Cascada del cuidado del VIH a partir del diagnóstico en Centro de Pruebas y Consejo

Rossi, Angélica da Mata; Albanese, Silvia Paulino Ribeiro; Vogler, Ingridt Hildegard; Pieri, Flávia Meneguetti; Lentine, Edvilson Cristiano; Birolim, Marcela Maria; Dessunti, Elma Mathias

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Revista Brasileira de Enfermagem

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 73 (6) • 2020 • https://doi.org/10.1590/0034-7167-2019-0680 copiar

Cascada del cuidado del VIH a partir del diagnóstico en Centro de Pruebas y Consejo

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

Analizar la cascada del cuidado del VIH a partir del diagnóstico en Centro de Pruebas y Consejo (CTA); y las características sociodemográficas, clínicas y laboratoriales relacionadas al sexo.

Método:

Estudio epidemiológico, realizado con datos de indivíduos atendidos en un Centro de Pruebas y Consejo y acompañados en ambulatorio de VIH/sida. Han sido utilizados el test chi cuadrado y regresión logística binaria, para obtención del odds ratio, considerando alfa < 0,05.

Resultados:

La prevalencia de VIH nos 5.229 usuarios ha sido de 5%, con mayor chance de resultado positivo entre hombres, franja etaria de 14 a 33 años, que no presentaban unión estable. En el análisis de linfocitos TCD4+ y carga viral (CV) de 238 casos, 56,1% realizaron diagnóstico tardío. Han sido identificadas lagunas en la cascada del cuidado, especialmente en la vinculación, retención en el cuidado y supresión de la carga viral.

Conclusión:

Los resultados sugieren diagnóstico tardío para ambos los sexos, además dificultad en alcanzar la meta de supresión viral.

Descriptores:
Infecciones por VIH; Diagnóstico Precoz; Resultado del Tratamiento; Continuidad de la Asistencia al Paciente; Epidemiología

Characteristics Sociodemographic	Gender						OR (95% CI)	p value
	Male		Female		Total
	n	%	n	%	n	%
Age group								0.018
14 to 33 years old	131	64.9	27	47.4	158	61.0	2.05 (1.13-3.72)
34 to 68 years old	71	35.1	30	52.6	101	39.0	1:00
Education in Years (n = 258)^* * Excluded ignored cases/not applicable								0.001
0 to 7	69	34.2	33	58.9	102	39.5	1:00
8 and more	133	65.8	23	41.1	156	60.5	2.77 (1.51-5.07)
Race/color (n = 256) ^* * Excluded ignored cases/not applicable								0.818
White	160	79.6	43	78.2	203	79.3	1.09 (0.53-2.25)
Non-white	41	20.4	12	21.8	53	20.7	1:00
Marital status (n = 256)^* * Excluded ignored cases/not applicable								< 0.001
Domestic Partnership	49	24.5	30	53.6	79	30.9	1:00
Not in a domestic partnership	151	75.5	26	46.4	177	69.1	3.56 (1.92-6.58)

Exames	Gender				Total
	Male		Female		Total
	n	%	n	%	n	%
Cytomegalovirus
IgG (130^* * Excluded ignored cases/not applicable and when there was no mention in the medical record. )	91	96.8	35	97.2	126	96.7
IgM (118^* * Excluded ignored cases/not applicable and when there was no mention in the medical record. )	03	3.4	-	-	03	2.5
Toxoplasmosis
IgG (145^* * Excluded ignored cases/not applicable and when there was no mention in the medical record. )	51	47.7	25	65.8	76	52.4
IgM (141^* * Excluded ignored cases/not applicable and when there was no mention in the medical record. )	05	4.8	01	2.7	06	4.3
Syphilis
FTA-Abs (182^* * Excluded ignored cases/not applicable and when there was no mention in the medical record. )	50	36.0	03	7.0	53	29.1
VDRL (172^* * Excluded ignored cases/not applicable and when there was no mention in the medical record. )	41	31.1	01	2.5	42	24.4
Anti-HAV (123^* * Excluded ignored cases/not applicable and when there was no mention in the medical record. )	55	62.5	30	85.7	85	69.1
Anti-HCV (190^* * Excluded ignored cases/not applicable and when there was no mention in the medical record. )	02	1.4	02	4.4	04	2.1
Hepatitis B
HBsAg (195^* * Excluded ignored cases/not applicable and when there was no mention in the medical record. )	03	2.1	01	2.0	04	2.1

Clinical Status	Gender				Total		p value
	Male		Female		Total
	n	%	n	%	n	%
Symptoms (n = 210^* * Excluded ignored cases/not applicable and when there was no mention in the medical record * Pearson's chi-square test. )
Yes	82	50.0	23	50.0	105	50.0	0.566^* ***** Fisher's exact test.
No	82	50.0	23	50.0	105	50.0	0.566^* ***** Fisher's exact test.
Coinfections (177^* * Excluded ignored cases/not applicable and when there was no mention in the medical record * Pearson's chi-square test. )
Yes	101	68.7	20	47.6	121	64.0	0.012^* * Excluded ignored cases/not applicable and when there was no mention in the medical record * Pearson's chi-square test. ^* * Excluded ignored cases/not applicable and when there was no mention in the medical record * Pearson's chi-square test.
No	46	31.3	22	52.4	68	36.0
Other STIs (n = 108^* * Excluded ignored cases/not applicable and when there was no mention in the medical record * Pearson's chi-square test. )
Yes	80	80.8	10	55.6	90	76.9	0.031^* ***** Fisher's exact test.
No	19	19.2	8	44.4	27	23.1	0.031^* ***** Fisher's exact test.
Comorbidities (n = 145^* * Excluded ignored cases/not applicable and when there was no mention in the medical record * Pearson's chi-square test. )
Yes	30	25.4	12	31.6	42	26.9	0.457^* * Excluded ignored cases/not applicable and when there was no mention in the medical record * Pearson's chi-square test. ^* * Excluded ignored cases/not applicable and when there was no mention in the medical record * Pearson's chi-square test.
No	88	74.6	26	68.4	114	73.1

	Viral Load (copies/ML)
	< 50		50-100.000		≥ 100.000		Total
	n	%	n	%	n	%	n	%
1^ST Examination CD4⁺ T L/µL
< 200	0	0.0	17	7.0	31	12.7	48	19.7
200 to 349	1	0.4	29	11.9	13	5.3	43	17.6
350 to 499	0	0.0	30	12.3	18	7.4	48	19.7
≥ 500	5	2.0	74	30.3	26	10.7	105	43.0
Total	6	2.4	150	61.5	88	36.1	244	100.0
Last Examination CD4⁺ T L/µL
< 200	0	0.0	6	2.5	17	7.0	23	9.4
200 to 349	9	3.7	7	2.9	1	0.4	17	7.0
350 to 499	28	11.5	17	7.0	2	0.8	47	19.3
≥ 500	127	52.0	29	11.9	1	0.4	157	64.3
Total	164	67.2	59	24.2	21	8.6	244	100.0

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[1] Corresponding author: Angélica da Mata Rossi. E-mail: ang1ros@hotmail.com