title: Late-stage diagnosis of HIV infection in Brazilian children: evidence from two national cohort studies.
abstract: This study analyzed data from two consecutive retrospective cohort samples (1983 to 1998 and 1999 to 2002) of Brazilian children with AIDS (N = 1,758) through mother-to-child-transmission. Late-stage diagnosis (CDC category C) was investigated in relation to the following variables: year of birth, year of HIV diagnosis, and time periods related to changes in government treatment guidelines. Late-stage diagnosis occurred in 731 (41.6%) of cases and was more prevalent in infants under 12 months of age. The rate of late-stage diagnosis decreased from 48% to 36% between the two periods studied. We also observed a reduction in the proportion of late-stage diagnoses and the time lapse between HIV diagnosis and ART initiation. A significant association was found between timely diagnosis and having been born in recent years (OR = 0.62; p = 0.009) and year of HIV diagnosis (OR = 0.72; p = 0.002/OR = 0.62; p < 0.001). Infants under the age of 12 months were more likely to be diagnosed at a late stage than older children (OR = 1.70; p = 0.004). Despite advances, there is a need to improve the effectiveness of policies and programs focused on improving early diagnosis and management of HIV/AIDS.
authors.affiliation: Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Brasil. novaes@ufc.br
authors.forename: Alberto Novaes
authors.initials: AN
authors.lastname: Ramos
authors.forename: Luiza Harunari
authors.initials: LH
authors.lastname: Matida
authors.forename: Carlos Henrique
authors.initials: CH
authors.lastname: Alencar
authors.forename: Norman
authors.initials: N
authors.lastname: Hearst
authors.forename: Jorg
authors.initials: J
authors.lastname: Heukelbach
mesh_terms: D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000635:transmission; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies