Abstract
To evaluate the effect of the distance between the place of residence and the specialized treatment service on the survival time of people living with HIV/Aids in Alagoas, Northeast Brazil. Data from the notification and mortality systems related to individuals aged 13 years or older diagnosed with the infection between 2007 and 2013 were used. The cases were observed for a period of follow-up until December 2017. For the analyses, the Pearson's χ2 test, Kaplan-Meier method, and Cox regression were adopted according to the outcome of the case, place of residence, distance to the health unit, population size of the municipality of residence, sex, skin color/ethnicity, and age. Of the 2,732 analyzed cases, 760 individuals died of Aids-related causes. The average estimate of survival time for individuals residing in the capital was 98.6 months (95%CI 96.1-101). Among residents of inland cities, the estimate was 92.7 months (95%CI 89.3-96.1). There was a significant difference in curves throughout the period. The group residing in inland municipalities and those traveling a distance of >70 km had a higher average relative risk of death (RR=1.21, 95%CI 1.05-1.4 and RR=1.18, 95%CI 1.01-1.39, respectively). Living in or near the capital decreases the average relative risk of death. In order to increase the survival time of HIV/Aids patients in Alagoas, it is suggested to decentralize specialized health care, that is, to create regional centers to care for these people.
Highlights
Infection with the Human Immunodeficiency Virus (HIV) is a major public health problem worldwide
For the group residing at a distance of ≤70 km from the specialized service, the average estimate of survival time was 97.5 months (95%CI 95.2–99.7), and for those residing at a distance of >70 km, the estimate was 92.7 months (95%CI 88.3–97.0)
The data found in this study demonstrated a significant association between the occurrence of deaths, survival time, geographical location of the people living with HIV/Aids (PLWHA) residence, and the distance in relation to specialized healthcare services, even at different time intervals during the observed period and in the models in which the personal characteristics of age and sex were considered
Summary
Infection with the Human Immunodeficiency Virus (HIV) is a major public health problem worldwide. It is estimated that 37.9 million people live with the virus. Latin America is considered the third most affected global region, in which about a quarter of individuals with HIV do not know their diagnosis and 40% have no access to antiretroviral therapy[1]. Brazil has been prominent in the infection treatment scenario due to the free antiretroviral treatment protocols of universal access. The Northeast region recorded 55,090 cases (18.3%) and, with the exception of the state of Bahia, all of its states showed an increase in the detection rate[2]. Data related to the mortality of people living with HIV/Aids (PLWHA) do not follow a uniform trend between Brazilian regions. In the North and Northeast regions, there was an increase of 26.0 and 2.8% in this coefficient, respectively[2]
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