Variables associated with underreporting of AIDS patients in Rio de Janeiro, Brazil, 1996

OBJECTIVE: The underreporting of AIDS cases in the municipality of Rio de Janeiro, Brazil, is significant. The study intends to analyze the factors associated to this event. METHODS: Using data provided by the Hospital Information System for the year of 1996, in Rio de Janeiro city, and by the National Surveillance System, patients were randomly selected and their medical records reviewed to verify an AIDS diagnosis. A multinomial model was used to perform an analysis of the variations on the chances of underreporting of AIDS cases versus reporting and on the chances of underreporting without evidences to fulfill the case definition of AIDS versus reporting. RESULTS: No significant associations were found between the variables such as "age", "marital status", "level of education", "occupation", and "severity of illness" and the underreporting of AIDS cases. The variable "female gender" showed a strong association with hospitalization without evidence of an AIDS diagnosis. A strong association was found between two or more admissions in an inpatient unit care and reporting. The existence of a epidemiological surveillance department in the hospital is inversely associated with the underreporting of AIDS cases. CONCLUSION: The significant association between organizational variables and underreporting of AIDS cases found in the study point out to the need of standardization of the surveillance procedures, the especial need for the creation and maintenance of surveillance departments in hospitals to improve the quality of the health information system and, therefore, AIDS prevention and care.     

Death certificates as a marker for under-recording of AIDS cases

This study aimed to estimate and evaluate the under-recording of AIDS cases that evolved to death. From 1991 to 1995, the Mortality Information System recorded 9,213 adult deaths due to AIDS, related by name, date of birth, and date of death to 15,505 AIDS recorded by the Disease Data Registration System from 1982 to 1996. This procedure showed that 51.9% of AIDS deaths recorded in the period were not recorded as AIDS cases as they should have been. Univariate and multivariate analysis showed that women had a greater chance of under-recording than men (OR = 1.27). A lower probability of proper recording was observed in individuals with less schooling, and illiterates had a two-fold chance of not being properly recorded, as compared to individuals with college degrees. Deaths that occurred in health facilities classified as private units had a greater probability of not being recorded than those occurring elsewhere (mainly those classified as public reference units) (OR = 2.58). Deaths occurring in the city of Rio de Janeiro had a greater probability of under-recording than those in other cities (OR = 2.20).     

Relative risk for AIDS between homo/bisexual and heterosexual men

OBJECTIVE: To assess the relative risk for AIDS between men who have sex with other men and heterosexual men. METHODS: Estimates on the proportion of men who have sex with men in Brazil and AIDS data from Brazil's Information System for Notifiable Diseases, were utilized. Estimates were calculated for the relative risk (RR) for AIDS of men who have sex with men with respect to heterosexual masculine population in Brazil; state and city of S?o Paulo; and state and city of Rio de Janeiro, from 1996 to 2003. The trajectory of the RR in this period was also analyzed. RESULTS: The estimates for relative risk decreased, with a tendency to stabilize: from 34.3 to 19.3 in the entire country and from 32.1 and 6.3 in the locations analyzed. In the country in 2003, the relative risk of bisexual men in relation to heterosexual men was 16.0. The RR for exclusive homosexuals had a decreasing trajectory in all of the locations studied, but not for the bisexual population. CONCLUSIONS: In all locations, the relative risk for men who have sex with other men was higher in relation to heterosexual men. This result indicates a high and persistent vulnerability among this population.     

Study of the under-reporting of AIDS cases in Alagoas (Brazil), 1999-2005

The under-reporting of Aids (Acquired Immune Deficiency Syndrome) cases makes it difficult and even impossible to plan means to control the epidemic. This study aims to check out the under-reporting of Aids cases from 1999 to 2005 in Alagoas (Brazil). The deaths certificates causes by Aids stored at the Mortality Data System (SIM) in comparison to the Data System of Notification Diseases (Sinan), has been analyzed using the technique of relationship between these two data systems in Alagoas. According to the study, the proportion of under-reporting of Aids cases during this period was of 12.4%. Among the 49 deaths studied, 67% (33) were men and 33% (16) were women configuring a gender rate of 2:1. As to education level, 4,08% (2) and 6,12% (3) of the deaths by Aids were of people having 1 to 3 and from 4 to 7 years of study, respectively. The age group that presented the largest number of deaths was from 20 to 49 years old, either female (11; 68,7%) or male gender (23; 69,6%). The comparison between the Mortality Data System and Data System for Disease Notification revealed a high proportion of under-reporting of deaths by Aids, stressing the need for a specific public policy on the matter.     

AIDS in adults 50 years of age and over: characteristics,trends and spatial distribution of the risk

Objective

to analyze the sociodemographic characteristics, epidemic trend and spatial distribution of the risk of AIDS in adults 50 years of age and over.

