Survival benefits of antiretroviral therapy in Brazil: a model‐based analysis

Luz, Paula M.; Girouard, Michael P.; Grinsztejn, Beatriz; Freedberg, Kenneth A.; Veloso, Valdiléa G.; Losina, Elena; Struchiner, Cláudio J.; MacLean, R; Paltiel, A. David; Walensky, Rochelle P.

doi:10.7448/ias.19.1.20623

Cited by 20 publications

(12 citation statements)

References 44 publications

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“…That programme, in turn, has enabled Mexico to provide universal ART access [161]. Similarly, national level ART investments since 1996 have provided population benefits in Brazil [162].…”

Section: Promising Approaches To Economic and Livelihood Interventionsmentioning

confidence: 99%

Improving antiretroviral therapy adherence in resource‐limited settings at scale: a discussion of interventions and recommendations

Haberer

Sabin

Amico

et al. 2017

Journal of the International AIDS Society

166

137

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Introduction: Successful population‐level antiretroviral therapy (ART) adherence will be necessary to realize both the clinical and prevention benefits of antiretroviral scale‐up and, ultimately, the end of AIDS. Although many people living with HIV are adhering well, others struggle and most are likely to experience challenges in adherence that may threaten virologic suppression at some point during lifelong therapy. Despite the importance of ART adherence, supportive interventions have generally not been implemented at scale. The objective of this review is to summarize the recommendations of clinical, research, and public health experts for scalable ART adherence interventions in resource‐limited settings. Methods: In July 2015, the Bill and Melinda Gates Foundation convened a meeting to discuss the most promising ART adherence interventions for use at scale in resource‐limited settings. This article summarizes that discussion with recent updates. It is not a systematic review, but rather provides practical considerations for programme implementation based on evidence from individual studies, systematic reviews, meta‐analyses, and the World Health Organization Consolidated Guidelines for HIV, which include evidence from randomized controlled trials in low‐ and middle‐income countries. Interventions are categorized broadly as education and counselling; information and communication technology‐enhanced solutions; healthcare delivery restructuring; and economic incentives and social protection interventions. Each category is discussed, including descriptions of interventions, current evidence for effectiveness, and what appears promising for the near future. Approaches to intervention implementation and impact assessment are then described. Results and discussion: The evidence base is promising for currently available, effective, and scalable ART adherence interventions for resource‐limited settings. Numerous interventions build on existing health care infrastructure and leverage available resources. Those most widely studied and implemented to date involve peer counselling, adherence clubs, and short message service (SMS). Many additional interventions could have an important impact on ART adherence with further development, including standardized counselling through multi‐media technology, electronic dose monitoring, decentralized and differentiated models of care, and livelihood interventions. Optimal targeting and tailoring of interventions will require improved adherence measurement. Conclusions: The opportunity exists today to address and resolve many of the challenges to effective ART adherence, so that they do not limit the potential of ART to help bring about the end of AIDS.

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“…That programme, in turn, has enabled Mexico to provide universal ART access [161]. Similarly, national level ART investments since 1996 have provided population benefits in Brazil [162].…”

Section: Promising Approaches To Economic and Livelihood Interventionsmentioning

confidence: 99%

Improving antiretroviral therapy adherence in resource‐limited settings at scale: a discussion of interventions and recommendations

Haberer

Sabin

Amico

et al. 2017

Journal of the International AIDS Society

166

137

View full text Add to dashboard Cite

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“…The iPrEX (Pre‐Exposure Prophylaxis Initiative) trial, which enrolled participants at participating sites in Rio de Janeiro and São Paulo, estimated the annual HIV incidence rate in the placebo arm at 5.0% (95% CI 2.7% to 9.2%) [23]. Our findings show that the HIV incidence rate remains high despite wide ART and PrEP availability and suggests that the populational impact of these interventions may take several years to be realized [24,25]. As of 2015, continuum of care estimates of the country reveals that 46.0% of individuals living with HIV have detectable viremia [26], which likely fuels HIV transmission in the setting of high HIV prevalence [17,27].…”

Section: Resultsmentioning

confidence: 99%

Evidence of an untamed HIV epidemic among MSM and TGW in Rio de Janeiro, Brazil: a 2018 to 2020 cross‐sectional study using recent infection testing

