Introduction Even though Brazil was the first country to provide universal and free access to ARVs, substantial regional differences exist in the timing that services and care are accessed. Studies among people living with HIV have documented delays in accessing services, with the largest proportion of delayed access reported in the Northeastern Region. Further investigation is needed to understand the factors contributing to this delay despite the availability of HIV/AIDS services.
Methods This is a retrospective cohort of patients (n=1440) from the only state reference center located in Salvador, the capital city in the Northeastern state of Bahia. The data were abstracted from the electronic medical records of all new patients between 2007 and 2009, and is supplemented with information from two national databases. The dependent variable, delayed access, is defined as patients accessing services with a CD4 count <350 cells/mm3. The independent variables are based on a comprehensive review of the literature. Frequencies and cross tables informed the final logistic regression model.
Results Nearly 35% of patients were delayed in accessing HIV/AIDS services. The final logistic regression model (p value=0.05) showed that individuals who both drank and smoked were 3.4 times more likely to delay in accessing services (p value=0.036). Additionally, individuals with a family income of <1 minimum wage were 1.9 times more likely to delay in accessing services (p value=0.07).
Conclusions Considering this documented delay, it is clear additional efforts are necessary to ensure HIV/AIDS services in Brazil are truly free and universal.
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