Method

population-based, ecological study, that used secondary data from the Notifiable Disease Information System (Sinan/AIDS) of Paraíba state from the period January 2000 to December 2010.

Results

during the study period, 307 cases of AIDS were reported among people 50 years of age or over. There was a predominance of males (205/66, 8%), mixed race, and low education levels. The municipalities with populations above 100 thousand inhabitants reported 58.5% of the cases. There was a progressive increase in cases among women; an increasing trend in the incidence (positive linear correlation); and an advance in the geographical spread of the disease, with expansion to the coastal region and to the interior of the state, reaching municipalities with populations below 30 thousand inhabitants. In some locations the risk of disease was 100 times greater than the relative risk for the state.

Conclusion

aging, with the feminization and interiorization of the epidemic in adults 50 years of age and over, confirms the need for the induction of affirmative policies targeted toward this age group.     

AIDS in adult women in the Municipality of Rio de Janeiro

This paper presents the main epidemiological characteristics of AIDS cases observed among adult women in Rio de Janeiro Municipality (Rio) during 1980-89. Higher incidence rates as compared to Brazilian and Canadian women, rising participation of either sexual transmission and EV drug addiction and an increasing involvement of young women were also observed. The disease does not present a random spatial distribution in Rio, and case clusters in definite high risks areas were shown. Tuberculosis was found to be the second most frequent opportunistic infection detected among cases. Finally, some of the main trends and questions related to AIDS control among women in the studied area are discussed.     

2007-2017年广东省HIV/AIDS流行时空分布特征

目的 了解2007-2017年广东省艾滋病病毒感染者（human immunodeficiency virus,HIV）和艾滋病病人（acquired immunodeficiency syndrome,AIDS）的流行特征及其时空分布特征,为制定防治策略提供依据。方法 以2007-2017年广东省各县（区）历年报告的HIV/AIDS为基础,用OpenGeoDa 1.8软件进行全局空间自相关和局部空间自相关分析,SaTScan 9.4进行时空扫描分析,用Arcgis 10.4进行可视化展示。结果 广东省2007-2017年共新发现HIV/AIDS 76 476例,病例的空间分布范围逐年扩大并且局部地区分布集中。各年全局Moran's I 0.25~0.43之间（均有P<0.05）,说明2007-2017年存在全局空间自相关。时空扫描统计分析显示深圳市6个县（区）为一类聚集区域,阳江市、罗定市等6个县（区）为二类聚集区域,广州市、佛山等19个县（区）为三类聚集区域（均有P<0.05）。结论 艾滋病发病的高高聚集区域逐渐覆盖珠三角大部分县（区）,阳江市及周边地区逐步退出高高聚集区,提示珠三角区域为广东省近几年艾滋病防控重点区域。     

1997-2014年来宾市的艾滋病流行特征研究

目的 研究来宾市艾滋病流行特征及疫情趋势,为制定防控策略提供科学依据。方法 从中国疾病预防控制信息系统下载1997-2014年来宾市HIV/AIDS个案信息,用描述性流行病学方法分析。结果 共报告HIV/ AIDS 6251例（HIV 43.31%、AIDS 56.69%）;报告数持续逐年上升状态于2012年出现下降拐点,2012、2013、2014年分别同比降11.10%、13.54%、10.66%;年均报告率C县30.24/10万、E县26.18/10万、F县6.16/10万;报告数20-49岁占64.36%,老年人占比逐年上升;男女性别比为2.35:1;农民占66.57%,家政与家务者占12.59%,离退休和在职干部职工病例逐年增多;性途径传播占84.96%,呈逐年上升态势。结论 来宾市艾滋病疫情呈逐年上升趋势,但疫情较快上升势头已被遏制,疫情从高危人群向一般人群扩散,传播途径以异性传播为主。应深入开展健康教育,持续加大重点地区、重点人群的筛查与干预力度,强化切断传播途径为主导的综合性防治措施。     

Spatial distribution of leptospirosis in the city of Rio de Janeiro, Brazil, 1996-1999

Leptospirosis, one of the most widely disseminated zoonoses in the world, is endemic in Brazil and is characterized by outbreaks during seasons with the greatest rainfall. In 1996 the city of Rio de Janeiro experienced one of the largest urban epidemics in the country, shortly after heavy rainstorms in the month of February, with 1,732 reported cases and 51 deaths. The objective of this work was to describe the spatial distribution of leptospirosis in the city of Rio de Janeiro during the period 1996-1999. Data were from the National Information System for Reportable Diseases. The kernel ratio for cases and population generated a smoothed surface, which estimates the intensity of the leptospirosis incidence rate. In the resulting maps over the course of the study period, the sites with the highest leptospirosis intensity were not repeated, and the sites normally considered as having the highest risk -- slum areas and flooded areas -- were not always the most heavily affected. The techniques used can represent an important methodological acquisition for establishing territory-based surveillance.     

