ABSTRACT
This study compared healthcare utilization by injection drug users (IDUs) and non-IDUs. Data were abstracted from patients' medical records, admitted on HIV/AIDS treatment centers, between 1986 and 2002, forming a non-concurrent cohort study. Variables included: sociodemographics, HIV/AIDS exposure group, healthcare utilization (consultations, procedures, and prescriptions). Descriptive analyses included age-period and cohort effects. Out of 170 patients, with an average age of 30 years, 39.4% were IDUs, 71.8% were males and had low levels of education. At the first consultation, 86.5% neither received an ARV prescription nor had a request for CD4 or viral load. Injection drug users, as compared to non-IDUs, were less likely to receive ARV prescriptions and requests for CD4 lymphocyte and viral load counts, even though the number of consultations did not differ between the two groups. Healthcare utilization increased in calendar-year in the non-IDUs group, parallel to the implementation of the Brazilian health policy of universal care. However, this favorable trend was not observed among IDUs. Differential outcomes for HIV/AIDS among IDUs, towards worse prognosis, suggest difficulties in terms of adherence and follow-up of ARV therapy in this population.
Subject(s)
HIV Infections/drug therapy , Health Services Accessibility/statistics & numerical data , Health Services/statistics & numerical data , Substance Abuse, Intravenous , Antiretroviral Therapy, Highly Active/statistics & numerical data , Brazil , CD4 Lymphocyte Count , Cohort Studies , Drug Prescriptions/statistics & numerical data , Female , HIV Infections/immunology , Humans , Male , Multivariate Analysis , Quality of Health Care , Socioeconomic Factors , Substance Abuse, Intravenous/epidemiology , Viral LoadABSTRACT
Objetivou-se descrever a utilizacão de servicos, comparando usuários de drogas injetáveis (UDIs) e não-UDIs. Informacões coletadas nos prontuários de pacientes em atendimento para HIV/AIDS, de 1986 a 2002, estabeleceram uma coorte não concorrente. As variáveis incluíam: dados sócio-demográficos, exposicão ao HIV/AIDS e utilizacão de servico (consultas, prescricões e solicitacões de exames). Análises descritivas e verificacão dos efeitos calendário e de coorte foram realizadas. Dos 170 pacientes, com trinta anos na mediana idade, 39,4 por cento eram UDIs, 71,8 por cento homens e com baixa escolaridade; 86,5 por cento não receberam, na primeira consulta, prescricão ARV, solicitacão de CD4 ou carga viral. Usuários de drogas injetáveis tiveram menor chance de receber prescricão de ARV, solicitacão de CD4/carga viral, seja na primeira consulta, seja nas demais, apesar de o número de consultas não diferir em virtude de ser ou não UDIs. Observou-se incremento na utilizacão dos servicos para pacientes não-UDIs ao longo do tempo, coincidindo com a implementacão de políticas públicas visando à ampliacão do acesso; porém, tal impacto não foi observado entre UDIs. Evolucão diferencial da infeccão pelo HIV, com piores prognósticos entre os UDIs, sugere deficiências na adesão e manutencão do tratamento ARV.
