| Differential survival benefit of universal HAART access in Brazil: a nation-wide comparison of injecting drug users versus men who have sex with men. | |
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MedLine Citation:
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PMID: 19675464 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Brazil accounts for approximately 70% of injection drug users (IDUs) receiving highly active antiretroviral therapy (HAART) in low-income/middle-income countries. We evaluated the impact of HAART availability/access on AIDS-related mortality among IDUs versus men who have sex with men (MSM). DESIGN: Nation-wide analysis on Brazilian IDU and MSM diagnosed with AIDS in 2000-2006. METHODS: Four national information systems were linked, and Cox regression was used to assess impact of HAART availability/access on differential AIDS-related mortality. RESULTS: Among 28,426 patients, 6777 died during 87,792 person-years of follow-up. Compared with MSM, IDU were significantly less likely to be receiving HAART, to have ever had determinations for CD4 or viral load. After controlling for confounders, IDU had a significantly higher risk of death (adjusted hazard ratio: 1.94; 95% confidence interval: 1.84 to 2.05). Among the subset that had at least 1 CD4 and viral load determination, higher risk of death among IDU persisted (hazard ratio: 1.82; 95% confidence interval: 1.58 to 2.11). Nonwhite ethnicity significantly increased this risk, whereas prompt HAART uptake after AIDS diagnosis reduced the risk of death. After controlling for spatially correlated survival data, AIDS-related mortality remained higher in IDU than in MSM. CONCLUSIONS: Despite free/universal HAART access, differential AIDS-related mortality exists in Brazil. Efforts are needed to identify and eliminate these health disparities. |
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Authors:
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Monica Malta; Francisco I Bastos; Cosme M F P da Silva; Gerson Fernando Mendes Pereira; Francisca F A Lucena; Maria G P Fonseca; Steffanie A Strathdee |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Journal of acquired immune deficiency syndromes (1999) Volume: 52 ISSN: 1944-7884 ISO Abbreviation: J. Acquir. Immune Defic. Syndr. Publication Date: 2009 Dec |
Date Detail:
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Created Date: 2009-11-25 Completed Date: 2009-12-21 Revised Date: 2011-03-03 |
Medline Journal Info:
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Nlm Unique ID: 100892005 Medline TA: J Acquir Immune Defic Syndr Country: United States |
Other Details:
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Languages: eng Pagination: 629-35 Citation Subset: IM; X |
Affiliation:
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Social Science Department, Sergio Arouca School of Public Health (DCS/ENSP), Oswaldo Cruz Foundation, Rio de Janeiro, Brazil. momalta@cict.fiocruz.br |
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| MeSH Terms | |
Descriptor/Qualifier:
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Acquired Immunodeficiency Syndrome
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drug therapy,
mortality* Adolescent Adult Aged Aged, 80 and over Antiretroviral Therapy, Highly Active Brazil / epidemiology Databases, Factual Developing Countries HIV-1* Health Services Accessibility* Healthcare Disparities* Homosexuality, Male* Humans Male Middle Aged Risk Factors Substance Abuse, Intravenous* |
| Grant Support | |
ID/Acronym/Agency:
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5 P30 AI 036214/AI/NIAID NIH HHS; P30 AI036214-10/AI/NIAID NIH HHS; R25 TW007500-01A1/TW/FIC NIH HHS; R25-TW007500/TW/FIC NIH HHS |
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