Profile of the cohort of people being treated for HIV infection in the SUS, Brazil, 2015-2018.

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.

Beyond access to medication: the role of SUS and the characteristics of HIV care in Brazil.

OBJECTIVE: To estimate the public-private composition of HIV care in Brazil and the organizational profile of the extensive network of public healthcare facilities. METHODS: Data from the Qualiaids-BR Cohort were used, which gathers data from national systems of clinical and laboratory information on people aged 15 years or older with the first dispensation of antiretroviral therapy between 2015-2018, and information from SUS healthcare facilities for clinical-laboratory follow-up of HIV, produced by the Qualiaids survey. The follow-up system was defined by the number of viral load tests requested by any SUS healthcare facility: follow-up in the private system - no record; follow-up at SUS - two or more records; undefined follow-up - one record. SUS healthcare facilities were characterized as outpatient clinics, primary care and prison system, according to the respondents' self-classification in the Qualiaids survey (72.9%); for non-respondents (27.1%) the classification was based on the terms present in the names of the healthcare facilities. RESULTS: During the period, 238,599 people aged 15 years or older started antiretroviral therapy in Brazil, of which 69% were followed-up at SUS, 21.7% in the private system and 9.3% had an undefined system. Among those followed-up at SUS, 93.4% received care in outpatient clinics, 5% in primary care facilities and 1% in the prison system. CONCLUSION: In Brazil, antiretroviral treatment is provided exclusively by SUS, which is also responsible for clinical and laboratory follow-up for most people in outpatient clinics. The study was only possible because SUS maintains records and public information about HIV care. There is no data available for the private system.

Profile of the cohort of people being treated for HIV infection in the SUS, Brazil, 2015-2018 / Perfil da coorte de pessoas em tratamento da infecção por HIV no SUS, Brasil, 2015-2018

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.

RESUMO OBJETIVO Construir uma base integrada de dados individuais e dos serviços da coorte de pessoas que iniciaram terapia antirretroviral (TARV) entre 2015 e 2018 no Brasil. MÉTODOS Estudo de coorte aberta que incluiu pessoas de 15 anos ou mais que iniciaram TARV entre 2015 e 2018, com acompanhamento em serviços do Sistema Único de Saúde (SUS), e que responderam ao inquérito nacional Qualiaids de 2016/2017. A fonte de dados individuais foi o banco relacionado do HIV, proveniente do relacionamento probabilístico entre dados dos sistemas de informação de diagnóstico, medicação, exames e óbitos do SUS. A fonte de dados dos serviços foi o banco de respostas dos serviços ao inquérito Qualiaids. Após análise de consistência e exclusões, o banco dos indivíduos foi relacionado deterministicamente com o banco de serviços. RESULTADOS A coorte reuniu 132.540 pessoas acompanhadas em 941 serviços do SUS. Desses serviços, 59% localizam-se na região Sudeste e 49% acompanharam 51 a 500 participantes da coorte. O desempenho médio de organização e gerência da assistência ao paciente variou de 29% a 75%. A maioria dos participantes da coorte é do sexo masculino, preto e pardo, com idade entre 20 e 39 anos e tem entre 4 e 11 anos de escolaridade. O T-CD4 mediano basal foi de 419 células/mm3, 6% tiveram episódio de tuberculose e 2% foram a óbito por doença do HIV. CONCLUSÃO A coorte oportuniza pela primeira vez no Brasil a análise conjunta de fatores individuais e dos serviços na produção dos desfechos clínicos positivos e negativos do tratamento do HIV.

Beyond access to medication: the role of SUS and the characteristics of HIV care in Brazil / Para além do acesso ao medicamento: papel do SUS e perfil da assistência em HIV no Brasil

ABSTRACT OBJECTIVE To estimate the public-private composition of HIV care in Brazil and the organizational profile of the extensive network of public healthcare facilities. METHODS Data from the Qualiaids-BR Cohort were used, which gathers data from national systems of clinical and laboratory information on people aged 15 years or older with the first dispensation of antiretroviral therapy between 2015-2018, and information from SUS healthcare facilities for clinical-laboratory follow-up of HIV, produced by the Qualiaids survey. The follow-up system was defined by the number of viral load tests requested by any SUS healthcare facility: follow-up in the private system - no record; follow-up at SUS - two or more records; undefined follow-up - one record. SUS healthcare facilities were characterized as outpatient clinics, primary care and prison system, according to the respondents' self-classification in the Qualiaids survey (72.9%); for non-respondents (27.1%) the classification was based on the terms present in the names of the healthcare facilities. RESULTS During the period, 238,599 people aged 15 years or older started antiretroviral therapy in Brazil, of which 69% were followed-up at SUS, 21.7% in the private system and 9.3% had an undefined system. Among those followed-up at SUS, 93.4% received care in outpatient clinics, 5% in primary care facilities and 1% in the prison system. CONCLUSION In Brazil, antiretroviral treatment is provided exclusively by SUS, which is also responsible for clinical and laboratory follow-up for most people in outpatient clinics. The study was only possible because SUS maintains records and public information about HIV care. There is no data available for the private system.

