A five-year review of vertical HIV transmission in a specialized service: cross-sectional study

Hoffmann, Izabel Cristina; Santos, Wendel Mombaque dos; Padoin, Stela Maris de Mello; Barros, Sônia

doi:10.1590/1516-3180.2016.0139140616

Cited by 11 publications

(11 citation statements)

References 12 publications

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“…The small number of cases resulted in an inaccurate estimate, varying from 0.3%-13.8%, and prevented the estimation of the MTCT by region in the country. However, these values are compatible with regional variation reported in local studies: rates of 2%-3% in studies conducted in the South [ 16 , 17 ], Southeast [ 7 , 8 , 18 – 20 ] and Midwest [ 21 , 22 ], and rates close to 10% in the North [ 10 ] and Northeast [ 9 ] regions of the country. The detection rate of cases of AIDS in children under 5 years old in the country follows this same pattern, with the Southeast, South and Midwest regions showing the biggest reduction trends; 73.2%.…”

Section: Discussionsupporting

confidence: 88%

Mother to child transmission of HIV in Brazil: Data from the "Birth in Brazil study", a national hospital-based study

2018

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Aimsto estimate the mother to child transmission (MTCT) of HIV among infected pregnant women identified in the "Birth in Brazil" study and to evaluate care practices provided in order to identify missed opportunities at preventing the MTCT of HIV infection in the country.MethodsDescriptive study using data obtained from the consultation of different databases: the “Birth in Brazil” study database and the Brazilian National Information Systems (NIS) databases. We used cases of pregnant women infected with HIV identified in the “Birth in Brazil” study, and cases of AIDS in children under 5 years old identified in the NIS, to estimate the MTCT of HIV infection in the country, with a 95% confidence interval. We also estimated the HIV cascade (HIV diagnosis; use of antiretroviral treatment (ART) during pregnancy, labour, and for the newborn; adequate care during childbirth considering viral load at birth; and no breastfeeding) using data from the same sources.ResultsMTCT of HIV of 2.0% (95% CI 0.3%-13.8%). At birth, 84.0% of HIV infected woman showed a positive HIV diagnosis, 74.9% received combined ART during pregnancy, 80.7% received ART during childbirth, 77.1% received adequate care during childbirth, 86.8% of newborns received ART within the first 24 hours after birth, and 2.8% of newborns were breastfed. Considering all steps, 61.3% of the women (95% CI 48.3%-72.8%) received all available medical interventions. In the analysis restricted to women identified in the NIS, 65.3% (95% CI 48.0%-79.3%) of HIV infected women received all available medical interventions.ConclusionBrazil has healthcare policies that guarantee free access to tests, ART and substitutes for maternal milk. However, missed opportunities to prevent MTCT of HIV were identified in at least one-third of women and may be making it difficult to reach HIV-elimination targets especially in the less developed country regions.

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Section: Discussionsupporting

confidence: 88%

Mother to child transmission of HIV in Brazil: Data from the "Birth in Brazil study", a national hospital-based study

2018

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“…21 The percentage of mothers of infected children who received no prenatal care was similar in the present study, and a lack of prenatal care was considered a risk factor for increased MTCT. Other studies have also found an association between increased MTCT and no prenatal care 16,[22][23][24][25] The importance of administering ART during pregnancy has been known for some decades, and currently, with combined therapy, HIV MTCT rates have become significantly lower. 26 This was also confirmed in the current study which detected that no use or inappropriate ART use was related to higher MTCT rates.…”

Section: Discussionmentioning

confidence: 99%

Mother-to-Child HIV Transmission among Pregnant Women in a City with the Highest Rates of HIV in Brazil

