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.

Monitoramento do cuidado contínuo em HIV: a experiência de um serviço especializado de IST/AIDS de Porto Alegre / Monitoring of ongoing HIV care: the experience of a specialized STI/AIDS service in Porto Alegre

Introdução: O monitoramento do cuidado contínuo em HIV tem sido utilizado visando melhoria assitencial às pessoas vivendo com HIV (PVHIV). Objetivo: Realizar o monitoramento de PVHIV assistidas em um serviço especializado em IST/Aids no município de Porto Alegre. Métodos: Estudo de coorte histórica de 2013 a 2019, cujos dados sociodemográficos e clínicos foram coletados do SINAN, SISCEL, SICLOM e SIM. Os dados são apresentados em estatística descritiva utilizando-se o conceito de cascata de cuidado contínuo. O método de Kaplan-Meier foi utilizada para estimar a primeira dispensação de terapia antirretroviral (TARV). Comparações foram realizadas por teste de qui-quadrado de Pearson para investigar as variáveis associadas à carga viral (CV) indetectável em 6 meses. Resultados: A amostra foi composta de pacientes jovens, predominantemente homens, com baixa escolaridade e 37,8% negros. Vinculação e retenção foram de 79,9% e 68,6%, respectivamente. PVHIV com CV suprimida sustentada aos 12, 18 e 24 meses foram 40%, 33% e 27,8%, respectIvamente. Ao final de 2019, 57,2% apresentava CV indetectável e o percentual de óbito foi de 4,6%. A mediana de tempo para a primeira dispensação de TARV foi de 2 meses (IC95% = 1,63 ­ 2,36). Em 15 dias após o diagnóstico do HIV, 90,1% das PVHIV não tinha dispensação de TARV, em 30 dias 75,4% e em 45 dias 58,4%. Na comparação quanto à CV indetectável em 6 meses, 81,8% da pessoas que realizou a primeira dispensação de TARV em até 30 dias atingiu CV indetectável em 6 meses (p = 0,003). Conclusão: Percentuais de vinculação e retenção são semelhantes aos do país. A proporção de pessoas com a primeira dispensação de TARV em 30 dias, as proporções de pessoas com CV suprimida sustentada ao longo do tempo e a proporção de óbito constituem indicadores essenciais no monitoramento do cuidado contínuo. O percentual da amostra que iniciou TARV em tempo oportuno foi considerado baixo.

Introduction: Monitoring of continuous HIV care has been used to improve care for people living with HIV (PLHIV). Objective: To carry out the monitoring of assistance for PLHIV in a specialized STI/AIDS service in the city of Porto Alegre, Brazil. Methods: A historical cohort study from 2013 to 2019, whose sociodemographic and clinical data were collected from SINAN, SISCEL, SICLOM and SIM. The data are presented in descriptive statistics using the concept of the cascade of continuous care. The Kaplan-Meier method was used to estimate the first dispensation of antiretroviral therapy (ART). Comparisons were made with Pearson's chi-square test to investigate the variables associated with the undetectable viral load (VL) in 6 months. Results: The sample consisted of young patients, predominantly men, with limited education, 37.8% of whom were black. Binding and retention were 79.9% and 68.6%, respectively. PLHIV with suppressed VL sustained at 12, 18 and 24 months were 40%, 33%, and 27.8%, respectively, at the end of 2019. 57.2% had undetectable VL, and 4.6% died. The median time for the first HAART dispensation was 2 months (95% CI = 1.63 - 2.36). In 15 days after the HIV diagnosis, 90.1% of PLHIV received no ART dispensation, in 30 days 75.4%, and in 45 days 58.4%. When comparing undetectable VL in 6 months, 81.8% of those who received the first HAART dispensation in up to 30 days reached undetectable VL in 6 months (p = 0.003). Conclusion: The percentage of attachment and retention are similar to those in Brazil as a whole. The proportion of people receiving the first ART dispensation in 30 days, the proportion of people with suppressed VL sustained over time, and the proportion of deaths are essential indicators in monitoring continuous care. The percentage of the sample that started ART at an appropriate time was considered to be low.

Characterization of deaths and therapeutic itineraries investigated by the Porto Alegre AIDS Mortality Committee, Brazil, in 2015. / Caracterização dos óbitos e dos itinerários terapêuticos investigados pelo Comitê Municipal de Mortalidade por Aids de Porto Alegre em 2015.

