Vulnerability factors associated with HIV/AIDS hospitalizations: a case-control study

Lopes, Livia Maria; Andrade, Rubia Laine de Paula; Arakawa, Tiemi; Magnabosco, Gabriela Tavares; Nemes, Maria Ines Battistella; Netto, Antonio Ruffino; Monroe, Aline Aparecida

doi:10.1590/0034-7167-2018-0979

Brasil

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 73 (3) • 2020 • https://doi.org/10.1590/0034-7167-2018-0979 linkcopy

Vulnerability factors associated with HIV/AIDS hospitalizations: a case-control study

Factores de vulnerabilidad asociados a la hospitalización del VIH/SIDA: estudio de control de casos

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives: to identify the association between HIV/AIDS hospitalizations and factors that integrate individual, social, and programmatic vulnerabilities.

Methods: a case-control study conducted in 2014 in a municipality in the state of São Paulo. “Cases” included people living with HIV (PLHIV) hospitalized and “control” those who were outpatients. Interviews were conducted using a tool with sociodemographic variables, clinical characteristics and other vulnerabilities. Data were analyzed by conditional logistic regression.

Results: fifty-six cases and 112 control participated. Risk factors for HIV hospitalization were: unemployed and retired individuals; homeless people; non-antiretroviral users; individuals who did not regularly attend returns. Access to social workers was a protective factor for hospitalization.

Conclusions: this research contributed to measure the social, individual and programmatic vulnerabilities that interfere with HIV worsening and, consequently, unfavorable outcome such as hospitalization.

Descriptors: Acquired Immunodeficiency Syndrome; Vulnerable Populations; Hospitalization; Delivery of Health Care; Public Health

Individual/social vulnerabilities		Hospitalized (N=56)		Not hospitalized (N=112)		Total (n=168)		p ^a a Chi-square test (p <0.05).
Individual/social vulnerabilities		n	%	n	%	n	%	p ^a a Chi-square test (p <0.05).
Sex	Male	29	51.8	54	48.2	83	49.4	0.662
Sex	Female	27	48.2	58	51.8	85	50.6	0.662
Age group	18 – 39 years	21	37.5	28	25.0	49	29.1	0.175
	40 – 60 years	32	57.1	60	53.6	92	54.8	0.175
	> 60 years	3	5.4	24	21.4	27	16.1
Color/Race	White	22	39.3	51	45.5	73	43.4	0.441
Color/Race	Non-white	34	60.7	61	54.5	95	56.6	0.441
Schooling	No SCH or incomplete HE	32	57.1	47	41.9	79	47.1	0.044
	Complete ES	11	19.7	17	15.2	28	16.6
	Complete HS/complete HE	13	23.2	48	42.9	61	36.3
Occupation	Employed/Self-Employed	17	30.4	61	54.5	78	46.5	0.002
	Unemployed	26	46.4	24	21.4	50	29.7
	Others (retired/homemaker)	13	23.2	27	24.1	40	23.8
Religion	Yes	40	71.4	94	83.9	134	79.7	0.573
Religion	No	16	28.6	18	16.1	34	20.3	0.573
Homeless	Yes	15	26.8	1	0.9	16	9.5	0.000
Homeless	No	41	73.2	111	99.1	152	90.5	0.000
HIV/AIDS diagnosis acceptance	Yes	46	82.1	99	88.4	145	86.3	0.266
HIV/AIDS diagnosis acceptance	No	10	17.9	13	11.6	23	13.7	0.266
Alcoholic beverage consumption	Yes	20	35.7	25	22.3	45	26.8	0.064
Alcoholic beverage consumption	No	36	64.3	87	77.7	123	73.2	0.064
Drug use	Yes	13	23.2	10	8.9	23	13.7	0.011
Drug use	No	43	76.8	102	91.1	145	86.3	0.011
Prison history	Yes	17	30.3	9	8.1	26	15.5	0.000
Prison history	No	39	69.7	103	91.9	142	84.5	0.000
Benefits in exchange for sex	Yes	10	17.8	7	6.2	17	10.1	0.018
Benefits in exchange for sex	No	46	82.2	105	93.8	151	89.9	0.018
Chronic condition presence	Yes	29	51.8	53	47.3	82	48.8	0.585
Chronic condition presence	No	27	48.2	59	52.7	86	51.2	0.585
Regular ART	Yes	22	39.3	94	83.9	116	69.1	0.000
Regular ART	No	34	60.7	18	16.1	52	30.9	0.000
Difficulty to take ART	Yes	33	58.9	19	16.9	52	30.9	0.000
Difficulty to take ART	No	23	41.1	93	83.1	116	69.1	0.000
ART withdrawal	Yes	34	60.7	20	17.8	54	32.8	0.000
ART withdrawal	No	22	39.3	92	82.2	114	67.8	0.000