Teixeira

Jalil

et al. 2021

J Int AIDS Soc

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Introduction Monitoring the HIV epidemic and identifying populations among whom HIV is spreading is critical. We aimed to provide an estimate of the annualized HIV incidence rate using recency testing among cisgender men who have sex with men (MSM) and transgender women (TGW) at a reference centre in Rio de Janeiro, Brazil. Methods We evaluated MSM and TGW who sought HIV testing at the Evandro Chagas National Institute of Infectious Diseases‐FIOCRUZ between March 2018 and January 2020. The Limiting Avidity assay (LAg) as part of a recent infection testing algorithm (RITA) was employed to identify recent infections (those with a normalized optical density ≤1.5 in the LAg that met all RITA criteria) among those who tested positive for HIV and the annualized HIV incidence was estimated. Results and discussion Out of 3053 individuals assessed, 2591 (84.9%) were HIV negative and 462 (15.1%) were living with HIV. Among these, 302 (65.4%) with stored samples available were evaluated and 73/302 (24.2%) were classified as recent infections. The annualized incidence rate estimate using a false recency rate of zero was 7.35% (95% CI 5.76% to 9.25%). Conclusions Our results suggest that the HIV epidemic in Rio de Janeiro, Brazil, continues to disproportionately burden vulnerable populations, including MSM and TGW despite the existence and availability of effective preventive and therapeutic interventions.

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“…Nevertheless, the risk of death for late initiators of ART, although possibly underestimated, was significant in the present study. The association of increased mortality rates with delayed diagnosis and late treatment initiation in PVHIV was reported in studies conducted in Brazil [30, 31], low-income countries [32], and high-income countries [33].…”

Section: Discussionmentioning

confidence: 99%

Late Onset of Antiretroviral Therapy in Adults Living with HIV in an Urban Area in Brazil: Prevalence and Risk Factors

Pacheco

Zara

Souza

et al. 2019

Journal of Tropical Medicine

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Introduction. Highly active antiretroviral therapy has been available since 1996. Early initiation of antiretroviral therapy (ART) leads to improved therapeutic response and reduced HIV transmission. However, a significant number of people living with HIV (PLHIV) still start treatment late. Objective. This study aimed to analyze characteristics and factors associated with late initiation of ART among HIV-infected treatment-naïve patients. Methods. This cross-sectional study included PLHIV older than 17 years who initiated ART at two public health facilities from 2009 to 2012, in a city located in Midwestern Brazil. Pregnant women were excluded. Data were collected from medical records, antiviral dispensing forms, and the Logistics Control of Medications System (SICLOM) of the Brazilian Ministry of Health. Late initiation of ART was defined as CD4+ cell count < 200 cells/mm3 or presence of AIDS-defining illness. Uni- and multivariate analysis were performed to evaluate associated factors for late ARV using SPSS®, version 21. The significance level was set at p<0.05. Results. 1,141 individuals were included, with a median age of 41 years, and 69.1% were male. The prevalence of late initiation of ART was 55.8% (95%CI: 52.9-58.7). The more common opportunistic infections at ART initiation were pneumocystosis, cerebral toxoplasmosis, tuberculosis, and histoplasmosis. Overall, 38.8% of patients had HIV viral load equal to or greater than 100,000 copies/mL. Late onset of ART was associated with higher mortality. After logistic regression, factors shown to be associated with late initiation of ARV were low education level, sexual orientation, high baseline viral load, place of residence outside metropolitan area, and concomitant infection with hepatitis B virus. Conclusion. These results revealed the need to increase early treatment of HIV infection, focusing especially on groups of people who are more socially vulnerable or have lower self-perceived risk.

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Survival benefits of antiretroviral therapy in Brazil: a model‐based analysis

Cited by 20 publications

References 44 publications

Improving antiretroviral therapy adherence in resource‐limited settings at scale: a discussion of interventions and recommendations

Improving antiretroviral therapy adherence in resource‐limited settings at scale: a discussion of interventions and recommendations

Evidence of an untamed HIV epidemic among MSM and TGW in Rio de Janeiro, Brazil: a 2018 to 2020 cross‐sectional study using recent infection testing

Late Onset of Antiretroviral Therapy in Adults Living with HIV in an Urban Area in Brazil: Prevalence and Risk Factors

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