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[Preprint]. 2023 Oct 3:2023.10.02.23296417.
doi: 10.1101/2023.10.02.23296417.

The effect of primary health care on AIDS incidence and mortality: a cohort study of 3.4 million Brazilians

Priscila Fps Pinto  1   2 , James Macinko  3 , Andréa F Silva  1   2 , Iracema Lua  1   2 , Gabriela Jesus  1   2 , Laio Magno  4 , Carlos As Teles Santos  2 , Maria Yury Ichihara  2 , Mauricio L Barreto  2 , Corrina Moucheraud  3 , Luis E Souza  1 , Inês Dourado  1 , Davide Rasella  1   5
Affiliations

The effect of primary health care on AIDS incidence and mortality: a cohort study of 3.4 million Brazilians

Priscila Fps Pinto et al. medRxiv. .

Update in

Abstract

Background: Primary Health Care (PHC) is essential for the health and wellbeing of people living with HIV/AIDS. This study evaluated the effects of one of the largest community-based PHC programs in the world, the Brazilian Family Health Strategy (FHS), on AIDS incidence and mortality.

Methods: A retrospective cohort study carried out in Brazil, from January 1 2007 to December 31 2015. We conducted a quasi-experimental effect evaluation using a cohort of 3,435,068 ≥13 years low-income individuals who were members of the 100 Million Brazilians Cohort, linked to AIDS diagnoses and deaths registries. We evaluated the effect of FHS on AIDS incidence and mortality and comparing outcomes between residents of municipalities with no FHS coverage with those in municipalities with full FHS coverage. We used multivariable Poisson regressions adjusted for all relevant municipal and individual-level demographic, socioeconomic, and contextual variables, and weighted with inverse probability of treatment weighting (IPTW). We also estimated FHS effect by sex and age, and performed a wide range of sensitivity and triangulation analyses.

Findings: FHS coverage was associated with lower AIDS incidence (rate ratio [RR]:0.76, 95%CI:0.68-0.84) and mortality (RR:0.68,95%CI:0.56-0.82). FHS effect was similar between men and women, but was larger in people aged ≥35 years old both for incidence (RR 0.62, 95%CI:0.53-0.72) and mortality (RR 0.56, 95%CI:0.43-0.72).

Conclusions: AIDS should be an avoidable outcome for most people living with HIV today, and our study shows that FHS coverage could significantly reduce AIDS incidence and mortality among low-income populations in Brazil. Universal access to comprehensive healthcare through community-based PHC programs should be promoted to achieve the Sustainable Development Goals of ending AIDS by 2030.

Keywords: Brazil; Community Health; HIV/AIDS; Health Inequality; Primary Health Care; Social Determinants of Health.

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Conflict of interest statement

Declaration of interests The authors declare no competing interests

Figures

Figure 1.
Figure 1.
Selection flowchart of the study cohort, The 100 Million Brazilians Cohort, 2007–15
See this image and copyright information in PMC

References

    1. UNAIDS. Global HIV & AIDS statistics - Fact Sheet 2022. Available at: https://www.unaids.org/en/resources/fact-sheet
    1. Mukherjee JS, Barry D, Weatherford RD, Desai IK, Farmer PE. Community-Based ART Programs: Sustaining Adherence and Follow-up. Curr HIV/AIDS Rep 2016; 13: 359–66. - PMC - PubMed
    1. Bekker L-G, Alleyne G, Baral S, et al. Advancing global health and strengthening the HIV response in the era of the Sustainable Development Goals: the International AIDS Society—Lancet Commission. The Lancet 2018; 392: 312–58. - PMC - PubMed
    1. WHO, UNAIDS. The AIDS Response and Primary Health Care: Linkages and Opportunities. Technical series on Primary Health Care. World Health Organization. 2018. Available at: https://www.who.int/docs/default-source/primary-health-care-conference/a...
    1. Havlir D V., Balzer LB, Charlebois ED, et al. HIV Testing and Treatment with the Use of a Community Health Approach in Rural Africa. New England Journal of Medicine 2019; 381: 219–29. - PMC - PubMed

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