Perfil das notificações e internações por HIV/AIDS no Paraná

Abstract

Introduction: The prevalence of HIV / AIDS is the biggest challenge for public health. Since the beginning of the epidemic, 76 million people have been infected with HIV and around 33 million people have died from the disease. Objective: To analyze the profile of notifications, their spatial distribution as well as hospitalizations for HIV / AIDS in 2019. Method: This is an ecological, descriptive study with a quantitative approach. The study was developed in the state of Paraná, in Brazil. Data were obtained from the Notifiable Diseases Information System (SINAN) and Hospital Information Systems (SIH). Descriptive analysis was performed. To compare and verify the existence of an association of profile characteristics and antecedents with the age group (adults or elderly), the chi-square test of association was used. To investigate possible associations between sociodemographic characteristics and antecedents with death from AIDS, univariate logistic regression was used, estimating the odds ratios with a 95% confidence interval. The spatial analysis of the incidence of HIV cases per 100 thousand inhabitants was carried out by Health Region. To check for the existence of spatial autocorrelation, the global Moran index was first calculated, then the local Moran index was used to identify clusters of areas with similar risks for the outcome of interest. Results: In Paraná, Brazil, 4,305 cases of HIV / AIDS were reported in 2019, which shows a prevalence of 37.4 / 100,000 inhabitants. Of the total, 85.83% are of patients under 60 years of age, while the remaining 14.17% are cases of elderly people, with 60 years of age or more. Among the Rio de Janeiro / Caracas criteria evaluated, the most frequently presented by patients, regardless of age group, were cachexia or weight loss greater than 10% (12.47%), asthenia greater than or equal to 1 month (9.59%) persistent cough or any pneumonia (7.13%) and fever greater than or equal to 38ºC for a period greater than or equal to 1 month (6.39%), with none of the others reaching more than 5% of patients. As with the Rio de Janeiro / Caracas criteria, it can be seen that for most of the CDC criteria, adapted to the percentage of patients who meet the same requirements, it is higher among the elderly than among adults. Considering the outcomes, it appears that the highest percentage of deaths from AIDS was among the elderly (10.16%). Of the total, it was observed that 4.30% of the notified patients died from AIDS. The variables zone of residence and race have no significant association with death (p-values of 0.876, and 0.578, respectively), with all other sociodemographic characteristics and antecedents, a significant association was observed. Concerning hospitalizations, it appears that in total 901 subjects were hospitalized in 2019. Hospitalizations occurred more in males, with a difference of 55.2% more hospitalizations. Hospitalizations are concentrated on subjects under 60 years of age. Regarding hospitalization costs, it appears that the most expensive age group is between 40-49 years old, however the highest average value is in the age group between 70-79 years old. Furthermore, it is observed that the male sex is also responsible for higher costs compared to the female. Regarding the average length of stay, elderly people aged 60-69 years stay on average for a longer time. Mortality is higher in males, except for the 40-49 age group where it was lower than females. Mortality in men from HIV / AIDS is increasing from 30-39 years onwards. It can be seen that three health regions stand out with the highest incidences of AIDS per 100 thousand inhabitants, being the 1st regional, in Paranaguá, with an incidence of 52.5 cases per 100 thousand inhabitants, the 2nd regional, metropolitan, with 54, 1 cases per 100 thousand inhabitants, and the 15th regional, from Maringá, with 52.86 cases per 100 thousand inhabitants. The spatial autocorrelation analysis showed that only the 1st health regional, in Paranaguá, showed significant local spatial dependence (p <0.001), with a high incidence of AIDS cases, similar to that observed in neighboring regions, in this case, the 2nd regional (Metropolitan). The other local spatial relationships were not significant. Final considerations: This study made it possible to better understand the profile of notifications and hospitalizations for HIV/AIDS in Paraná, Brazil, and, from there, strategies can be designed and rethought to combat this disease, which is relatively silent, but which affects and afflicts a portion of the population and that burdens the public health system