Evaluation of the care cascade in individuals with HIV/AIDS at an ambulatory reference center in Northeast Brazil
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Síndrome da Imunodeficiência Adquirida
Terapia Antirretroviral de Alta Atividade
Cuidados em Saúde
Cascata de Cuidado. Acquired Immunodeficiency Syndrome
High-Activity Antiretroviral Therapy
Health Care
Care Cascade. Síndrome de la Inmunodeficiencia Adquirida
Terapia Antirretroviral de Gran Actividad
Atención Médica
Cascada de Tratamiento.

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Background: The continuous care cascade has emerged as a strategy to transpose HIV infection to attain the ultimate goal of care, which is viral suppression. The study aims to describe the care cascade in individuals with HIV / AIDS in a Specialized Ambulatory Service.
Methods: The study design is a retrospective cohort of adult individuals with a confirmed diagnosis of HIV/AIDS who initiated their follow-up at the Integrated Medical Care Center (NAMI) of Universidade de Fortaleza (UNIFOR), in the city of Fortaleza, state of Ceará, northeastern Brazil. The following data were used in the investigation: CD4+/CD8+ viral load and HIV viral load. The subjects were classified into two groups: retained (group 1) and non-retained (group 2), totaling a sample of 511 participants.
Results: The univariate analysis between these groups showed that there was a significant predominance of male patients with a higher mean age in group 1 (p = 0.01). A history of previous drug addiction and at the first consultation was more frequent in the second group (p = 0.001 and p = 0.01 respectively). Patients from group 1 more often had a history of sexually-transmitted infections (STIs) (p = 0.002) and were more immunosuppressed at the time of diagnosis (p = 0.002). The use of ART at the first consultation was also more significant in the group of retained patients (p <0.001).
Conclusions: The study suggests a need to improve the "cascade of care" by expanding it to address dynamic behavioral risks, which can transpose the systemic barriers of access to health services for people living with HIV/AIDS.

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