Variability in life expectancy among people with HIV in Brazil by gender and sexual orientation
Introduction: In Brazil, though Antiretroviral Therapy (ART) is available to all, the benefits may not be experienced uniformly. We projected Life Expectancy (LE) for People Living with HIV (PLHIV) in care as currently observed and estimated the impact of guideline-concordant care. Methods: Using a...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-01-01
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| Series: | Brazilian Journal of Infectious Diseases |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1413867024000059 |
| _version_ | 1797279243544035328 |
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| author | Paula M. Luz Hailey Spaeth Justine A. Scott Beatriz Grinsztejn Valdilea G. Veloso Kenneth A. Freedberg Elena Losina |
| author_facet | Paula M. Luz Hailey Spaeth Justine A. Scott Beatriz Grinsztejn Valdilea G. Veloso Kenneth A. Freedberg Elena Losina |
| author_sort | Paula M. Luz |
| collection | DOAJ |
| description | Introduction: In Brazil, though Antiretroviral Therapy (ART) is available to all, the benefits may not be experienced uniformly. We projected Life Expectancy (LE) for People Living with HIV (PLHIV) in care as currently observed and estimated the impact of guideline-concordant care. Methods: Using a microsimulation model, we projected LE for a cohort of PLHIV and for four population groups: cisgender Men who have Sex with Men (MSM), cisgender Men who have Sex with Women (MSW), Cisgender Women (CGW), and Transgender Women (TGW). Cohort data from Evandro Chagas National Institute of Infectious Diseases/Oswaldo Cruz Foundation (INI/Fiocruz) informed model parameters. We modeled five scenarios: 1) Current care: ART initiation, adherence, and retention in care as currently observed, 2) Guideline-concordant care: immediate ART initiation, full adherence to treatment, and consistent retention in care, 3) Immediate ART initiation with observed adherence to treatment and retention in care, 4) Full adherence to treatment with observed timing of ART initiation and retention in care, and 5) Consistent retention in care with observed timing of ART initiation and adherence. Results: With current care, LE from age 15 would be 45.9, 44.4, 54.2, and 42.3 years, for MSM, MSW, CGW, and TGW. With guideline-concordant care, LE would be 54.2, 54.4, 63.1, and 53.2 years, for MSM, MSW, CGW and TGW, with TGW experiencing the greatest potential increase in LE (10.9 years). When investigating the components of care separately, MSW and CGW would gain most LE with immediate ART initiation, whereas for MSM and TGW consistent retention in care would be most impactful. Conclusions: In settings like INI/Fiocruz, MSW and CGW would benefit most from interventions focused on earlier diagnosis and linkage to care, whereas TGW and MSM would benefit from interventions to sustain engagement in care. Assessment of the HIV care continuum for specific populations should inform care priorities. |
| first_indexed | 2024-03-07T16:22:27Z |
| format | Article |
| id | doaj.art-2a4cacf54e4042beaaaeb44f591f8be9 |
| institution | Directory Open Access Journal |
| issn | 1413-8670 |
| language | English |
| last_indexed | 2024-03-07T16:22:27Z |
| publishDate | 2024-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brazilian Journal of Infectious Diseases |
| spelling | doaj.art-2a4cacf54e4042beaaaeb44f591f8be92024-03-04T04:12:00ZengElsevierBrazilian Journal of Infectious Diseases1413-86702024-01-01281103722Variability in life expectancy among people with HIV in Brazil by gender and sexual orientationPaula M. Luz0Hailey Spaeth1Justine A. Scott2Beatriz Grinsztejn3Valdilea G. Veloso4Kenneth A. Freedberg5Elena Losina6Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil; Corresponding author.Massachusetts General Hospital, Medical Practice Evaluation Center, Department of Medicine, Boston, MA, United StatesMassachusetts General Hospital, Medical Practice Evaluation Center, Department of Medicine, Boston, MA, United StatesFundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, BrazilFundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, BrazilMassachusetts General Hospital, Division of Infectious Diseases, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Massachusetts General Hospital, Division of General Internal Medicine, Boston, MA, United States; Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, United StatesHarvard Medical School, Boston, MA, United States; Harvard University Center for AIDS Research, Harvard Medical School, Boston, MA, United States; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, United States; Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States; Department of Epidemiology, Boston University School of Public Health, Boston, MA, United StatesIntroduction: In Brazil, though Antiretroviral Therapy (ART) is available to all, the benefits may not be experienced uniformly. We projected Life Expectancy (LE) for People Living with HIV (PLHIV) in care as currently observed and estimated the impact of guideline-concordant care. Methods: Using a microsimulation model, we projected LE for a cohort of PLHIV and for four population groups: cisgender Men who have Sex with Men (MSM), cisgender Men who have Sex with Women (MSW), Cisgender Women (CGW), and Transgender Women (TGW). Cohort data from Evandro Chagas National Institute of Infectious Diseases/Oswaldo Cruz Foundation (INI/Fiocruz) informed model parameters. We modeled five scenarios: 1) Current care: ART initiation, adherence, and retention in care as currently observed, 2) Guideline-concordant care: immediate ART initiation, full adherence to treatment, and consistent retention in care, 3) Immediate ART initiation with observed adherence to treatment and retention in care, 4) Full adherence to treatment with observed timing of ART initiation and retention in care, and 5) Consistent retention in care with observed timing of ART initiation and adherence. Results: With current care, LE from age 15 would be 45.9, 44.4, 54.2, and 42.3 years, for MSM, MSW, CGW, and TGW. With guideline-concordant care, LE would be 54.2, 54.4, 63.1, and 53.2 years, for MSM, MSW, CGW and TGW, with TGW experiencing the greatest potential increase in LE (10.9 years). When investigating the components of care separately, MSW and CGW would gain most LE with immediate ART initiation, whereas for MSM and TGW consistent retention in care would be most impactful. Conclusions: In settings like INI/Fiocruz, MSW and CGW would benefit most from interventions focused on earlier diagnosis and linkage to care, whereas TGW and MSM would benefit from interventions to sustain engagement in care. Assessment of the HIV care continuum for specific populations should inform care priorities.http://www.sciencedirect.com/science/article/pii/S1413867024000059DisparitiesLife expectancyHIV care continuumBrazilModelingKey and vulnerable populations |
| spellingShingle | Paula M. Luz Hailey Spaeth Justine A. Scott Beatriz Grinsztejn Valdilea G. Veloso Kenneth A. Freedberg Elena Losina Variability in life expectancy among people with HIV in Brazil by gender and sexual orientation Brazilian Journal of Infectious Diseases Disparities Life expectancy HIV care continuum Brazil Modeling Key and vulnerable populations |
| title | Variability in life expectancy among people with HIV in Brazil by gender and sexual orientation |
| title_full | Variability in life expectancy among people with HIV in Brazil by gender and sexual orientation |
| title_fullStr | Variability in life expectancy among people with HIV in Brazil by gender and sexual orientation |
| title_full_unstemmed | Variability in life expectancy among people with HIV in Brazil by gender and sexual orientation |
| title_short | Variability in life expectancy among people with HIV in Brazil by gender and sexual orientation |
| title_sort | variability in life expectancy among people with hiv in brazil by gender and sexual orientation |
| topic | Disparities Life expectancy HIV care continuum Brazil Modeling Key and vulnerable populations |
| url | http://www.sciencedirect.com/science/article/pii/S1413867024000059 |
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