Factors associated with loss to follow up among HIV-exposed children: a historical cohort study from 2000 to 2017, in Porto Alegre, Brazil.

BACKGROUND: There are many inequalities in terms of prevention and treatment for pregnant women with HIV and exposed children in low and middle-income countries. The Brazilian protocol for prenatal care includes rapid diagnostic testing for HIV, compulsory notification, and monitoring by the epidemiological surveillance of children exposed to HIV until 18 months after delivery. The case is closed after HIV serology results are obtained. Lost to follow-up is defined as a child who was not located at the end of the case, and, therefore, did not have a laboratory diagnosis. Lost to follow-up is a current problem and has been documented in other countries. This study analyzed factors associated with loss to follow-up among HIV-exposed children, including sociodemographic, behavioral, and health variables of mothers of children lost to follow-up. METHODS: This historical cohort study included information on mothers of children exposed to HIV, born in Porto Alegre, from 2000 to 2017. The research outcome was the classification at the end of the child's follow-up (lost to follow-up or not). Factors associated with loss to follow-up were investigated using the Poisson regression model. Relative Risk calculations were performed. The significance level of 5% was adopted for variables in the adjusted model. RESULTS: Of 6,836 children exposed to HIV, 1,763 (25.8%) were classified as lost to follow-up. The factors associated were: maternal age of up to 22 years (aRR 1.25, 95% CI: 1.09-1.43), the mother's self-declared race/color being black or mixed (aRR 1.13, 95% CI: 1.03-1.25), up to three years of schooling (aRR 1.45, 95% CI: 1.26-1.67), between four and seven years of schooling (aRR 1.14, 95% CI: 1.02-1.28), intravenous drug use (aRR 1.29, 95% CI: 1.12-1.50), and HIV diagnosis during prenatal care or at delivery (aRR 1.37, 95% CI: 1.24-1.52). CONCLUSION: Variables related to individual vulnerability, such as race, age, schooling, and variables related to social and programmatic vulnerability, remain central to reducing loss to follow-up among HIV-exposed children.

Survival and predictors of death in tuberculosis/HIV coinfection cases in Porto Alegre, Brazil: A historical cohort from 2009 to 2013.

BACKGROUND: Tuberculosis is a curable disease, which remains the leading cause of death among infectious diseases worldwide, and it is the leading cause of death in people living with HIV. The purpose is to examine survival and predictors of death in Tuberculosis/HIV coinfection cases from 2009 to 2013. METHODS: We estimated the survival of 2,417 TB/HIV coinfection cases in Porto Alegre, from diagnosis up to 85 months of follow-up. We estimated hazard ratios and survival curves. RESULTS: The adjusted risk ratio (aRR) for death, by age, hospitalization, and Directly Observed Treatment was 4.58 for new cases (95% CI: 1.14-18.4), 4.51 for recurrence (95% CI: 1.11-18.4) and 4.53 for return after abandonment (95% CI: 1.12-18.4). The average survival time was 72.56 ± 1.57 months for those who underwent Directly Observed Treatment and 62.61 ± 0.77 for those who did not. CONCLUSIONS: Case classification, age, and hospitalization are predictors of death. The occurrence of Directly Observed Treatment was a protective factor that increased the probability of survival. Policies aimed at reducing the mortality of patients with TB/HIV coinfection are needed.

Investigação do tempo entre primeira consulta e diagnóstico e do tempo entre diagnóstico e início de tratamento e fatores associados em pacientes com câncer de pulmão, mama e próstata, atendidos em um hospital público de referência em Porto Alegre, de 2012-2016 / Investigation of the time between first consultation and diagnosis and of time between diagnosis and initiation of treatment and factors associated in patients with lung, breast and prostate, treated at a public referral hospital in Porto Alegre, from 2012-2016

