Family Health Strategy Research Articles

Inequalities in access to early child services in Bulgaria

Abstract Background Children’s health has been a major focus of European health policy since 2000, with particular emphasis on early childhood and integrated services for children with chronic diseases. However, research on early child care in Bulgaria is sparse, mainly focusing on the role of nurseries, kindergartens and nursing care. Our aim is to investigate whether there are disparities in access to early childhood health services in Bulgaria. Methods A survey was conducted among mothers of children up to 7 years old between April and June 2022. The questionnaire, containing 49 questions, was based on the theoretical framework from the EU project ‘Models of child health appraise’, covering topics as: geographical and financial access to services, equity, quality, responsiveness to children and family needs, considered key features of outpatient child medical care. Statistical analysis utilized Chi-square, Fisher’s exact and ANOVA tests. Results A total of 413 Bulgarian women, with a mean age of 34.3 (±5.1), participated in the study. Almost all women (91.3%) reported that their children had a primary care provider. The mean time to reach the GP/pediatrician’s office was 16 minutes (95% CI 14.6 - 16.7), longest for residents of small towns and villages (21 minutes), p = 0.004. Parents from small towns (including villages) were six times more likely to experience financial difficulties related to their children’s healthcare services compared to those from the capital city (p = 0.047), as well as parents with low-income (p = 0.031). Emergency healthcare was the most demanded service by families with children under 7 years old, possibly due to its free availability. Parents with secondary education and from small towns lack access to non-medical health-promoting or preventive services such as breastfeeding consultations, speech therapy and others. Conclusions Significant financial and geographic disparities in access to early child health services exist in Bulgaria. Key messages • There are serious social health inequalities related to the access to outpatient child health services in Bulgaria. • There is an urgent need for specific child and family health strategy based on the principles of proportionate universalism.

DESAFIOS NA ADESÃO MEDICAMENTOSA SOB A PERSPECTIVA DOS PROFISSIONAIS DE SAÚDE DA ATENÇÃO PRIMÁRIA

This study explores the factors influencing medication adherence among patients of the Family Health Strategy (ESF) in Embu das Artes/SP, based on the perspectives of healthcare professionals. The qualitative research, which involved semi-structured interviews and a literature review, identified low health literacy among patients as the primary barrier. Adherence to treatment is influenced by internal factors, such as patient perception and motivation, as well as external factors, including socioeconomic status and cultural aspects. The lack of understanding regarding the importance of medications and the chronic nature of diseases exacerbates the problem, leading to elevated risks such as mortality and hospital readmission. Professionals reported challenges such as fear of side effects and confusion over medication schedules. These issues underscore the need to enhance healthcare professionals' training to develop educational strategies aimed at providing health literacy and achieving more effective treatment adherence.

Family Management of Hypertension in Brazil: A Cross-Sectional Study.

In Brazil, research indicates that primary family members are the main source of support for individuals with chronic conditions such as hypertension (HTN). The burden of caregiving not only hinders effective HTN management but can also cause stress and anxiety, potentially leading to HTN in caregivers. Despite this, few studies have explored the impact of caregiving on these family members. Aims of the study were to: (1) Describe the prevalence of blood pressure (BP) control in family members of individuals with HTN; (2) identify family member perspectives on facilitators and barriers to HTN management; and (3) identify influences that help or interfere with family member functioning (levels of stress, quality of life [QOL], and caregiver burden). This descriptive, cross-sectional study included 213 family members randomly selected from 3 Family Health Strategy units. Family members were largely female (n = 143; 67.1%); the mean age was 60.1 years (SD ± 17.02) and 42.6% (n = 96) had less than a high school education. The three most important facilitators and barriers were related to medication, medical visits, healthy eating, physical activity, and stress. The mean systolic BP was 132.7 (SD ± 21.9) mmHg and a diastolic BP of 85.9 (SD ± 18.1) mmHg with 120 (56.3%) of family members classified as having normal BP. In regard to family member contributions to the self-care of the individual with HTN, family members displayed low levels of self-care maintenance (n = 148; 69.4%) and management (n = 47; 71.2%) support, while a slight majority (n = 114; 53.5%) had adequate levels of self-care confidence in supporting the individual with HTN. Family members (n = 189; 88.8%) showed moderate-to-high levels of perceived stress, but good physical (n = 189; 88.7%) and mental QOL (n = 196; 92%) and low levels of caregiver burden (n = 113; 53.1%). A variety of contextual sociocultural influences were associated with the outcomes under study. Family-based interventions are urgently needed to address the inadequate management of HTN.

