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.

Fatores associados ao abandono do tratamento para tuberculose em casos de coinfecção tuberculose/HIV em Porto Alegre / Factors associated with treatment dropout for tuberculosis in cases of tuberculosis/HIV co-infection in Porto Alegre

Objetivo: Analisar os fatores associados ao abandono do tratamento de tuberculose em indivíduos coinfectados por Tuberculose/HIV, no município de Porto Alegre no período de 2009 a 2013. Métodos: Estudo de coorte retrospectiva conduzido com pacientes com coinfecção TB/HIV registrados entre 2009 e 2013. Foram coletados dados demográficos, clínicos, ocorrência de internações e óbito, de três bases de dados nacionais distintas que fazem parte do sistema nacional de vigilância em saúde, e utilizou-se a técnica de linkage de dados. Realizaram-se análises de estatística descritiva utilizando-se frequências e percentuais, e medidas de tendência central e dispersão. Comparações entre os grupos foram realizadas por meio de teste de homogeneidade de proporções baseado na estatística de qui quadrado de Pearson ou Fisher para variáveis categóricas, ou teste t Student ou Mann Whitney para variáveis quantitativas. A fim de estimar a razão de chances (odds ratios) de cada categoria exploratória de variáveis, foi utilizado o modelo de regressão logística. Resultados: Na análise univariada, estiveram associadas ao desfecho de interesse: ser homem, pertencer a população negra, baixa escolaridade, estar em situação de rua, já ter internado por complicações relacionadas ao TB/HIV (p< 0,001). Uma maior idade esteve associada a uma maior chance de abandono de tratamento. A situação de entrada no serviço como reingresso após abandono se mostrou um fator de proteção para um novo abandono. Na análise ajustada, mantiveram-se estiveram associadas ao desfecho: uma maior idade, baixa escolaridade, situação de entrada no serviço como reingresso após abandono e histórico de internação por complicações relacionadas à TB/HIV. Conclusões: O abandono de tratamento no município de Porto Alegre apresenta taxas elevadas, o que contribui para que o município esteja entre as capitais com um dos maiores índices de tuberculose e de coinfecção TB/HIV no Brasil.

Aim: To analyze the factors associated with the abandonment of tuberculosis treatment in individuals co infected with Tuberculosis/HIV, in the city of Porto Alegre, Brazil, from 2009 to 2013. Methods: A retrospective cohort study conducted with pati ents with TB/HIV co infection registered between 2009 and 2013. Demographic, clinical, hospitalization and death data were collected from three different national databases that are part of the Brazilian national health surveillance system, with use of the data linkage technique. Descriptive statistical analyses were performed using frequencies and percentages, and measures of central tendency and dispersion. Comparisons between groups were performed using the homogeneity of proportions test based on Pearson's or Fisher's chi square statistic for categorical variables, or the Student's t test or the Mann Whitney test for quantitative variables. In order to estimate the odds ratio of each exploratory category of variables, the logistic regression model was us ed. Results: In the univariate analysis, the variables were associated with the outcome in analysis: being a man, belonging to the black population, having a limited education, being homeless, having already been hospitalized for complications related to TB/HIV (p <0.001). Older age was associated with a greater chance of dropping out of treatment. Re-entering treatment after abandonment proved to be a protective factor against further abandonment. In the adjusted analysis, the factors remained associated with the outcome: older age, low education, situation of entering treatment such as re-entry after abandonment, and history of hospitalization for complications related to TB/HIV. Conclusions: Abandonment of treatment in the municipality of Porto Alegre has high rates, and this contributes to the municipality being among the capitals with one of the highest rates of tuberculosis and TB/HIV co-infection in Brazil.

Factors associated with directly observed treatment in tuberculosis/HIV coinfection cases in Porto Alegre, 2009-2013: A retrospective cohort.

BACKGROUND: TB/HIV coinfection is a serious public health issue in Brazil, and patients with coinfection have difficulty adhering to treatments. Directly observed treatment (DOT) has been recommended by the World Health Organization, considering the vulnerability of those affected. The purpose is to investigate the occurrence of DOT and associated factors compared to conventional treatment in Porto Alegre, Brazil. METHODS: A retrospective cohort study was carried out with all patients with coinfection from 2009 to 2013 in the city of Porto Alegre, Brazil, the state capital with the highest rate of coinfection in Brazil. The data came from national health information systems. The dependent variable was the performance of DOT. Bivariate and multivariable models were used to determine factors associated with DOT. The percentage of cure and death was verified in a period of two years, comparing patients who received and did not receive DOT. RESULTS: 2,400 cases of coinfection were reported, with 1,574 males and 826 females and a mean age of 38 years ± 9.91 years. The occurrence of DOT was 16.9%. In the multivariable analysis, factors independently associated to DOT were the year (with greater chances of being received in 2012 and 2013), place of origin, non-white race (OR = 1.29, 95% CI = 1.08-1.54), cases of relapse (OR = 1.33; 95% CI = 1.03-1.73), readmission after abandonment (OR = 1.48, 95% CI = 1.20-1.83), transfer (OR = 2.04; 95% CI = 1.40-2.98), acid-fast bacilli (AFB) test with positive result in first sample (OR = 1.73, 95% CI = 1.24-2.42), alcohol abuse (OR = 1.39; 95% CI = 1.16-1.67), and mental disorders (OR = 1.83; 95% CI = 1.38-2.44.) Of the 532 cases of death, occurring in two years, 10.2% were in patients who underwent DOT and 89.8% in patients who did not undergo DOT (p<0.001). O percentual de óbitos em pessoas que receberam DOT foi de 13% e o percentual de óbitos para pessoas que receberam tratamento convencional foi de 24%. CONCLUSIONS: There was an increase in the percentage of DOT over the years in the scenario studied, and the predictors for DOT were related to social vulnerability. In relation to death within two years, a lower proportion was found in patients who underwent DOT, suggesting a protective effect of the strategy.