Programmatic vulnerability		Hospitalized (N=56)		Not hospitalized (N=112)		Total (n=168)		p*
Programmatic vulnerability		n	%	n	%	n	%	p*
Satisfaction with outpatient care	Satisfactory	47	83.9	107	95.5	154	91.6	0.010
Satisfaction with outpatient care	Unsatisfactory	9	16.1	5	4.5	14	8.4	0.010
Difficulties in receiving care	Satisfactory	52	92.8	109	97.3	161	95.8	0.172
Difficulties in receiving care	Unsatisfactory	4	7.1	3	2.7	7	4.2	0.172
Return appointment attendance	Satisfactory	24	42.8	95	84.8	119	70.8	0.000
Return appointment attendance	Unsatisfactory	32	57.2	17	15.2	49	29.2	0.000
Appointment with infectious physician	Satisfactory	51	91.1	112	100.0	163	97.1	0.001
Appointment with infectious physician	Unsatisfactory	5	8.9	0	0.0	5	2.9	0.001
Appointment with nursing staff	Satisfactory	51	91.1	111	99.1	162	96.4	0.008
Appointment with nursing staff	Unsatisfactory	5	8.9	1	0.9	6	3.6	0.008
Social worker support	Yes	15	26.8	62	55.4	77	45.8	0.000
Social worker support	No	41	73.2	50	44.6	91	54.1	0.000
Appointment with psychologist	Satisfactory	5	8.9	13	11.6	18	10.7	0.596
Appointment with psychologist	Unsatisfactory	51	91.1	99	88.4	150	89.3	0.596
Appointment with nutritionist	Yes	6	10.7	12	10.7	18	10.7	---
Appointment with nutritionist	No	50	89.3	100	89.3	150	89.3	---
Antiretroviral therapy side effect	Satisfactory	8	14.3	14	12.5	22	13.1	0.746
Antiretroviral therapy side effect	Unsatisfactory	48	85.7	98	87.5	146	86.9	0.746
Other health services use	Yes	49	87.5	88	78.6	137	81.5	0.159
Other health services use	No	7	12.5	24	21.4	31	18.5	0.159
Emergency Care Units use	Yes	47	83.9	83	74.1	130	77.4	0.151
Emergency Care Units use	No	9	16.1	29	25.9	38	22.6	0.151
Basic Health Units use	Yes	18	32.1	38	33.9	56	33.3	0.817
Basic Health Units use	No	38	67.9	74	66.1	112	66.6	0.817
Health insurance use	Yes	5	9.9	18	16.1	23	13.7	0.204
Health insurance use	No	51	91.1	94	83.9	145	86.3	0.204
Medical appointment payment	Yes	10	17.8	12	10.7	22	13.1	0.195
Medical appointment payment	No	46	82.2	100	89.3	146	86.9	0.195
Question about living conditions	Yes	26	46.4	63	56.3	89	53.0	0.742
Question about living conditions	No	30	53.6	49	43.7	79	47.0	0.742
Question complications	Yes	48	85.7	102	91.1	150	89.3	0.289
Question complications	No	8	14.3	10	8.9	18	10.7	0.289
Emergency health services use	Yes	50	89.2	109	97.32	159	94.6	0.113
Emergency health services use	No	6	10.7	3	2.68	9	5.36	0.113

Risk factors		OR	95% CI	Adj. OR	95% CI	p value
Occupation	Employee/Self-Employed	1		1		0.017^a a Presents statistical significance.
	Unemployed	3.93	[1.75–8.83]	3.63	[1.06–12.51]
	Retired/Homemaker	1.76	[0.70–4.46]	7.14	[1.38–36.94]
Homeless	Yes	30.0	[3.96–227.11]	10.18	[1.06–97.80]	0.016^a a Presents statistical significance.
Homeless	No	1		1		0.016^a a Presents statistical significance.
Drug use	Yes	3.46	[1.29–9.31]	0.18	[0.02–1.85]	0.127
Drug use	No	1		1		0.127
Benefits in exchange for sex	Yes	6.90	[1.45–32.78]	1.13	[0.06–21.23]	0.935
Benefits in exchange for sex	No	1				0.935
Regular ART	Yes	1		1		0.001^a a Presents statistical significance.
Regular ART	No	6.75	[3.09–14.76]	9.68	[2.38–39.40]	0.001^a a Presents statistical significance.
Return appointments attendance	Satisfactory	1		1		0.002^a a Presents statistical significance.
Return appointments attendance	Unsatisfactory	7.25	[3.16–16.65]	7.62	[1.85–31.50]	0.002^a a Presents statistical significance.
Social worker	Yes	1		1		0.020^a a Presents statistical significance.
Social worker	No	0.27	[0.13–0.59]	0.25	[0.07–0.88]	0.020^a a Presents statistical significance.

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[TFN1] Note: SCH - schooling; ES - elementary school; HS - high school; HE - higher education; ART - antiretroviral therapy

[TFN2] ^a
Chi-square test (p <0.05).