HPV Vaccination Coverage in Brazil's State of Paraná: Spatial Distribution and Advances in Public Health.

Background/Objectives: To analyze the spatial distribution of HPV vaccination coverage in relation to sociodemographic variables in a state of Southern Brazil. Methods: This was an ecological, retrospective study with secondary data from the Department of Information Technology of the Unified Health System/Ministry of Health from 2015 to 2022. The cohort method was used to calculate vaccination coverage. Geographically weighted regression was used for the independent variables. Results: There was a 22.04% reduction in vaccination between the first and second doses. Coverage with the first dose of the vaccine reached 95.17% for the female population, 64.67% for the male population, and 79.57% for both sexes. In 50.62% of cities, coverage exceeded 90% for both sexes. In 80.45% of cities, the recommended coverage for females was achieved. The variable municipal performance was positively significant for the increase in vaccination coverage in 45.45% of the regions for girls, 18.18% for boys, and 36.36% for both sexes. The family health strategy variable was significant in 9.09% of the regions for girls and both sexes. The education variable showed an inverse significance for girls in 40.90%, for boys in 18.18%, and for both sexes in 36.36% of the regions. Conclusions: HPV vaccination declined between the first and second doses, with high first-dose coverage among females and moderate coverage among males. Municipal performance notably impacted coverage, particularly for girls. The family health strategy was relevant in specific regions, while educational factors had a variable effect. Addressing these variables may enhance vaccination coverage and minimize the gap between doses.

Territorial-based mental health in Brazil: a systematic review of the literature

The research aims to investigate the actions of territorial and community-based services focused on mental health, with the participation of the Psychosocial Care Network, focusing on the family health strategy team. The Systematic Review methodology is used. The analysis of the key characteristics listed in the RAPS and the synthesis of the data were carried out according to the availability of data from the 10 eligible studies, covering topics such as Psychosocial Care Center, referral and matrix support, medicalization, care strategies in the territory, public policies, stigma/prejudice, training and social reintegration. Through the analyzed studies, it could be concluded that this service network is still under development, pointing out the importance of territorial-based care, and the need for expansion and implementation of extra-hospital infrastructure closer to the daily lives of mental health users, to that does not overload the insufficient substitutive services of assistance that are characteristically community, inadequate assistance approaches to the point of lack of assistance in some cases.

Smoking: Profile of an Elderly Sample in the City of Porto Alegre-RS/Brazil

Objective: The objective of this study is to determine the profile of smokers in a sample of elderly people served by the Family Health Strategy (ESF) in the city of Porto Alegre/RS. Theoretical Framework: Smoking is one of the main risk factors for several chronic diseases, including cardiovascular disease, cancer, chronic obstructive pulmonary disease (COPD) and several other conditions. Although the number of smokers is declining in many countries, the impact of smoking remains a significant public health concern. Method: Cross-sectional study with prospective data collection involving a sample of 567 elderly people. 30 ESF teams from different Health Districts were chosen through a stratified random draw and 36 elderly people were selected from each team. Results and Discussion: The prevalence of smoking was 21.5%, with a higher prevalence in men (26%). Widowed elderly people had less history of smoking (47.8%), as did retired elderly people (54.7%), religious practitioners (50.7%) and those with higher incomes. An increase in prevalence was observed in elderly people who stopped smoking, with an increase in age groups. Research Implications: The research can provide specific data on the profile of elderly smokers in Porto Alegre, allowing public policies to be created or adjusted to more effectively serve this population. Originality/Value: While many studies on smoking focus on younger populations or middle-aged adults, the choice to specifically study smoking among older adults is less common and therefore fills a significant gap in the literature.

Intersectional equity in Brazil's remote rural municipalities: the road to efficiency and effectiveness in local health systems.

