School of Public Health
Evaluation of universal antiretroviral therapy guidelines in Rio de Janeiro, Brazil
Early initiation of antiretroviral therapy (ART) is highly efficacious for improving outcomes among persons living with HIV (PLHIV) and reducing HIV transmission, and is endorsed by the World Health Organization (WHO). However, while the benefits of early ART are well established in controlled settings, the public health impact of universal HIV treatment guidelines has not been quantified in many settings. The Brazilian government released guidelines recommending universal ART for all PLHIV, regardless of CD4 count, in December 2013. Multiple citywide databases allow for comprehensive monitoring of HIV-infected patients, including surveillance databases with individual information on HIV/AIDS, mortality, and other reportable infections such as tuberculosis and hepatitis; laboratory and pharmaceutical databases with information on viral load, CD4 counts, and antiretroviral use; and electronic medical records for patients engaged in care at HIV clinics. These databases have been linked to enable epidemiologic investigation of the local HIV epidemic. Our goal is to identify HIV-infected patients who have been lost to follow-up in national surveillance databases to provide better estimates of the burden of HIV in Rio de Janeiro.
PI Mentor: Jonathan Golub