Introdução: em 2018 o câncer causou 9 milhões de mortes, das quais 70% em países de baixa e média renda. As desigualdades sociais associadas ao câncer potencializam o atraso no acesso ao diagnóstico e início do tratamento e consequente aumento de letalidade. Objetivo: investigar o tempo entre a primeira consulta e o diagnóstico e o tempo entre o diagnóstico e o início do tratamento e possíveis fatores associados. Métodos: emprego de registros da base de dados hospitalar de um hospital de referência no Sul do Brasil, período 2012-2016. Os fatores associados incluíram variáveis sociodemográficas e clínicas. Os tempos investigados foram categorizados a partir de legislação específica. Comparações foram realizadas por meio do teste de homogeneidade de proporções baseado na estatística de qui- quadrado de Pearson. Os fatores associados aos tempos foram investigados por modelo de regressão de Poisson com variação robusta. Resultados: a amostra de casos estudados totaliza 2.606 pessoas, sendo 1.023 (39,3%) casos com câncer de mama, 983 (37,7%) câncer de pulmão e 600 (23%) câncer de próstata. Nos casos de câncer de pulmão há predomínio de pessoas com idade de 50 a 79 anos (86,8%), sexo masculino (57,6%), branca (88,9%), ensino fundamental completo (76,3%), estadiamento 4 (60,3%) e 45,1% evoluiu para o óbito. As pessoas com estadiamento 0 apresentaram o maior RR do tempo superior a 30 dias entre a primeira consulta e o diagnóstico (4,33 vezes maior do que para pacientes com estadiamento 4 - referência); o maior RR (1,76) do tempo superior a 60 dias entre o diagnóstico e o início do tratamento foi no grupo de estadiamento 2. Nos casos de câncer de mama há predomínio de pessoas com idade de 50 e 69 anos (50,8%), branca (92,8%), ensino fundamental completo (55,4%), estadiamento 2 (46,4%) e 6,6% evoluiu para o óbito. No desfecho tempo entre a primeira consulta e o diagnóstico acima de 30 dias os pacientes, quando comparados aos pacientes com estadiamento 4 (referência), o estadiamento 0 apresentou o maior RR ( 8,81); n o desfecho tempo entre o diagnóstico e o início de tratamento acima de 60 dias, pacientes com estadiamento 1 apresentaram o maior RR (2,46). Nos casos de câncer de próstata há predomínio de pessoas com idade de 60 a 69 anos (43,4%), branca (89,8%), ensino fundamental completo (76,5%), estadiamento classificação 2 (59,5%) e 5,8% evoluiu para o óbito. No desfecho de tempo entre a primeira consulta e o diagnóstico acima de 30 dias o estadiamento 1 apresentou o maior RR (1,50); no desfecho de tempo entre a primeira consulta e o diagnóstico acima de 60 dias, os pacientes com estadiamento 1 apresentaram o maior RR (2,45). Conclusão: o desfecho de tempo entre a primeira consulta e o diagnóstico acima de 30 dias, para os casos de câncer de pulmão, permaneceram no modelo como variáveis explicativas do desfecho a faixa etária (p = 0,05) e o estadiamento (p < 0,001); para o desfecho de tempo entre o diagnóstico e o início do tratamento acima de 60 dias, permaneceram variáveis explicativas do desfecho a faixa etária (p = 0,024) e o estadiamento (p = 0,03) e apresentaram-se com RR de proteção as faixas etárias de 20 a 49 anos (RR = 0,29, IC95% = 0,20 ­ 0,55) e 60 a 69 anos (RR = 0,53, IC95% = 0,31 ­ 0,90). Os respectivos riscos relativos brutos e ajustados para o desfecho tempo entre a primeira consulta e o diagnóstico acima de 30 dias, para os casos de câncer de mama ajustado por faixa etária, raça/cor e escolaridade, mostraram que o RR de estadiamento diminuiu a medida que a classificação aumentou; para o desfecho tempo entre o diagnóstico e o início de tratamento acima de 60 dias, permaneceram no modelo explicativo final as variáveis faixa etária (p = 0,003) e estadiamento (p = 0,003). O desfecho de tempo entre a primeira consulta e o diagnóstico acima de 30 dias, para os casos de câncer de próstata, o estadiamento ficou a variável explicativa do tempo entre a primeira consulta e o diagnóstico, com significância estatística para as classificações 1 e 2 quando comparadas à classificação 4; para o desfecho de tempo entre o diagnóstico e o início do tratamento acima de 60 dias, permaneceu no modelo explicativo somente a variável estadiamento.