The Brazilian remote rurality has been classified more reliably only recently, according to demographic density, proportion of urban population, and accessibility to urban centers. It comprises 5.8% of the municipalities, in nearly half of the states, with a population of 3,524,597 (1.85%). Remote rural localities (RRL) have reduced political/economic power, facing greater distances and barriers. Most health strategies are developed with the urban space in mind. We aim to understand how RRL are positioned concerning efficiency/effectiveness in health, compared to other urban-rural typologies of Brazilian localities, focusing on Primary Health Care (PHC), and its organizational models. We evaluated the efficiency and effectiveness of the organizational models using the health production model, from 2010-2019, gradually deepening the immersion into the RRL reality. We analyzed the human and financial resources dimensions, emphasizing teams, the results of PHC actions, and health levels. We used the fixed effects model and data envelopment analysis, cross-sectioned by intersectional inequities. We compared the Brazilian states with and without RRL, Brazilian municipalities according to rural-urban typologies, and RRL clusters. Brazilian RRL states show superior resource/health efficiency through services utilization according to health needs. The remote rural typology demonstrated greater efficiency and effectiveness in health than the other typologies in the RRL states. The organizational models with the Family Health Strategy (FHS) teams and the Community Health Worker (CHW) visits played a key role, together with local per capita health expenditures and intergovernmental transfers. Thus, financial resources and health professionals are essential to achieve efficient/effective results in health services. Among the RRL, the Amazon region clusters stand out, denoting the importance of riverine and fluvial health teams, the proportion of diagnostic/treatment units in addition to the proportion of illiteracy and adolescent mothers along with the inequity of reaching high levels of schooling between gender/ethnicity. Hopefully, these elements might contribute to gains in efficiency and effectiveness, prioritizing the allocation of financial/human resources, mobile FHS teams, availability of local diagnosis/treatment, and basic sanitation. Finally, one should aim for equity of gender/ethnicity in income and education and, above all, of place, perceived in its entirety.

Smoking and Cognitive and Mental Disorders: Evaluation of This Relationship in Elderly People in the Municipality of Porto Alegre – RS/Brazil

Objective: The objective of this study is to compare elderly smokers with elderly nonsmokers and to assess the prevalence of disorders in groups of current smokers, nonsmokers, and patients who have quit smoking. Theoretical Framework: Smoking is one of the main risk factors for a series of chronic diseases and debilitating conditions, including cognitive and mental disorders. The elderly population is particularly vulnerable to these impacts due to the coexistence of multiple comorbidities and the natural aging of the central nervous system (CNS). Method: Descriptive, cross-sectional study with prospective data collection, conducted in the city of Porto Alegre, capital of the state of Rio Grande do Sul, Brazil, with the elderly population (60 years or older) registered in the Family Health Strategy (ESF). Results and Discussion: In terms of current smoking, men (25.2%) tend to smoke more than women (18.4%), which is confirmed throughout their lives, representing 73.3% and 45.7%, respectively. Research Implications: The research can help to identify elderly individuals who are at greater risk of developing cognitive and mental disorders due to smoking early. This enables early interventions, such as smoking cessation programs integrated with psychological and psychiatric support. Originality/Value: The research focuses on a specific population — elderly individuals from Porto Alegre —, which allows for detailed analysis of a demographic group that is often underrepresented in studies on smoking and mental health.

O PAPEL DO AGENTE COMUNITÁRIO DE SAÚDE NA MELHORIA DOS DADOS EPIDEMIOLÓGICOS COMO REDUÇÃO DE ÓBITOS SENSÍVEIS À ATENÇÃO BÁSICA

Introduction: The Community Health Agent (CHA) is responsible for working in the prevention and promotion of health by informing the Family Health Strategy (FHS) team of the population’s needs. Objective: To analyze the responsibilities of CHAs in the care of patients with certain conditions sensitive to primary healthcare, such as Diabetes Mellitus (DM), hypertension (HTN), and acute myocardial infarction (AMI) in the municipality of São João Del Rei/MG (SJDR) in the year 2020. Methodology: A quantitative study was conducted using data from the Department of Informatics of the Unified Health System (DATASUS), gathering the number of deaths from certain preventable causes due to the performance of Primary Health Care (PHC), alongside a literature review. Results: The municipality of SJDR reported deaths from causes sensitive to PHC interventions, such as DM, HTN, and AMI in 2020. When compared to the state of Minas Gerais, the municipality had nearly twice the number of deaths from HTN and AMI, highlighting the need for patient engagement with PHC, as the high mortality rates from these causes negatively impacted the state’s data. Conclusion: It is concluded that the municipality of SJDR had higher mortality rates from DM, HTN, and AMI compared to the state of Minas Gerais in 2020. These data suggest the need for more effective and targeted interventions to prevent the worsening of these conditions, with the role of CHAs becoming crucial in this contexto.

