P3.194 Investigating hiv/aids mortality in the state of sao paulo (brazil): a strategy for intervention

IntroductionThe response to the AIDS epidemic in the State of Sãão Paulo contributes significantly for the positive results of the Brazilian National Program. There was a decrease of 71.6% in the State’s mortality rates between the years of 1995 and 2014, when the rate reached 6.5 per 1 00 000 inhabitants/year.MethodsSince 2014 Sao Paulo State’s STI/AIDS Programme has compiled investigative data on deaths of HIV-infected individuals, tracing profiles and evaluating causes of death and associated vulnerabilities.ResultsFrom 1586 deaths investigated between 2013 and 2016, a significant ratio (66%) is under 50 years old and a considerable number (32%) of individuals survived until two years after the diagnosis. Late-diagnosis, late implementation of TARV and poor adhesion are notable among the deaths, as well as a significant ratio (29%) of substance-abusing individuals. AIDS-defining illnesses (particularly tuberculosis) rank as the highest causes of death (55%) followed by non-AIDS-defining bacterial infections (18%), which are both predominant among the deaths of those patients with therapeutic disruption and/or advanced HIV infection. Causes unrelated to HIV and bacterial infections are predominant among patients with suppression of HIV-replication and recent CD4 count above 500 cells/mm3.ConclusionEven in light of a positive context due to the decrease of MR, the oversight of deaths of HIV-infected individuals remains a fundamental practice for identifying vulnerabilities and works as a guiding principle for interventions that may contribute to a decrease in the number of avoidable-deaths. The results indicate the relevance of actions towards early-diagnosing, monitoring of patient-enrollment and adhesion to services, timely start of antiretroviral therapy, continued oversight of patient-adhesion to medications and diagnosis as well as towards the treatment of potentially-avoidable conditions such as latent infection of tuberculosis and vaccination for pneumococo.Some groups - such as drug and alcohol-abusing individuals - require a case-by-case approach.