Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Virol. Sep 25, 2024; 13(3): 96416
Published online Sep 25, 2024. doi: 10.5501/wjv.v13.i3.96416
Human immunodeficiency virus cascade–continuum of care stages and outcomes in a hospital in southern Brazil
Manoela Badinelli Vaucher, Patrícia Fisch, Dimas Alexandre Kliemann
Manoela Badinelli Vaucher, Dimas Alexandre Kliemann, Department of Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre 90050-170, Rio Grande do Sul, Brazil
Manoela Badinelli Vaucher, Department of Medicine, Universidade do Vale do Taquari (UNIVATES), Lajeado 95914-014, Rio Grande do Sul, Brazil
Manoela Badinelli Vaucher, Department of Life Sciences, Universidade de Santa Cruz do Sul (UNISC), Santa Cruz do Sul 96815-900, Rio Grande do Sul, Brazil
Patrícia Fisch, Department of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre 90619-900, Rio Grande do Sul, Brazil
Patrícia Fisch, Department of Epidemiology, Hospital Nossa Senhora da Conceição, Porto Alegre 91350-250, Rio Grande do Sul, Brazil
Dimas Alexandre Kliemann, Department of Infectious Disease, Hospital Nossa Senhora da Conceição, Porto Alegre 91350-250, Rio Grande do Sul, Brazil
Author contributions: Fisch P and Kliemann DA designed the research study; Vaucher MB and Fisch P performed the research; Vaucher MB and Kliemann DA analyzed the data and wrote the manuscript. All authors read and approved the final manuscript.
Institutional review board statement: This study was approved by the Research Ethics Committee of the Hospital Group.
Informed consent statement: The requirement for informed consent was waived by the Research Ethics Committee of the Hospital Group, as it is a non-intervention study, upon commitment to patient confidentiality.
Conflict-of-interest statement: All authors declare no conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement- checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Manoela Badinelli Vaucher, MD, MSc, Doctor, Professor, Department of Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Sarmento Leite, 245 Centro Histórico, Porto Alegre 90050-170, Rio Grande do Sul, Brazil. manuvaucher@hotmail.com
Received: May 6, 2024
Revised: June 6, 2024
Accepted: July 18, 2024
Published online: September 25, 2024
Processing time: 114 Days and 20.6 Hours
Abstract
BACKGROUND

The human immunodeficiency virus (HIV) continuum of care cascade illustrates the 90-90-90 goals defined by the Joint United Nations Program on HIV/acquired immunodeficiency syndrome (UNAIDS). The care cascade includes the following five steps: Diagnosis, linkage to care, retention in care, adherence to antiretroviral therapy (ART), and viral suppression.

AIM

To elaborate the HIV cascade of patients diagnosed with HIV at the Nossa Senhora da Conceição Hospital (HNSC) and to determine possible local causes for the loss of patients between each step of the cascade.

METHODS

This retrospective cohort study included patients diagnosed with HIV infection from January 1, 2015 to December 31, 2016 and followed up until July 31, 2019. The data were analyzed by IBM SPSS software version 25, and Poisson regression with simple robust variance was used to analyze variables in relation to each step of the cascade. Variables with P < 0.20 were included in multivariable analysis, and P < 0.05 was considered significant. Pearson’s χ2 test was used to compare the groups of patients followed up at the HNSC and those followed up at other sites.

RESULTS

The results were lower than those expected by the UNAIDS, with 94% of patients linked, 91% retained, 81% adhering to ART, and 84% in viral suppression. Age and site of follow-up were the variables with the highest statistical significance. A comparison showed that the cascade of patients from the HNSC had superior results than outpatients, with a significant difference in the last step of the cascade.

CONCLUSION

The specialized and continued care provided at the HNSC was associated with better results and was closer to the goals set by the UNAIDS. The development of the HIV cascade using local data allowed for the stratification and evaluation of risk factors associated with the losses occurring between each step of the cascade.

Keywords: Cascade; Continuum care; Human immunodeficiency virus; Antiretroviral therapy; Adherence

Core Tip: The capital of southern Brazil, Porto Alegre, has the highest acquired immunodeficiency syndrome (AIDS)-related mortality rate. These data demonstrate that human immunodeficiency virus (HIV)/AIDS is an important public health problem in the city, and it is important to carry out studies to improve indicators. The HIV cascade was adopted as a portrait of implemented public policies. That is why we decided to carry out this study with the objective of identifying the steps and results of continuity of care in patients diagnosed with HIV infection in a hospital located in Porto Alegre. The development of the HIV cascade using local data allowed for the stratification and assessment of risk factors associated with losses occurring between each stage of the cascade, to develop new strategies aimed at achieving the 90-90-90 target in future assessments.