Evolution Of Child Health Policies And The Impact Of The Environment On Development: An Integrative Review

Background: A Despite the advances in child health policies in Brazil since the 1980s, the influence of the environment and parenting practices on the holistic development of children still requires a critical and indepth analysis. The aim of this study was to analyze the evolution of child health policies in Brazil, focusing on the impact of these policies on the holistic development of children, highlighting the role of the environment and parenting practices in supporting child growth and development. Materials and Methods: This is an Integrative Review study following the PRISMA protocol. Data collection took place in September 2023, using the BVS (LILACS, MEDLINE) and SciELO databases. The eligibility criteria included original articles published between 2018 and 2023, available for free in Portuguese, English, or Spanish. The search and selection process resulted in 8 publications that formed the theoretical corpus. Results: The analysis of the results revealed two central thematic categories: "Evolution of Child Health Policies and Historical Milestones" and "Child Development and the Importance of the Environment." The analysis shows that child health policies in Brazil since the 1980s have significantly improved children's holistic development, emphasizing the importance of the environment and parenting practices. Conclusion: Programs such as "Primeira Infância Melhor" (Better Early Childhood) and the Family Health Strategy were essential. The Covid-19 pandemic highlighted the need for flexible policies to address future crises.

P075 IS OFFICE BLOOD PRESSURE MEASUREMENT SUFFICIENT FOR DIAGNOSING HYPERTENSION IN PRIMARY HEALTH CARE?

Background and Objective: Recent guidelines have recommended out-of-office blood pressure (BP) measurement to improve the accuracy of the diagnosis of hypertension (HTN) but there are few studies evaluating its use in the scope of primary care. Our objective is to assess the degree of agreement between office BP and HBPM, evaluating their use in a young population assisted in primary care. Methods: This is a cross-sectional population study with adults between 20-50 years old registered in the Family Health Strategy. Sociodemographic, anthropometric data and CV risk factors were recorded. Office BP was the mean of 2 measurements and HBPM followed the 7-day protocol. HBPM < 135 x 85 mmHg and office BP < 140 x 90 mmHg were considered normal, identifying the 4 phenotypes: Normotension (controlled office BP and HBPM); white-coat HTN (uncontrolled office BP and controlled HBPM); masked HTN (controlled office BP and uncontrolled HBPM) and sustained HTN (uncontrolled office BP and HBPM). Results: 475 individuals were included (male sex: 38%; mean age: 37.6 years ± 8.8 years, of which 93 (20%) had their diagnosis modified after HBPM (43 with white-coat and 47 with masked HTN). In multiple logistics regression, male gender (OR 3.87: 95%CI 1.70-8.82) was independently correlated with white-coat HTN, while obesity and prehypertension increased the risk of masked HTN by 2 and 5.5 times, respectively. Uncontrolled office BP has high specificity (89%) and low sensitivity (49%) for detecting sustained HTN, with a low concordance in the diagnosis of HTN (kappa=0.388) Among men with uncontrolled office BP, 55.6% had a diagnosis of white-coat HTN and among women, 37.1%. Conclusion: Office BP was not a sufficient measurement to diagnose hypertension. HBPM was a useful procedure in this young and apparently healthy population in primary care, especially in those with uncontrolled office BP to identify white-coat HTN and in those with high normal office BP, especially if they are male or obese for early diagnosis of masked HTN.

P115 CLINICAL PROFILE AND PREVALENCE OF OBSTRUCTIVE SLEEP APNEA IN A POPULATION OF YOUNG ADULTS REGISTERED IN A PRIMARY CARE UNIT IN RIO DE JANEIRO

