Sociodemographic determinants of attrition in the HIV continuum of care in Brazil, in 2016

The aim of this study was to identify sociodemographic factors associated with attrition in the 3 steps of the HIV continuum of care related to the 90-90-90 targets – access to diagnosis, treatment initiation, and virologic suppression, in Brazilian adults (15 years or older), in 2016. Programmatic data were obtained from 2 information systems from the Brazilian Ministry of Health, which register all antiretroviral therapy (ART) dispensations and all CD4(+) and viral load counts (VL) performed within the country's public health system. The 3 attrition indicators were late presentation to care, defined as a first CD4 count <350 cells/mm(3) among ART-naive individuals who performed a first CD4(+) count in 2016; not being on ART, defined as having no recorded dispensation within the last 100 days of the year, among those who were linked to care in 2016; and not being virologically suppressed, defined as having the last recorded VL >200 copies/mL in 2016, among those with a recorded VL count who were on treatment for at least 6 months. Association of sociodemographic factors with these indicators was analyzed by unconditional logistic regression analysis. Lower educational level and black/brown/indigenous race/color were associated with worse outcomes in the 3 indicators. Environmental indicators, namely the region, size, and social vulnerability index of the municipality of residence, also played an important role in the models. Younger age was strongly associated with not being on ART and not showing virological suppression. Our findings help identify the barriers in the different stages of the HIV continuum of care, which need to be addressed in order to progress toward the achievement of the 90-90-90 targets.