Óbitos por Aids entre jovens de 15 a 24 anos no estado do Rio de Janeiro em 2020: perfil e fatores de evitabilidade relacionados à linha de cuidado das Pessoas Vivendo com HIV/Aids

Abstract

In 2020, the highest AIDS detection rate in Brazil was observed in the young group, aged 20 to 29 years. In the same year, the state of Rio de Janeiro was the fourth state with the highest detection rate and the third with the highest standardized AIDS mortality rate. It is understood that deaths from AIDS can be considered preventable, in the context of universal access to ART, particularly among young people. The objective of the study was to describe the sociodemographic and clinical-care profile of young people aged 15 to 24 years old who died from AIDS in the state of Rio de Janeiro in 2020 and the preventability factors related to these deaths. Secondary data from the Mortality Systems (SIM), Notifiable Diseases Information System (SINAN), Laboratory Test Control System of the National Network for CD4+/CD8+ Lymphocyte Count and HIV Viral Load (SISCEL) and Logistics Control of Medicines (SICLOM) were analysed. For the study of care trajectories and factors associated with death (preventability factors), data analysis from the information systems mentioned above and document analysis of files and reports of death investigation meetings were performed. The clinical-care trajectories of those diagnosed with HIV were analyzed separately from those already diagnosed with AIDS. Most deaths in young people occurred in males (72.9%), black (69.4%), single (94.2%) and with low education (61.2%). A third were not notified; in 34.1% of the cases the diagnosis of AIDS was made very close to death and they did not have SISCEL. Among those who had (65.8%), those diagnosed with HIV had more ART (94.4%), had longer follow-up, frequency of abandonment (88.2%) and viral suppression (75.0%) than those diagnosed with AIDS. In the analysis of the trajectories of 14 cases, “late diagnosis” was the most observed factor; then, “delay between diagnosis and attachment/start of ART”; “difficulty in adherence” and “abandonment of ART”. The findings of this research are in line with the profile of AIDS deaths in the Brazilian population, composed mostly of black men, which points to inequalities in access to HIV diagnosis and treatment. More than a third of the young people who died were diagnosed in an advanced stage of the disease, with a high prevalence of abandonment and underreporting, indicating weaknesses in HIV surveillance and in prevention policies and care line for PLWHA.