Background: Obstructive Sleep Apnea (OSA) is strongly associated with high blood pressure (BP) and cardiovascular risk (CVR). There is a lack of studies and specific screening for younger populations, which could allow for early intervention and potentially reduce CVR. Objective: Analyze the prevalence and clinical profile of OSA, identifying the best screening method in a young population attended by a Family Health Strategy Unit in Rio de Janeiro. Methods: Cross-sectional population study of adults between 20 and 65 years old. Sociodemographic characteristics, anthropometric measures and CVR were obtained. Office BP was calculated using two measurements. The risk of OSA was assessed using STOP-BANG (SB) and Epworth Sleepiness Scale (ESS) questionnaires. All underwent home polysomnography. Result: 67 individuals included [38.9% men; average age of 38.9 ± 8 years]: 35 without OSA, 20 with mild OSA, 9 with moderate OSA and 3 with severe OSA. The prevalence of moderate/severe OSA was 18%. Individuals with moderate/severe OSA were older, more obese, had higher prevalence of increased neck circumference, dyslipidemia and heart rate. High risk for OSA in screening by SB, ESS and both questionnaires was respectively 55.2%, 44.8% and 19.4%. SB confirmed moderate/severe OSA in 30% in high-risk individuals, and excluded in 97% of low risk, with 60% accuracy. The sensitivity, specificity, PPV and NPV of SB to identify moderate/severe OSA were respectively 92%, 53%, 36% and 97%. In those with high risk according to the ESS, moderate/severe OSA was confirmed in 13%, while in those with low risk it was excluded in 78%. The accuracy of the ESS was 49%. The sensitivity, specificity, PPV and NPV of the ESS to identify moderate/severe OSA were respectively 33%, 53%, 13% and 78%. Conclusion: Moderate/severe OSA was more associated with an adverse metabolic profile than with high BP. The best screening questionnaire for this population is the STOP-BANG.

The role of primary healthcare amid the COVID-19 pandemic: Evidence from the Family Health Strategy in Brazil

This paper investigates the role of primary healthcare in mitigating the consequences of the COVID-19 pandemic, focusing on the Brazilian Family Health Strategy (ESF) as a case study. ESF is Brazil’s major primary care initiative, with prior evidence indicating its effectiveness in improving various health outcomes. The COVID-19 pandemic submitted the Brazilian healthcare system to a rigorous and unprecedented stress test, whose repercussions are still under study. Using comprehensive administrative microdata from 2016 to 2022 encompassing dimensions related to mortality, healthcare service, supply of family health teams, and vaccination coverage, our empirical strategy accounts for heterogeneous effects based on program intensity and pandemic evolution of the 5570 Brazilian municipalities. Our findings reveal that municipalities with high-intensity of ESF coverage (i.e. stronger primary care) experienced 347.93 (95% CI: 289.04, 406.81) fewer COVID-19 and cardiorespiratory deaths per million inhabitants throughout the pandemic period, compared to those in low-intensity ESF areas, despite sharing similar profiles of deaths from respiratory and cardiovascular causes. Among the channels contributing to this relative performance, high-intensity ESF municipalities were found to engage in more home-based primary care visits and health promotion activities while maintaining a similar supply of community health workers. Additionally, they achieved higher vaccination coverage, and these effects were more pronounced in areas with greater ESF presence, emphasising the importance of primary care coverage. In conclusion, our findings underscore the relevance of strong primary care in mitigating the consequences of the pandemic and addressing post-pandemic health challenges.

Factors associated with low handgrip strength in people with hypertension registered in family health strategy units Rio Branco, Acre, Brazil

Factors associated with low handgrip strength in people with hypertension registered in family health strategy units Rio Branco, Acre, Brazil

Factors associated with low handgrip strength in people with diabetes registered in family health strategy units, Rio Branco, Acre, Brazil

Factors associated with low handgrip strength in people with diabetes registered in family health strategy units, Rio Branco, Acre, Brazil

Improvement Proposal for Enhancing the Role of Dentists Within the Family Health Strategy Workframe

Objective: This research aimed to develop an improvement proposal for enhancing the role of dentists within the Family Health Strategy (FHS) framework in a municipality in the Vale do Itajaí region. Method: The methodology adopted in this study comprised exploratory, descriptive, and qualitative research. Data collection took place in a municipality with 18 primary health care units. The participants were 10 dentists working in these units, who responded to semi-structured interviews. Results and Discussion: Data were consolidated through content analysis, revealing four categories for discussion: 1) management and its implications on dental practice; 2) strategic planning as a tool for dental practice-related actions; 3) the impact of the COVID-19 pandemic and post-pandemic on the work process of dentists; and 4) the importance of more dental professionals within the FHS. Research Implications: the oral health management model of the study municipality was not well defined, there is a lack of epidemiological data, health indicators and the territorialization process in the territory assigned to each UBS, difficulty in communication and understanding as required of the coordinator in oral health. Originality/Value: The proposed flowchart for improving the dentist's role within the Family Health Strategy represents innovation in Primary Care.