2000-2009年威海市艾滋病监测资料分析

目的 分析山东省威海市艾滋病流行现状与特征,为今后的防治工作提供依据.方法 对2000 - 2009年威海市不同人群艾滋病病毒(HIV)感染者资料进行统计分析.结果 HIV抗体阳性者117例,其中威海本地居民19例,外省流动人口81例,远高于本地人口.艾滋病以性传播途径为主,占44.44％,其次为血液传播占37.61％.结论 威海市艾滋病仍处于低流行水平,但诸多的感染HIV高危行为普遍存在,应继续加强艾滋病的监测和防病知识宣传力度,开展以健康教育为主的行为干预,遏制艾滋病的流行和蔓延.     

山东省2009-2015年HIV/AIDS流行的时空分布特征

目的 分析山东省2009-2015年HIV/AIDS流行时空特征。方法 应用全局空间自相关性统计量（Moran''s I）和局部空间自相关性统计量（local indicators of spatial association）分析历年发现HIV/AIDS的空间聚集性,时空扫描（SatScan）统计量分析时空聚集性。结果 山东省2009-2015年累计发现HIV/AIDS有9 144例,病例的空间分布范围逐年扩大且局部地区分布集中。除2009年外,历年发现HIV/AIDS的空间分布在县区水平有空间自相关性,“热点”区域分布在济南市的天桥区、市中区和历城区及青岛市的市南区和崂山区。时空扫描发现1个一类时空聚集区,聚集地区覆盖济南市历下区、市中区、槐荫区和天桥区（RR=11.29,LLR=1 592.84,P<0.001）;4个二类时空聚集区,分别覆盖青岛市市南区、市北区和李沧区（RR=7.35,LLR=682.40,P<0.001）、潍坊市潍城区和奎文区（RR=7.33,LLR=363.49,P<0.001）、烟台市的芝罘区和莱山区（RR=7.66,LLR=117.63,P<0.001）及淄博市的周村区和张店区（RR=6.09,LLR=268.68,P<0.001）;聚集时间均为2013-2015年。结论 山东省HIV/AIDS的空间和时间分布均具有聚集性。济南、青岛、淄博、潍坊、烟台市较其他地区聚集性高,需重点防治。     

Spatial distribution of mortality from acute myocardial infarction in Rio de Janeiro, Brazil

The study analyzes the spatial distribution of mortality from acute myocardial infarction (AMI) in Rio de Janeiro, Brazil. Data from the Mortality Information System refers to the year 2000. Empirical Bayes smoothing technique was used to minimize random variation in mortality coefficients due to the population size in the geographic analytical units. Spatial distribution of AMI mortality in the city of Rio de Janeiro is heterogeneous and displays a pattern associated with a strong socioeconomic gradient. The decreased AMI risk in the West Side of the city fails to reflect the social inequality and limited access to healthcare services observed there. A more likely hypothesis is that the risk of AMI death was underestimated in the West Side, due to the high proportion of ill-defined causes of death in that region. In the rest of the city, the spatial pattern of AMI mortality showed higher values in poorer areas. The various hospitals treating AMI also show a clear pattern in their areas of influence.     

Evolution of CD4+ T-cell count among AIDS patients in socially unequal contexts

This study analyzed the evolution in CD4+ T-cell count in AIDS patients in the city of Rio de Janeiro, Brazil, who were on highly active antiretroviral treatment (HAART) at the Municipal Health Centers in the Maré neighborhood, located in a large slum area, and in Copacabana, located in the city's more affluent South Side. Immediately prior to HAART, the median CD4+ T-lymphocyte count was 181 cells/mm(3) in Maré and 182 cells/mm(3) in Copacabana. After 24 weeks of HAART, the median count reached 302 and 315/mm3 in the two health centers, respectively. Following HAART, individuals with AIDS in Maré had 2.8 times the odds of not presenting an immune response as compared to cases in Copacabana (95%CI: 1.1-7.2). Slum residents from Maré had 3.7 the odds of not presenting an immune response as compared to slum residents from Copacabana (95%CI: 1.2-11.5). Males from Maré had 4.4 the odds of not presenting an immune response as compared to those from Copacabana (95%CI: 1.1-18.2). The results suggest a worse prognosis and higher case-fatality for AIDS patients from slums, independently of access to HAART.     

