Background: AIDS-mortality rate has stabilized since 2005 in Uruguay – 5/100.000 inhabitants. But, it has not decreased as expected despite the universal access to care and ART therapy since mid 90's. The National Study of Global Burden of Illness in our country places HIV / AIDS in the age group of 20 to 64 years, in 10th place as cause of premature death, in 5th in burden of morbidity (DALY) and in 8th in years of life adjusted for disability.
Reducing AIDS-mortality rate by 2020, is a priority goal for the Ministry of Health of Uruguay. The aim of this study was to evaluate the distribution of deaths due to AIDS in the HIV cascade of continuum of care.
Materials and methods: We conducted a cross-sectional study through the review of deaths coded as 'AIDS' in 18 years old or more, in the National Mortality Registry in 2014.
Results: We found 175 deaths coded as AIDS, accessing to 124 records, of which only 105 fulfilled the CDC definition of AIDS-related death. The remaining 19 were deaths due to conditions non-AIDS related (coding error). The mean age was 43.7±11.6 years, 68% were men, 72% had low educational level (9 years), 47.1% drug users, 15.4% were homeless, 15.4% prisoners and 37.5% were included in social assistance plan. Public health system provided care to 77% study sample. Sexual transmission explained 98% of cases, mean of time between HIV diagnosis and death was 6.2±6.2 years; 72% had CD4 count <200/mml at diagnosis; 43.3% had opportunistic infections (OI) at diagnosis; 64% receipt HAART at any time; 19.4% reached viral load suppressed at any time. HIV late diagnosis was seen in 71.4% and 37.1% of the death occurred in the first year of the diagnosis.
Distribution of death in cascade of continuum of HIV care, to AIDS-related versus those who died due to events unrelated to HIV/AIDS, is shown in Table 2. Mortality AIDS-related was independently associated with no retention in care (OR 14.09, 95% CI: 1.946-700.42); OI at diagnosis (OR 11.66, 95% CI: 1.35-514.25); CD4 count nadir for each unit of increase (OR 0.989, 95% CI: 0.984-0.999); viral load suppressed before death (OR 0.034, 95% CI: 0.002-0.354).
Conclusions: High proportion of patients who died due to AIDS before the linkage and follow-up in the health system demonstrates the need to adopt proven strategies to improve access and continuity of care. In addition, the strategies must be adequate for the conditions of social vulnerability of this population.