Introdution: in 2018, cancer caused 9 million deaths, of which 70% in low- and middle-in- come countries. The social inequalities associated with cancer enhance the delay in access to diagnosis and initiation of treatment and the consequent increase in lethality. Objective: to investigate the time between the first consultation and diagnosis and the time between diagnosis and the start of treatment and possible associated factors. Methods: use of hos- pital database records from a reference hospital in southern Brazil, period 2012-2016. Asso- ciated factors included sociodemographic and clinical variables. The investigated times were categorized based on specific legislation. Comparisons were performed using the ho- mogeneity of proportions test based on Pearson's chi-square statistics. Factors associated with times were investigated using a Poisson regression model with robust variation. Re- sults: the sample of cases studied totals 2,606 people, with 1,023 (39.3%) cases with breast cancer, 983 (37.7%) lung cancer and 600 (23%) prostate cancer. In cases of lung cancer, there is a predominance of people aged 50 to 79 years (86.8%), male (57.6%), white (88.9%), complete elementary school (76.3%) , stage 4 (60.3%) and 45.1% progressed to death. People with stage 0 had the highest RR for the time greater than 30 days between the first consultation and diagnosis (4.33 times higher than for patients with stage 4 - reference); the highest RR (1.76) for the time greater than 60 days between diagnosis and the start of treatment was in the stage 2 group. In cases of breast cancer there is a predominance of people aged 50 and 69 years (50.8 %), white (92.8%), completed elementary school (55.4%), stage 2 (46.4%) and 6.6% progressed to death. In the outcome time between the first consultation and the diagnosis above 30 days, patients, when compared to patients with stage 4 (reference), stage 0 had the highest RR (8.81); in the outcome time between diagnosis and start of treatment above 60 days, patients with stage 1 had the highest RR (2.46). In cases of prostate cancer, there is a predominance of people aged 60 to 69 years (43.4%), white (89.8%), complete elementary education (76.5%), stage 2 classification (59.5%) and 5.8% progressed to death. In the outcome of time between the first consultation and diagnosis over 30 days, stage 1 had the highest RR (1.50); in the outcome of time between the first consultation and the diagnosis above 60 days, patients with stage 1 had the highest RR (2.45). Conclusion: The time outcome between the first consultation and the diagnosis above 30 days, for cases of lung cancer, remained in the model as explanatory variables of the outcome age (p = 0.05) and staging (p < 0.001); for the outcome of time between diagnosis and beginning of treatment above 60 days, the explanatory variables of the outcome were age (p = 0.024) and staging (p = 0.03) and presented with RR of protection as age groups from 20 to 49 years (RR = 0.29, 95%CI = 0.20 - 0.55) and 60 to 69 years (RR = 0.53, 95%CI = 0.31 - 0.90). The respective crude and adjusted relative risks for the outcome time between the first visit and the diagnosis above 30 days, for cases of breast cancer adjusted for age group, race/color and education, showed that the RR for staging decreased the measure. that the rating has increased; for the outcome time between diagnosis and start of treatment above 60 days, the variables age group (p = 0.003) and stage (p = 0.003) remained in the final explanatory model. The outcome of time between the first visit and diagnosis over 30 days, for cases of prostate cancer, staging was the explanatory variable of the time between the first visit and diagnosis, with statistical significance for classifications 1 and 2 when compared to classification 4; for the outcome of time between diagnosis and start of treatment above 60 days, only the staging variable remained in the explanatory model.