Distribution of AIDS cases in women in Rio de Janeiro,Brazil, 1982-1997: a spatial analysis

The AIDS epidemic has spread and reached various population groups differently. The epidemic's dynamics have also differed according to the characteristics of different areas within cities, related to the principal modes of spread. This study analyzes the AIDS epidemic in women in the city of Rio de Janeiro using the space referential. The epidemic is on the rise among women, particularly in the Northern and Western Zones of the city. In this group it constitutes a "sub-epidemic", to the extent that it displays different characteristics in terms of clinical presentation, access to health services, and knowledge of risks. There was a high proportion of unknown transmission category among the women, thus revealing ignorance of their own risk situation. In addition, the high proportion of unknown level of schooling emphasizes the implications of the investigative system on quality of data recorded for women.     

2009年山东省艾滋病疫情分析

[目的]了解山东省2009年艾滋病流行状况,为控制艾滋病的传播提供科学依据。[方法]对2009年山东省艾滋病疫情资料进行分析。[结果]2009年山东省报告HIV感染者/艾滋病病人498例,其中艾滋病病人162例;死亡103例。按现住址统计报告数居前5位的是青岛市(69例)、菏泽市(69例)、济南市(60例)、临沂市(53例)和潍坊市(40例);男性361例,女性137例;20~29岁172例,30~39岁187例,40~49岁78例;农民198例,工人48例,商业服务人员42例;异性传播的215例,同性传播的138例。样本来源为自愿检测咨询的149例,其他就诊者检测的80例,术前检测的51例,专题调查的40例,无偿献血人员检测的39例,阳性配偶或性伴检测的36例。[结论]山东省艾滋病防治工作形势依然严峻。     

Reliability and accuracy of reported causes of death from cancer. II. Accuracy of stomach cancer reported in the municipality of Rio de Janeiro County, Brazil

Quality of data is a central concern in epidemiological studies, particularly when using secondary data. This study aims to carry out on reliability and accuracy of stomach cancer mortality data in the city of Rio de Janeiro. A simple random sample of 97 death certificates was obtained from a total of 645 stomach cancer deaths in 1990, and was used for validation. A questionnaire specifically designed to obtain clinical and laboratory data was completed for each case. Two physicians read this questionnaire and completed the new death certificates, allowing analysis of the instrument's reliability. A total of 86 cases were studied as a consequence of 11 losses (11.3%). Reliability analysis of questionnaires revealed 90.7% agreement according to stomach cancer diagnosis (kappa = 0.73). Accuracy was calculated by positive predictive value: 90.7%. Eight cases were discharged after clinical and laboratory revision. The study concludes that mortality data by stomach cancer in the city of Rio de Janeiro are very reliable, and that their level of accuracy is adequate for use in epidemiological studies.     

AIDS epidemic dynamics in the municipality of Rio de Janeiro, Brazil, 1988-1996: Spatial-temporal statistic modeling]

This study uses a spatial-temporal model to analyze the spatial spread of the AIDS epidemic (adult cases) in the municipality of Rio de Janeiro, Brazil, during three periods: 1988-1990, 1991-1993, and 1994-1996. City districts were used as the geographic units of analysis. A spatial analysis was also performed for pediatric AIDS cases due to vertical HIV transmission, according to period of birth, 1985-90 and 1991-96. For total adult AIDS cases, the initial period was characterized by a polygonal cluster located around the harbor area, which expanded from west to east. Among homosexual cases, in situ growth predominated, and a decrease in the intensity of the diffusion process was observed from the second to the final period. Among heterosexual cases, the epidemic displayed a relevant geographic spread, mainly from 1988-1990 to 1991-1993. Among female cases in the final time period, a cluster of high incidence rates was found towards the northwest, including very poor areas. Among pediatric cases in 1991-1996, a significant correlation was found between AIDS incidence rates and poverty levels in the respective municipal districts. The results suggest that a more complete understanding of AIDS spatial-temporal dynamics can make a major contribution to preventive measures.     

Decentralization, AIDS, and harm reduction: the implementation of public policies in Rio de Janeiro, Brazil

This paper assesses how decentralization of resources and initiatives by the Brazilian National SDT/AIDS Program has impacted the transfer of funds for programs to prevent HIV/AIDS among injecting drug users in Rio de Janeiro, Brazil (1999-2006). The effects of the decentralization policy on Rio de Janeiro's Syringe Exchange Programs (SEPs) are assessed in detail. Decentralization effectively took place in Rio de Janeiro in 2006, with the virtual elimination of any direct transfer from the Federal government. The elimination of direct transfers forced SEPs to seek alternative funding sources. The structure of local SEPs appears to be weak and has been further undermined by current funding constraints. Of 22 SEPs operating in 2002, only two are still operational in 2006, basically funded by the State Health Secretariat and one municipal government. The current discontinuity of SEP operations may favor the resurgence of AIDS in the IDU population. A more uniform, regulated decentralization process is thus needed.