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      Mortalidade por HIV/Aids no Brasil, 2000-2015: motivos para preocupação? Translated title: HIV/AIDS Mortality in Brazil, 2000-2015: Are there reasons for concern?

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          Abstract

          RESUMO: Introdução e objetivo: Estudos de mortalidade são fundamentais no monitoramento da epidemia de HIV/Aids. Qualidade e completude dos dados do sistema de informação de mortalidade (SIM) requerem abordagens complementares. Métodos: Foram utilizadas duas fontes de dados para avaliação das tendências de mortalidade por HIV/Aids no Brasil entre 2000 e 2014/15: a) dados do SIM publicados pelo Departamento de DST, Aids e Hepatites Virais; e b) estudos de carga de doença 2015 (GBD 2015). Foi conduzida a análise descritiva e realizada uma comparação das tendências de redução relativa dos coeficientes de mortalidade por 100 mil, padronizados por idade. Resultados: A magnitude dos coeficientes de mortalidade estimados pelo GBD para o Brasil e estados foi maior do que a daqueles obtidos pelo SIM. A redução relativa foi maior para os dados gerados pelo SIM e houve mudança de ranking de acordo com os estados. Entre 2000 e 2014/15, houve aumento nos coeficientes de mortalidade para a maioria dos estados (78 e 88%, segundo o SIM e o GBD, respetivamente). Conclusões: São preocupantes os dados sobre mortalidade por HIV/Aids no Brasil, independentemente do método utilizado. As diferenças de magnitude, redução relativa e ranking podem ser atribuídas a diferenças metodológicas, sendo o GBD mais abrangente e com maior capacidade de captar dados classificados incorretamente, não registrados ou não codificados como causa de óbito devido ao HIV/Aids. O estudo de fontes complementares e metodologias alternativas podem fornecer importantes subsídios para as políticas públicas de HIV/Aids no Brasil.

          Translated abstract

          ABSTRACT: Introduction and objective: Mortality studies are essential for the monitoring of the HIV/AIDS epidemic. Quality and completeness of data from the mortality information system (SIM) require complementary approaches. Methods: Two sources of data were used to assess mortality trends due to HIV/AIDS in Brazil from 2000 and 2014/15: a) data from the SIM published by the Department of STDs, AIDS, and viral hepatitis, and b) Global Burden of Disease 2015 (GBD 2015) studies. Descriptive analyses were carried out and trends in relative reduction of age-adjusted mortality rates per 100,000 inhabitants were compared according to the two methods. Results: Overall, the magnitude of the mortality rates estimated by the GBD method, for Brazil and its Federative Units (FU), was greater than those obtained from the SIM. The relative reduction was higher for SIM data and there were shifts in the ranking according to the FUs. Between 2000 and 2014/15 there was an increase in the mortality rates for most of the FUs (78 and 88% according to the SIM and GBD, respectively). Conclusion: Data regarding mortality due to HIV/AIDS in Brazil should be of concern, regardless of the method used. Differences in magnitude, relative reductions, and ranking can be attributed to methodological differences, but the GBD is broader, with a higher capacity to capture incorrectly classified data and causes of death not registered or not coded as being due to HIV/AIDS. Alternative and complementary data sources can provide important information for HIV/AIDS public policies in Brazil.

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          A critical analysis of the Brazilian response to HIV/AIDS: lessons learned for controlling and mitigating the epidemic in developing countries.

          The Brazilian National AIDS Program is widely recognized as the leading example of an integrated HIV/AIDS prevention, care, and treatment program in a developing country. We critically analyze the Brazilian experience, distinguishing those elements that are unique to Brazil from the programmatic and policy decisions that can aid the development of similar programs in other low- and middle-income and developing countries.Among the critical issues that are discussed are human rights and solidarity, the interface of politics and public health, sexuality and culture, the integration of prevention and treatment, the transition from an epidemic rooted among men who have sex with men to one that increasingly affects women, and special prevention and treatment programs for injection drug users.
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            The UNAIDS Estimation and Projection Package: a software package to estimate and project national HIV epidemics.

            This paper describes the Estimation and Projection Package (EPP) for estimating and projecting HIV prevalence levels in countries with generalised epidemics. The paper gives an overall summary of the software and interface. It describes the process of defining and modelling a national epidemic in terms of locally relevant sub-epidemics and the four epidemiological parameters used to fit a curve to produce the prevalence trends in the epidemic. It also provides an example of using the EPP in a country with a generalised epidemic. The paper discusses the strengths and weaknesses of the software and its envisaged future developments.
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              Non-adherence among patients initiating antiretroviral therapy: a challenge for health professionals in Brazil.

              To assess the incidence, magnitude and factors associated with the first episode of non-adherence for 12 months after the first antiretroviral prescription. A prospective study of HIV-infected patients receiving their first antiretroviral prescription in public referral centers, Belo Horizonte, Brazil. Baseline assessment occurred at the moment of the first prescription and follow-up visits at the first, fourth and seventh month, from May 2001 to May 2003. Non-adherence was self-reported and defined as the intake of less than 95% of the prescribed doses for 3 days before the follow-up interviews. Cumulative and person-time incidence were estimated and Cox's proportional model was used to assess the relative hazard (RH) of non-adherence with 95% confidence interval for both univariate and multivariate analysis. Among 306 patients, the cumulative incidence of non-adherence was 36.9% (incidence rate 0.21/100 person-days). Multivariate analysis (P < 0.05) showed that unemployment (RH = 2.17), alcohol use (RH = 2.27), self-report of three or more adverse reactions (RH = 1.64), number of pills per day (RH = 2.04), switch in antiretroviral regimen (RH = 2.72), and a longer time between the HIV test result and the first antiretroviral prescription (RH = 2.27) were associated with an increased risk of non-adherence, whereas the use of more than one health service indicated a negative association (RH = 0.54). The current analysis has pointed out the importance of clinical and health service characteristics as potential indicators of non-adherence after initiating therapy. Early assessment and intervention strategies should be priorities in these AIDS public referral centres. Feasible and reliable indicators for the routine monitoring of adherence should be incorporated in clinical practice.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rbepid
                Revista Brasileira de Epidemiologia
                Rev. bras. epidemiol.
                Associação Brasileira de Saúde Coletiva (São Paulo, SP, Brazil )
                1415-790X
                1980-5497
                May 2017
                : 20
                : suppl 1
                : 182-190
                Affiliations
                [1] Belo Horizonte Minas Gerais orgnameUniversidade Federal de Minas Gerais orgdiv1Faculdade de Medicina orgdiv2Departamento de Medicina Preventiva e Social Brazil
                [2] Belo Horizonte Minas Gerais orgnameUniversidade Federal de Minas Gerais orgdiv1Instituto de Ciências Biológicas orgdiv2Departamento de Parasitologia Brazil
                Article
                S1415-790X2017000200182
                10.1590/1980-5497201700050015
                a0724644-194c-45c3-8450-535e25bac8e4

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 10 March 2017
                : 09 February 2017
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 15, Pages: 9
                Product

                SciELO Public Health

                Categories
                Artigos Originais

                AIDS,Mortality,Brazil,Descriptive epidemiology,Aids,Mortalidade,Brasil,Epidemiologia descritiva

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