HIV Care Continuum from diagnosis in a Counseling and Testing Center

To analyze the HIV care continuum from the diagnosis in an HIV/AIDS Counseling and Testing Center (CTC), and the sociodemographic, clinical, and laboratory characteristics related to gender.

Method:

Epidemiological study, conducted with data of individuals assisted at a Counseling and Testing Center, and followed in an outpatient clinic for HIV/AIDS. Pearson’s Chi-square test and binary logistic regression were used to obtain odds ratios, considering alpha value <0.05.

Results:

The prevalence of HIV among 5,229 users was 5%. The highest chance of positive results was among men, aged 14 to 33 years old, who were not in a domestic partnership. In the analysis of TCD4+ lymphocytes and viral load (VL) of 238 cases, 56.1% had a late diagnosis. We have identified gaps in the care cascade, especially linkage to the care, retention in care, and viral load suppression.

Conclusion:

The results suggest a late diagnosis for both genders, as well as difficulty in reaching the viral suppression goal.

Descriptors:
HIV Infections; Early Diagnosis; Treatment Outcome; Continuity of Patient Care; Epidemiology

Characteristics Sociodemographic	Gender						OR (95% CI)	p value
	Male		Female		Total
	n	%	n	%	n	%
Age group								0.018
14 to 33 years old	131	64.9	27	47.4	158	61.0	2.05 (1.13-3.72)
34 to 68 years old	71	35.1	30	52.6	101	39.0	1:00
Education in Years (n = 258)^* * Excluded ignored cases/not applicable								0.001
0 to 7	69	34.2	33	58.9	102	39.5	1:00
8 and more	133	65.8	23	41.1	156	60.5	2.77 (1.51-5.07)
Race/color (n = 256) ^* * Excluded ignored cases/not applicable								0.818
White	160	79.6	43	78.2	203	79.3	1.09 (0.53-2.25)
Non-white	41	20.4	12	21.8	53	20.7	1:00
Marital status (n = 256)^* * Excluded ignored cases/not applicable								< 0.001
Domestic Partnership	49	24.5	30	53.6	79	30.9	1:00
Not in a domestic partnership	151	75.5	26	46.4	177	69.1	3.56 (1.92-6.58)

Exames	Gender				Total
	Male		Female		Total
	n	%	n	%	n	%
Cytomegalovirus
IgG (130^* * Excluded ignored cases/not applicable and when there was no mention in the medical record. )	91	96.8	35	97.2	126	96.7
IgM (118^* * Excluded ignored cases/not applicable and when there was no mention in the medical record. )	03	3.4	-	-	03	2.5
Toxoplasmosis
IgG (145^* * Excluded ignored cases/not applicable and when there was no mention in the medical record. )	51	47.7	25	65.8	76	52.4
IgM (141^* * Excluded ignored cases/not applicable and when there was no mention in the medical record. )	05	4.8	01	2.7	06	4.3
Syphilis
FTA-Abs (182^* * Excluded ignored cases/not applicable and when there was no mention in the medical record. )	50	36.0	03	7.0	53	29.1
VDRL (172^* * Excluded ignored cases/not applicable and when there was no mention in the medical record. )	41	31.1	01	2.5	42	24.4
Anti-HAV (123^* * Excluded ignored cases/not applicable and when there was no mention in the medical record. )	55	62.5	30	85.7	85	69.1
Anti-HCV (190^* * Excluded ignored cases/not applicable and when there was no mention in the medical record. )	02	1.4	02	4.4	04	2.1
Hepatitis B
HBsAg (195^* * Excluded ignored cases/not applicable and when there was no mention in the medical record. )	03	2.1	01	2.0	04	2.1

Clinical Status	Gender				Total		p value
	Male		Female		Total
	n	%	n	%	n	%
Symptoms (n = 210^* * Excluded ignored cases/not applicable and when there was no mention in the medical record * Pearson's chi-square test. )
Yes	82	50.0	23	50.0	105	50.0	0.566^* ***** Fisher's exact test.
No	82	50.0	23	50.0	105	50.0	0.566^* ***** Fisher's exact test.
Coinfections (177^* * Excluded ignored cases/not applicable and when there was no mention in the medical record * Pearson's chi-square test. )
Yes	101	68.7	20	47.6	121	64.0	0.012^* * Excluded ignored cases/not applicable and when there was no mention in the medical record * Pearson's chi-square test. ^* * Excluded ignored cases/not applicable and when there was no mention in the medical record * Pearson's chi-square test.
No	46	31.3	22	52.4	68	36.0
Other STIs (n = 108^* * Excluded ignored cases/not applicable and when there was no mention in the medical record * Pearson's chi-square test. )
Yes	80	80.8	10	55.6	90	76.9	0.031^* ***** Fisher's exact test.
No	19	19.2	8	44.4	27	23.1	0.031^* ***** Fisher's exact test.
Comorbidities (n = 145^* * Excluded ignored cases/not applicable and when there was no mention in the medical record * Pearson's chi-square test. )
Yes	30	25.4	12	31.6	42	26.9	0.457^* * Excluded ignored cases/not applicable and when there was no mention in the medical record * Pearson's chi-square test. ^* * Excluded ignored cases/not applicable and when there was no mention in the medical record * Pearson's chi-square test.
No	88	74.6	26	68.4	114	73.1

	Viral Load (copies/ML)
	< 50		50-100.000		≥ 100.000		Total
	n	%	n	%	n	%	n	%
1^ST Examination CD4⁺ T L/µL
< 200	0	0.0	17	7.0	31	12.7	48	19.7
200 to 349	1	0.4	29	11.9	13	5.3	43	17.6
350 to 499	0	0.0	30	12.3	18	7.4	48	19.7
≥ 500	5	2.0	74	30.3	26	10.7	105	43.0
Total	6	2.4	150	61.5	88	36.1	244	100.0
Last Examination CD4⁺ T L/µL
< 200	0	0.0	6	2.5	17	7.0	23	9.4
200 to 349	9	3.7	7	2.9	1	0.4	17	7.0
350 to 499	28	11.5	17	7.0	2	0.8	47	19.3
≥ 500	127	52.0	29	11.9	1	0.4	157	64.3
Total	164	67.2	59	24.2	21	8.6	244	100.0

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] Corresponding author: Angélica da Mata Rossi. E-mail: ang1ros@hotmail.com