RESUMO OBJETIVO Estimar a composição público-privada da assistência em HIV no Brasil e o perfil organizacional da extensa rede de serviços públicos. MÉTODOS Foram utilizados dados da Coorte Qualiaids-BR, que reúne dados dos sistemas nacionais de informações clínicas e laboratoriais de pessoas com 15 anos ou mais com primeira dispensação de terapia antirretroviral, entre 2015-2018, e informações dos serviços do SUS de acompanhamento clínico-laboratorial do HIV, produzidas pelo inquérito Qualiaids. O sistema de acompanhamento foi definido pelo número de exames de carga viral solicitados por algum serviço do SUS: acompanhamento no sistema privado - nenhum registro; acompanhamento no SUS - dois ou mais registros; acompanhamento indefinido - um registro. Os serviços do SUS foram caracterizados como ambulatórios, atenção básica e sistema prisional, segundo autoclassificação dos respondentes ao inquérito Qualiaids (72,9%); para os não respondentes (27,1%) a classificação baseou-se nos termos presentes nos nomes dos serviços. RESULTADOS No período, 238.599 pessoas com 15 anos ou mais iniciaram a terapia antirretroviral no Brasil, das quais, 69% receberam acompanhamento no SUS, 21,7% no sistema privado e 9,3% tiveram o sistema indefinido. Entre os acompanhados no SUS, 93,4% foram atendidos em serviços do tipo ambulatório, 5% em serviços de atenção básica e 1% no sistema prisional. CONCLUSÃO No Brasil o tratamento antirretroviral é fornecido exclusivamente pelo SUS, que também é responsável pelo acompanhamento clínico-laboratorial da terapia da maior parte das pessoas em serviços ambulatoriais. O estudo só foi possível porque o SUS mantêm registros e informações públicas acerca do acompanhamento em HIV. Não há nenhum dado disponível para o sistema privado.

Association of Sickness Absence With Severe Psychiatric Outcomes in a Brazilian Health Workforce.

OBJECTIVES: To investigate the association of sickness absence with severe psychiatric outcomes in the workforce of a health institution. METHODS: This cross-sectional analysis included 16,890 employees from a health institution. The association of all-cause sick-leave spells and mental sick-leave spells with a composite outcome (psychiatric hospital admission and/or suicidality) was investigated with logistic regression, adjusted for age, sex, education, and job position. RESULTS: There were 18,855 sick-leave spells among 6428 employees and 8.2% were mental sick-leaves. All-cause sick-leave was associated with the composite outcome (OR = 6.81; 95% CI = 2.99-15.52). This association was driven by mental-sick leave (OR = 100.52; 95% CI = 41.26-244.91), and the odds were higher among men. CONCLUSION: Health promotion interventions on workers with mental sick-leave should be implemented to minimize the impact of mental disorders in this high-risk group.

Aedes aegypti breeding site in an underground rainwater reservoir: a warning.

We describe the discovery of Aedes aegypti underground breeding site in the Pinheiros neighborhood of São Paulo, SP, during an entomological survey program performed in 2016. Even with intense surveillance and vector control, large numbers of mosquitoes were present in this area. A detailed investigation allowed for the detection of Ae. aegypti in an underground reservoir used for rainwater storage. After the implementation of protection screens in the accesses, the presence of the vector was no longer detected. In this study, we discuss the frequent use of this type of reservoir structure and its risk for mosquito production.

Aedes aegypti breeding site in an underground rainwater reservoir: a warning / Criadouro de Aedes aegypti em reservatório subterrâneo de água da chuva: um alerta

ABSTRACT We describe the discovery of Aedes aegypti underground breeding site in the Pinheiros neighborhood of São Paulo, SP, during an entomological survey program performed in 2016. Even with intense surveillance and vector control, large numbers of mosquitoes were present in this area. A detailed investigation allowed for the detection of Ae. aegypti in an underground reservoir used for rainwater storage. After the implementation of protection screens in the accesses, the presence of the vector was no longer detected. In this study, we discuss the frequent use of this type of reservoir structure and its risk for mosquito production.

RESUMO Descreve-se o encontro de criadouro subterrâneo de Aedes aegypti no bairro de Pinheiros, São Paulo, SP, ocorrido durante um programa de levantamento entomológico, realizado em 2016. Mesmo com intensa vigilância e controle vetorial, grande quantidade de mosquitos estava presente nessa área. Investigação minuciosa permitiu a detecção de Ae. aegypti em reservatório subterrâneo para armazenamento de água pluvial. Após a implantação de telas de proteção nos acessos, não foi mais detectada a presença do vetor. O uso frequente desse tipo de estrutura e o seu risco para a produção de mosquitos é discutido.