and must be strengthened with additional data from subsequent years.
Highlights
To evaluate the trends in Acquired immune deficiency syndrome (AIDS) detection and the AIDS-attributed death rate in Brazil between 2007 and 2015 and to determine the population characteristics associated with AIDS detection
Approximately 42% of the people living with Human immunodeficiency virus (HIV)/ AIDS (PLWHA) in Latin America can be found in Brazil [1], with 842,710 AIDS cases registered as of June 2016 [2]
Data was obtained from several electronic surveillance subsystems: 1) the Notifiable Disorders Information System [Sistema de Informação de Agravos de Notificação (SINAN)]: AIDS cases, epidemiological characteristics; 2) the Mortality Information System [Sistema de Informaçoes sobre Mortalidade (SIM)]: death information such as cause of death, the date, and the municipality of death were recorded from the declaration of death document; 3) the Logistic Treatment Control System [Sistema de Controle Logistico de Medicamentos (Siclom)]; and 4) the Laboratory Testing Information System [Sistema de Informação de Exames Laboratoriais (Siscel)]
Summary
To evaluate the trends in AIDS detection and the AIDS-attributed death rate in Brazil between 2007 and 2015 and to determine the population characteristics associated with AIDS detection. An estimated 32,321 new HIV cases were reported in 2015, which corresponds to a rise of 81% since 2007 (6152) [2]. The reported number of AIDS deaths in Brazil has remained stable from 11,020 cases in 2004 to 12,298. Brazil HIV/AIDS epidemic scenario concentrates in key groups and is mainly spread by sexual transmission. The country reported an HIV prevalence of 0.4% among adults in 2010. The prevalence was higher in other groups such as men who have sex with men (MSM) (18.4%) [3], sex workers (5.3%), and drug/alcohol users (5.9%) [4, 5]. The majority of AIDS cases are men, with a sex ratio of 1.7 to one in 2012. Heterosexual transmission increased in the 1990s, but Pereira et al BMC Infectious Diseases (2019) 19:579
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