ArticlePLoS medicine2024
The impact of primary health care on AIDS incidence and mortality: A cohort study of 3.4 million Brazilians.
Article in PLoS medicine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- Multiprofessional prescribing and continuity of pre-exposure prophylaxis use: The role of pharmacy and nursing in strengthening access within a universal public health system.Exploratory research in clinical and social pharmacy · 2026Article
- The intersecting effects of race/ethnicity, wealth, education, and gender on AIDS among 28.3 million Brazilians.Nature communications · 2026Article
- The Promise of Integration of HIV Into Primary Care: Challenges and Opportunities.Journal of the International AIDS Society · 2026Article
- Family Health Strategy Team's Understanding of HIV: Actor-Network Theory.Revista brasileira de enfermagem · 2026Article
- Employment status, occupational profile, and common mental disorders among workers in urban informal settlements in Brazil.PLOS global public health · 2026Article
- Measuring impacts: a scoping review of healthcare impact evaluations.Health research policy and systems · 2025Article
- A serological household survey on social determinants of the generalized HIV epidemic in southern Brazil.Scientific reports · 2025Article
- Impact of the introduction of a package of care involving early detection of opportunistic infections, a prospective multicenter cohort study of people living with HIV/AIDS in Brazil.Lancet regional health. Americas · 2025Article
- Primary care to further improve vertical HIV programming outcomes: From spillover to strategy.PLoS medicine · 2024Article
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13 authors.
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Abstract
backgroundPrimary Health Care (PHC) is essential for effective, efficient, and more equitable health systems for all people, including those living with HIV/AIDS. This study evaluated the impact of the exposure to one of the largest community-based PHC programs in the world, the Brazilian Family Health Strategy (FHS), on AIDS incidence and mortality. METHODS AND
findingsA retrospective cohort study carried out in Brazil from January 1, 2007 to December 31, 2015. We conducted an impact evaluation using a cohort of 3,435,068 ≥13 years low-income individuals who were members of the 100 Million Brazilians Cohort, linked to AIDS diagnoses and deaths registries. We evaluated the impact of FHS on AIDS incidence and mortality and compared outcomes between residents of municipalities with low or no FHS coverage (unexposed) with those in municipalities with 100% FHS coverage (exposed). We used multivariable Poisson regressions adjusted for all relevant municipal and individual-level demographic, socioeconomic, and contextual variables, and weighted with inverse probability of treatment weighting (IPTW). We also estimated the FHS impact by sex and age and performed a wide range of sensitivity and triangulation analyses; 100% FHS coverage was associated with lower AIDS incidence (rate ratio [RR]: 0.76, 95% CI: 0.68 to 0.84) and mortality (RR: 0.68, 95%CI: 0.56 to 0.82). FHS impact was similar between men and women, but was larger in people aged ≥35 years old both for incidence (RR: 0.62, 95% CI: 0.53 to 0.72) and mortality (RR: 0.56, 95% CI: 0.43 to 0.72). The absence of important confounding variables (e.g., sexual behavior) is a key limitation of this study.
conclusionsAIDS should be an avoidable outcome for most people living with HIV today and our study shows that FHS coverage could significantly reduce AIDS incidence and mortality among low-income populations in Brazil. Universal access to comprehensive healthcare through community-based PHC programs should be promoted to achieve the Sustainable Development Goals of ending AIDS by 2030.
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