(P156) The impact of decentralization and use of rapid HIV tests in Brazil: a tool for early patient care

Tuesday, July 25, 2023

16:00 – 18:00 CST

Primary Presenter(s)

Maria Luiza Bazzo, Ph.D (she/her/hers)

Professor
Molecular Biology, Microbiology and Serology Laboratory (LBMMS), Federal University of Santa Catarina, Santa Catarina, Brazil

Co-author(s)

Pâmela Cristina Gaspar, MSc

Technical Consultant
Department of HIV/AIDS, Tuberculosis, Viral Hepatitis, and Sexually Transmitted Infections at Brazilian Ministry of Health/ Public Health Postgraduate Program at Brasília University, Brazil
Angélica E. Miranda, MD, PhD (she/her/hers)

Coordinator
Department of HIV/AIDS, Tuberculosis, Viral Hepatitis, and Sexually Transmitted Infections at Brazilian Ministry of Health
Brasilia, Brazil
Maria Luiza Bazzo, Ph.D (she/her/hers)

Professor
Molecular Biology, Microbiology and Serology Laboratory (LBMMS), Federal University of Santa Catarina, Santa Catarina, Brazil

Background: Rapid diagnostic tests (RDT) provide HIV diagnosis in places with difficult access to laboratories and shorten the time in patient care. This study sought to determine the distribution coverage and use of RDT to diagnose HIV infection in Brazil.

Methods: This longitudinal observational study analyzed secondary data from 2015 to 2019 from seven national databases. The databases were merged into a single worksheet to estimate the coverage of municipalities with HIV-RDT available and to create representative maps using QGIS software. The municipality identifier and the shapefile of the map were obtained on the Brazilian Institute of Geography and Statistics website. Data were also analyzed using SPSS statistical software and were expressed in frequency. The chi-square test was performed to compare the variables, using a significance level of 0.05.

Results: The combined analysis of the databases showed that 95% of the 5,570 Brazilian municipalities have RDT for diagnosing HIV (Figure 1). RDT began to be used in primary health care in 2012 in Brazil, and their use has expanded over the years. The North Region has 99% HIV- RDT coverage, reinforcing the importance of this test in that region with high levels of social vulnerability and logistical difficulties. The RDT speeds up the time between diagnosis, viral load quantification (VL), and CD4+ T lymphocyte count tests (p-value< 0.00001) and ART dispensing (p-value< 0.00003) when compared with laboratory tests. Performing viral load up to 15 days after diagnosis occurred in 34% of individuals tested with RDT and in only 20% of those diagnosed with laboratory tests. The accessibility provided by the RDT promotes the early detection of HIV (p-value< 0.00001) more than the laboratory according to the CD4 parameters, where 11% of those who used RDT had a CD4+ count ≤199 cells/ mm³ compared to 15% in laboratory tests.

Conclusion: The RDT allows early diagnosis than laboratory tests. Despite the high coverage of HIV-RDT in Brazilian municipalities, the distribution in the public health system can still be expanded. It is necessary to overcome some barriers, such as structural difficulties, lack of confidence in the methodology on the part of health professionals and organization of processes weakness.