et al. 2021

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Objective Most of the HIV pediatric infections are acquired through mother-to-child transmission (MTCT). Porto Alegre is a state capital of Brazil that had a HIV MTCT rate of 4.1% in 2013 and the highest rate of HIV-infected pregnant women in the country during 2018. Zidovudine and nevirapine have been used in Brazil for high-risk newborns since 2012. The aim of the study was to investigate HIV MTCT rate and the factors associated with HIV transmission at a hospital that is a reference center for HIV-infected mothers in Porto Alegre, after the introduction of this policy. Study Design This retrospective cohort study included all HIV-exposed infants born between February 2013 and December 2016 at the Hospital de Clínicas de Porto Alegre. Student's t-test or Fisher's exact test was used to compare variables between HIV-infected and uninfected groups of newborns. Poisson's regression with robust variance was used to determine the factors associated with HIV MTCT. Results A total of 375 newborns were exposed to HIV, with an outpatient loss of 14.4% (n = 54). The HIV MTCT rate was 2.18% (n = 7), with four infected during the intrauterine period. The risk factors for MTCT were no prenatal care (relative risk [RR] = 9.4; 95% confidence interval [CI]: 2.0–44.3), late maternal HIV diagnosis in the peripartum period (RR = 16.3; 95% CI: 3.6–73.0), syphilis infection during pregnancy (RR = 9.3; 95% CI: 2.1–40.3), maternal viral load >1,000 copies/mL in the third trimester or peripartum period (RR = 9.5; 95% CI: 1.7–50.5), and lack of or inappropriate antiretroviral therapy during pregnancy (RR = 8.2; 95% CI: 1.6–41.4). Conclusion MTCT rate was 2.18%. With the institution of two-drug prophylaxis for high-risk newborns, persistent cases HIV MTCT were predominantly found among women with absence of antenatal care, late HIV diagnosis, syphilis coinfection, high viral load, and inadequate ARV therapy during pregnancy. Although zidovudine and nevirapine were administered postnatally to high-risk newborns, this regimen could not prevent transplacental transmission. Key Points

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“…Research across various regions of Brazil has shown that lack of antenatal care and late diagnosis underlie substantial gaps in the PMTCT cascade [ 8 , 12 , 18 – 20 ]. In our cohort, while 19% of case and 29% of control mothers were not diagnosed prior to birth because they had not attended any or abandoned antenatal care, 25% of case and 14% of control mothers did not receive their diagnosis due to a failure in antenatal services—tests not being available, not ordered, or results not reported.…”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of risk factors and gaps in prevention strategies for mother-to-child HIV transmission in Rio de Janeiro, Brazil

et al. 2018

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BackgroundDespite great progress made in methods to prevent mother-to-child transmission of HIV (MTCT), delivery and uptake of these measures remains a challenge in many countries. Although the Brazilian Ministry of Health aimed to eliminate MTCT by 2015, infection still occured in 15–24% of infants born to HIV-infected mothers. We sought to identify remaining factors that constrain MTCT elimination.MethodsWe conducted a retrospective, matched case-control study by reviewing hospital charts of infants born to HIV-infected mothers between 1997 and 2014 at three MTCT reference hospitals in the Rio de Janeiro metropolitan area. Cases were defined as HIV-exposed children with two positive HIV tests before 18 months of age; controls were defined as HIV-exposed children with two negative HIV tests before 18 months of age. We performed bivariate and MTCT cascade analyses to identify risk factors for MTCT and gaps in prevention services.ResultsWe included 435 infants and their mothers (145 cases, 290 controls). Bivariate analyses of MTCT preventative care (PMTCT) indicated that cases were less likely to complete all individual measures in the antenatal, delivery, and postnatal period (p < 0.05). Assessing completion of the PMTCT cascade, the sequential steps of PMTCT interventions, we found inadequate retention in care among both cases and controls, and cases were significantly less likely than controls to continue receiving care throughout the cascade (p < 0.05). Motives for incompletion of PMTCT measures included infrastructural issues, such as HIV test results not being returned, but were most often due to lack of care-seeking. Over the course of the study period, PMTCT completion improved, although it remained below the 95% target for antenatal care, HIV testing, and antenatal ART set by the WHO. Adding concern, evaluation of co-infections indicated that case infants were also more likely to have congenital syphilis (OR: 4.29; 95% CI: 1.66 to 11.11).ConclusionsWhile PMTCT coverage has improved over the years, completion of services remains insufficient. Along with interventions to promote care-seeking behaviour, increased infrastructural support for PMTCT services is needed to meet the HIV MTCT elimination goal in Brazil as well as address rising national rates of congenital syphilis.

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A five-year review of vertical HIV transmission in a specialized service: cross-sectional study

Cited by 11 publications

References 12 publications

Mother to child transmission of HIV in Brazil: Data from the "Birth in Brazil study", a national hospital-based study

Mother to child transmission of HIV in Brazil: Data from the "Birth in Brazil study", a national hospital-based study

Mother-to-Child HIV Transmission among Pregnant Women in a City with the Highest Rates of HIV in Brazil

Retrospective analysis of risk factors and gaps in prevention strategies for mother-to-child HIV transmission in Rio de Janeiro, Brazil

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