The new and old challenges for knowledge about medicinal plants and phytotherapy in the Family Health Strategy after the COVID-19 pandemic

Resumo O uso e prescrição de plantas medicinais e fitoterápicos na Estratégia Saúde da Família enfrenta novos e velhos desafios no contexto pós-pandemia de Covid-19. No mundo, o modelo biomédico se fortaleceu como principal paradigma orientador do cuidado. No Brasil, o aumento da pobreza e o desinvestimento em políticas de saúde se somaram ao fenômeno da desinformação. O artigo discute como a oferta de fitoterapia e outras práticas integrativas e complementares foram afetadas nesse contexto a partir de dados de duas pesquisas anteriores à pandemia. A primeira, realizada com profissionais de saúde no município do Rio de Janeiro, identifica os conflitos entre categorias profissionais no uso e prescrição. A segunda, uma abordagem etnográfica, descreve como grupos populares têm reivindicado o reconhecimento de saberes sobre plantas medicinais como patrimônio cultural imaterial. A fim de evitar a categorização dessas práticas como desinformação em saúde, é necessário compreender o uso tradicional em contextos locais.

Characteristics of prenatal care performed by nurses in a city in Rio de Janeiro

Introduction: Prenatal care is essential for obstetric qualification and health promotion for women, newborns and society. The care occurs predominantly in Primary Health Care, in which the nurse represents an important professional in the reception, classification of gestational risk, evaluation and prescription of exams, performance of anamnesis and physical examination, definition of a care plan with guidelines and periodic evaluations. Method: This is a qualitative research of the descriptive type, in consideration of the object of study, since this type of research allows, in a systematized way, the identification, registration, description and analysis of the perspectives of the participants about the relationships and interactions related to prenatal care. To this end, the study had the participation of 15 nurses who work in the Family Health Strategy scenario of the Municipality of Teresópolis, in the Mountain Region of the State of Rio de Janeiro. The results evidenced is that the participants reported that the greatest approximation with women's health care emerged since their academic training and that this is a practice valued by them in the context of primary care. Other results were: extrinsic: insertion of the pregnant woman in the network, referrals of the pregnant woman in the network, adolescent pregnancy and nurses' autonomy in requesting tests and prescribing medications. Final Considerations: From the accomplishment of this study, it was possible to perceive that the professionals of the network provide qualified and systematized prenatal care. The reports show a relationship of identification and satisfaction in prenatal care by the research participants, although they face challenges.

Geographic accessibility of the elderly to primary care at a Family Health Strategy unit in Diamantina, MG

Geographic accessibility of the elderly to primary care at a Family Health Strategy unit in Diamantina, MG

The impact of primary health care on AIDS incidence and mortality: A cohort study of 3.4 million Brazilians.

Primary Health Care (PHC) is essential for effective, efficient, and more equitable health systems for all people, including those living with HIV/AIDS. This study evaluated the impact of the exposure to one of the largest community-based PHC programs in the world, the Brazilian Family Health Strategy (FHS), on AIDS incidence and mortality. A retrospective cohort study carried out in Brazil from January 1, 2007 to December 31, 2015. We conducted an impact evaluation using a cohort of 3,435,068 ≥13 years low-income individuals who were members of the 100 Million Brazilians Cohort, linked to AIDS diagnoses and deaths registries. We evaluated the impact of FHS on AIDS incidence and mortality and compared outcomes between residents of municipalities with low or no FHS coverage (unexposed) with those in municipalities with 100% FHS coverage (exposed). We used multivariable Poisson regressions adjusted for all relevant municipal and individual-level demographic, socioeconomic, and contextual variables, and weighted with inverse probability of treatment weighting (IPTW). We also estimated the FHS impact by sex and age and performed a wide range of sensitivity and triangulation analyses; 100% FHS coverage was associated with lower AIDS incidence (rate ratio [RR]: 0.76, 95% CI: 0.68 to 0.84) and mortality (RR: 0.68, 95%CI: 0.56 to 0.82). FHS impact was similar between men and women, but was larger in people aged ≥35 years old both for incidence (RR: 0.62, 95% CI: 0.53 to 0.72) and mortality (RR: 0.56, 95% CI: 0.43 to 0.72). The absence of important confounding variables (e.g., sexual behavior) is a key limitation of this study. AIDS should be an avoidable outcome for most people living with HIV today and our study shows that FHS coverage could significantly reduce AIDS incidence and mortality among low-income populations in Brazil. Universal access to comprehensive healthcare through community-based PHC programs should be promoted to achieve the Sustainable Development Goals of ending AIDS by 2030.