title: Evaluation of strategies by the Brazilian Ministry of Health to stimulate the municipal response to AIDS.
abstract: The aim of this study was to evaluate strategies by the Brazilian Ministry of Health to expand the municipal response to AIDS. Cities "included" and "not included" in Federal strategies for "municipalization" of the response were compared according to the response profile and trends in the epidemic. Multinomial logistic regression was used, among other statistical procedures. Municipalities included from 1994 to 1998 showed higher chances of providing HIV diagnostic testing [OR = 15.0; 95%CI: 5.6-40.1], of having AIDS services [OR = 18.4; 95%CI: 8.4-40.5], and reducing cases involving heterosexual [OR = 3.1; 95%CI: 1.4-7.3], homosexual/bisexual [OR = 3.0; 95%CI: 1.4-6.2], and IDU transmission [OR = 6.6; 95%CI: 2.9-14.9] as compared to those "included in 2003" and "not included". There were no associations between the included Municipalities, greater coverage in prevention, the reduction in cases due to vertical transmission or blood transfusion, or mortality rates. Municipalities with a more structured response were associated with better results. The findings suggest that the municipalization policy contributed to improvement in the local response to AIDS.
authors.affiliation: Departamento de Medicina, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil. ale.grangeiro@gmail.com
authors.forename: Alexandre
authors.initials: A
authors.lastname: Grangeiro
authors.forename: Maria Mercedes Loureiro
authors.initials: MM
authors.lastname: Escuder
authors.forename: Euclides Ayres de
authors.initials: EA
authors.lastname: Castilho
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology* / Q000517:prevention & control; D001938:Brazil / Q000453:epidemiology; D002947:Cities / Q000453:epidemiology; D005260:Female; D006293:Health Promotion / Q000379:methods / Q000458:organization & administration*; D006801:Humans; D009111:Local Government; D008297:Male; D009313:National Health Programs / Q000458:organization & administration*