The impact of primary health care on AIDS incidence and mortality: A cohort study of 3.4 million Brazilians.

IF 15.8 1区医学 Q1 Medicine

PLoS Medicine Pub Date : 2024-07-11 eCollection Date: 2024-07-01 DOI:10.1371/journal.pmed.1004302

Priscila F P S Pinto, James Macinko, Andréa F Silva, Iracema Lua, Gabriela Jesus, Laio Magno, Carlos A S Teles Santos, Maria Yury Ichihara, Mauricio L Barreto, Corrina Moucheraud, Luis E Souza, Inês Dourado, Davide Rasella

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Abstract

Background: Primary Health Care (PHC) is essential for effective, efficient, and more equitable health systems for all people, including those living with HIV/AIDS. This study evaluated the impact of the exposure to one of the largest community-based PHC programs in the world, the Brazilian Family Health Strategy (FHS), on AIDS incidence and mortality.

Methods and findings: A retrospective cohort study carried out in Brazil from January 1, 2007 to December 31, 2015. We conducted an impact 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 impact of FHS on AIDS incidence and mortality and compared outcomes between residents of municipalities with low or no FHS coverage (unexposed) with those in municipalities with 100% FHS coverage (exposed). 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 the FHS impact by sex and age and performed a wide range of sensitivity and triangulation analyses; 100% FHS coverage was associated with lower AIDS incidence (rate ratio [RR]: 0.76, 95% CI: 0.68 to 0.84) and mortality (RR: 0.68, 95%CI: 0.56 to 0.82). FHS impact 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 to 0.72) and mortality (RR: 0.56, 95% CI: 0.43 to 0.72). The absence of important confounding variables (e.g., sexual behavior) is a key limitation of this study.

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.

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初级卫生保健对艾滋病发病率和死亡率的影响：对 340 万巴西人的队列研究。

背景：初级卫生保健（PHC）是为所有人（包括艾滋病毒/艾滋病感染者）提供有效、高效和更公平的卫生系统的关键。本研究评估了巴西家庭健康战略（FHS）这一世界上最大的社区初级卫生保健计划对艾滋病发病率和死亡率的影响：2007年1月1日至2015年12月31日在巴西开展的一项回顾性队列研究。我们使用一个队列进行了影响评估，该队列包括 3,435,068 名年龄≥13 岁的低收入者，他们是 1 亿巴西人队列的成员，与艾滋病诊断和死亡登记处有关联。我们评估了家庭健康服务对艾滋病发病率和死亡率的影响，并比较了家庭健康服务覆盖率低或未覆盖（未暴露）的城市居民与家庭健康服务覆盖率 100%（暴露）的城市居民之间的结果。我们采用了多变量泊松回归法，对所有相关的城市和个人层面的人口、社会经济和环境变量进行了调整，并采用反向治疗概率加权法（IPTW）进行加权。我们还按性别和年龄估算了家庭健康服务的影响，并进行了广泛的敏感性和三角分析；100% 的家庭健康服务覆盖率与较低的艾滋病发病率（比率 [RR]：0.76，95% CI：0.68 至 0.84）和死亡率（比率：0.68，95% CI：0.56 至 0.82）相关。FHS 对男性和女性的影响相似，但对年龄≥35 岁者的影响更大，包括发病率（RR：0.62，95% CI：0.53 至 0.72）和死亡率（RR：0.56，95% CI：0.43 至 0.72）。缺乏重要的混杂变量（如性行为）是本研究的一个主要局限：艾滋病对于当今大多数艾滋病病毒感染者来说都是可以避免的，而我们的研究表明，在巴西，家庭健康服务的覆盖可以显著降低低收入人群的艾滋病发病率和死亡率。为了实现到 2030 年终结艾滋病的可持续发展目标，应通过社区初级保健计划促进全面医疗保健的普及。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

PLoS Medicine MEDICINE, GENERAL & INTERNAL-

CiteScore

17.60

自引率

0.60%

发文量

227

审稿时长

4-8 weeks

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