What's Pregnancy Got to Do with it? Late Presentation to HIV/AIDS Services in Northeastern Brazil

1 Pages Posted: 1 Jul 2018

See all articles by Ines Dourado

Ines Dourado

Federal University of Bahia (UFBA)

Sarah MacCarthy

Warren Alpert Medical School

Carlos Lima

Independent

Maria Amelia Veras

Independent

Lígia Kerr

Independent

Ana Maria de Brito

Oswaldo Cruz Foundation (FIOCRUZ)

Sofia Gruskin

University of Southern California Keck School of Medicine; University of Southern California Gould School of Law; Harvard School of Public Health

Date Written: July 17, 2014

Abstract

Despite the known benefits of early treatment initiation for individual morbidity and mortality, as well as for reducing the risk of transmission, late presentation (LP) to HIV/AIDS services remains a major concern in many countries. There is little information on LP from middle- and low-income countries and studies that do evaluate LP commonly disaggregate data by sex. It is rare, however, for researchers to further disaggregate the data by pregnancy status so it remains unclear if pregnancy status modifies the effects associated with sex. The study was conducted at the only State Reference Center for HIV/AIDS in Salvador, Brazil's third largest city. LP was defined as a patient accessing services with a CD4 < 350 cells/mm3. Data were abstracted from the electronic medical records of 1421 patients presenting between 2007 and 2009. CD4 counts and viral load (VL) information was validated with data from the National CD4/VL Database. Descriptive and bivariate statistics were conducted to inform the multivariate analysis. Adjusted prevalence ratios (APR) were estimated using generalized linear models due to the high frequency of the outcome. Half of the sample (52.5%; n = 621) was classified as LP. Compared to the prevalence among pregnant women (21.1%), the prevalence of LP was more than twice as high among non-pregnant women (56.0%) and among men (55.4%). The multivariate analysis demonstrated no statistical difference between men and nonpregnant women (APR 1.04; 95%CI 0.92–1.19), but the APR of LP for nonpregnant women was 53% less than men (APR 0.47; 95%CI 0.33–0.68). These results highlight the importance of analyzing data disaggregated not only by sex but also by pregnancy status to accurately identify the risk factors associated with LP so that programs and policies can effectively and efficiently address LP in Brazil and beyond.

Keywords: HIV/AIDS, late presentation, CD4 count, pregnancy, Brazil

JEL Classification: i14, I18, K33

Suggested Citation

Dourado, Ines and MacCarthy, Sarah and Lima, Carlos and Veras, Maria Amelia and Kerr, Lígia and de Brito, Ana Maria and Gruskin, Sofia, What's Pregnancy Got to Do with it? Late Presentation to HIV/AIDS Services in Northeastern Brazil (July 17, 2014). USC CLASS Research Paper No. CLASS18-22; USC Law Legal Studies Paper No. 18-23. Available at SSRN: https://ssrn.com/abstract=3025650 or http://dx.doi.org/10.2139/ssrn.3025650

Ines Dourado (Contact Author)

Federal University of Bahia (UFBA) ( email )

Av. Reitor Miguel Calmon, s/n
Vale do Canela
Salvador, Bahia
Brazil

Sarah MacCarthy

Warren Alpert Medical School ( email )

Providence, RI 02912
United States

Carlos Lima

Independent ( email )

No Address Available

Maria Amelia Veras

Independent ( email )

No Address Available

Lígia Kerr

Independent ( email )

No Address Available

Ana Maria De Brito

Oswaldo Cruz Foundation (FIOCRUZ) ( email )

Rio de Janeiro
Brazil

Sofia Gruskin

University of Southern California Keck School of Medicine ( email )

2001 N. Soto Street
Los Angeles, CA 90089
United States

HOME PAGE: http://globalhealth.usc.edu/ghhr

University of Southern California Gould School of Law ( email )

699 Exposition Boulevard
Los Angeles, CA 90089
United States

Harvard School of Public Health ( email )

677 Huntington Avenue
Boston, MA MA 02115
United States

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