OBJECTIVE: to characterize AIDS deaths eligible for Porto Alegre AIDS Mortality Committee (AIDSMC) investigation, Brazil, in 2015, and their therapeutic itineraries. METHODS: this was a descriptive study using secondary data from surveillance information systems and AIDSMC investigation forms. RESULTS: out of 336 deaths from AIDS-related causes, 113 (33.6%) were considered avoidable, of which 52 were analyzed by AIDSMC; there was predominance of males (30/52), low schooling level (29/52 incomplete elementary education), and less than 2 years between HIV infection diagnosis and death (28/52); tuberculosis was the most frequent cause of death (17/52); and in 50/52 cases at least one therapeutic itinerary inadequacy was identified. CONCLUSION: avoidable deaths of people with AIDS occurred mostly in men, those with low education level, those with recent HIV diagnosis and most deaths were due to tuberculosis.

Caracterização dos óbitos e dos itinerários terapêuticos investigados pelo Comitê Municipal de Mortalidade por Aids de Porto Alegre em 2015 / Caracterización de óbitos e itinerario terapéutico investigados por el Comité de Mortalidad por Sida de Porto Alegre, Brasil, en 2015 / Characterization of deaths and therapeutic itineraries investigated by the Porto Alegre AIDS Mortality Committee, Brazil, in 2015

Objetivo: caracterizar os óbitos por aids elegíveis para investigação pelo Comitê Municipal de Mortalidade por Aids (CMAids) de Porto Alegre, Brasil, em 2015, e seus itinerários terapêuticos. Métodos: estudo descritivo, com dados secundários de sistemas de informações de vigilância e das fichas de investigação do CMAids. Resultados: entre 336 óbitos por causas relacionadas à aids, 113 (33,6%) foram considerados evitáveis, dos quais 52 foram investigados pelo CMAids; verificou-se predomínio do sexo masculino (30/52), baixa escolaridade (29/52 casos até a 8ª série incompleta) e tempo de até 2 anos entre o diagnóstico da infecção pelo HIV e a morte (28/52); a tuberculose foi a causa de morte mais frequente (17/52); em 50/52 casos, identificou-se pelo menos uma falha no itinerário terapêutico. Conclusão: os óbitos evitáveis de pessoas com aids ocorreram, majoritariamente, em pessoas do sexo masculino, de baixa escolaridade, com diagnóstico recente de HIV e em decorrência da tuberculose.

Objetivo: caracterizar los óbitos por sida elegibles para investigación por el Comité de Mortalidad por Sida (CMSida) de Porto Alegre, Brasil, en 2015, y sus itinerarios terapéuticos. Métodos: estudio descriptivo con datos secundarios de los sistemas de información de vigilancia y formulario de investigación de CMSida. Resultados entre 336 muertes por sida, 113 (33,6%) se consideraron evitables, de las cuales 52 fueron investigadas por el CMSida; predominó el sexo masculino (30/52), el bajo nivel de educación (29/52 hasta 8º grado incompleto de primaria) y hasta 2 años entre el diagnóstico de la infección por VIH y la muerte (28/52); la tuberculosis fue la causa más frecuente de muerte (17/52); y en 50/52 casos, se identificó al menos una falla en los itinerarios terapéuticos. Conclusión: las muertes evitables de personas con sida ocurrieron principalmente en hombres, con baja escolaridad, diagnóstico reciente de VIH y debido a la tuberculosis.

Objective: to characterize AIDS deaths eligible for Porto Alegre AIDS Mortality Committee (AIDSMC) investigation, Brazil, in 2015, and their therapeutic itineraries. Methods: this was a descriptive study using secondary data from surveillance information systems and AIDSMC investigation forms. Results: out of 336 deaths from AIDS-related causes, 113 (33.6%) were considered avoidable, of which 52 were analyzed by AIDSMC; there was predominance of males (30/52), low schooling level (29/52 incomplete elementary education), and less than 2 years between HIV infection diagnosis and death (28/52); tuberculosis was the most frequent cause of death (17/52); and in 50/52 cases at least one therapeutic itinerary inadequacy was identified. Conclusion: avoidable deaths of people with AIDS occurred mostly in men, those with low education level, those with recent HIV diagnosis and most deaths were due to tuberculosis.

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.