Improved timely diagnosis of HIV related to the policy of expanding access to diagnosis in Brazil.

Background In the last years the Brazilian Ministry of Health expanded the use of rapid tests (RT) for HIV. RT is especially useful for pregnant women, vulnerable populations, people with limited access to health services and at national testing campaigns. This policy aims to ensure timely diagnosis and treatment, what will impact directly on morbimortality of people living with HIV/aids (PLWHA).

Methods National network consists of 90 national public laboratories responsible for performing CD4 count for the public health system. Between 2005 and 2012, 3.7 million tests were registered in its database. Based on the first CD4 count registered, diagnosis was classified as very late (< 200 cells/mm³), late (between 200 and 350 cells/mm³) and timely (> 350 cells/mm³).

Results Our database was comprised of 321 thousand PLWHA > 18 y.o. who started on follow up in the public health system between 2005 and 2012. In 2005, 30.6%, 21.6% and 47.7% of PLWHA were diagnosed very late, late and timely, respectively. In 2012 there was a significant decrease in very late and late diagnosis and an increase in timely diagnosis: 29%, 18% and 53% respectively.

Conclusion The policy of expanded access to rapid test certainly contributed to these results. Indeed, there was an increase in rapid tests supply: from 509,180 in 2005 to 3,750,000 in 2012, facilitating that PLWHA are diagnosed with higher CD4 counts, what is confirmed by the increase of median first CD4 count from 335 in 2005 to 365 cells/mm³ in 2012.