Avaliação da cascata de cuidado na prevenção da transmissão vertical do HIV no Brasil

Miranda, Angélica Espinosa; Pereira, Gérson Fernando Mendes; Araújo, Maria Alix Leite; Silveira, Mariângela Freitas da; Tavares, Leonor; Silva, Leila Cristina Ferreira da; Moreira-Silva, Sandra Fagundes; Saraceni, Valéria

doi:10.1590/0102-311x00118215

Cited by 25 publications

(38 citation statements)

References 21 publications

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“…It is estimated that, in Brazil, 98.7% of pregnant women receive prenatal care [ 23 ]. In this study, 95.8% of pregnant women with HIV had at least one prenatal care appointment, a value higher than that observed by Miranda et al [ 24 ] in a study that evaluated women who were recorded in the SINAN “HIV in pregnancy”, where the coverage ranged from 79% to 91%.…”

Section: Discussioncontrasting

confidence: 55%

“…A study carried out with pregnant women documented in SINAN “HIV in pregnancy” [ 24 ] identified missed opportunities of HIV-MTCT prevention in all five regions of the country, but with higher frequency in the North and Northeast regions. Less missed opportunities were observed in women diagnosed with pre-gestational infection and higher in those who did not receive a diagnosis of HIV during pregnancy.…”

Section: Discussionmentioning

confidence: 99%

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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: Discussioncontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

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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“…Upon accepting, men understood it would be a normal pregnancy, as they would need care to prevent the transmission of HIV to their child. In a study that evaluated the cascade of care for the reduction of vertical transmission of HIV in six Brazilian states, failures were identified in all healthcare points, as well as the need for a connection between referral and primary care services, focusing on family care (22) . Action planning in health services also involves establishing bonds and trust between users and professionals with the aim to minimize the dimensions related to prejudice and stigma that are still present in this relationship.…”

Section: Resultsmentioning

confidence: 99%

Men’s sexual and reproductive health in the situation of HIV-serodiscordance

2020

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Objective: to know men’s perspective in face of reproduction in the situation of HIV-serodiscordance. Method: qualitative study developed in a university hospital in Southern Brazil. Unstructured in-depth interviews were conducted with 11 men living with HIV and a thematic content analysis was performed. Results: men expressed not wanting to have children and that this pregnancy was different. They showed concerns related to the vertical transmission of HIV, sexual and reproductive rights and responsibility in the exercise of parenthood. Final considerations: men’s perspective is influenced by their role in the family, which is historically and culturally determined, and by the concerns about infection, which are socially determined and entail their understanding of reproductive rights and their participation in care. In services, men’s perspective must be considered in the planning and implementation of health care actions by supporting their participation in the exercise of fatherhood.

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“…Evaluating the data from HIV-infected pregnant women and children in five states and the Federal District, Miranda et al have shown that the best source to find children under 13 years of age with HIV was the SISCEL; SINAN contained less than a third of the cases 10 .…”

Section: Discussionmentioning

confidence: 99%

Notificação da infecção pelo HIV em gestantes: estimativas a partir de um estudo nacional

2018

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OBJECTIVE:To estimate the coverage of the reporting of cases of HIV-infected pregnant women, to estimate the increase in the coverage of the reporting with the routine search of data in other Brazilian health information systems, and to identify missed opportunities for identification of HIV-infected pregnant women in Brazilian maternity hospitals.METHODS:This is a descriptive study on the linkage of Brazilian databases with primary data from the “Nascer no Brasil” study and secondary database collection from national health information systems. The “Nascer no Brasil” is a national-based study carried out in 2011–2012 with 23,894 pregnant women, which identified HIV-infected pregnant women using prenatal and medical records. We searched for cases of HIV-infected pregnant women identified in the “Nascer no Brasil” study in the Information System of Notifiable Diseases, the Control System for Laboratory Tests of the National CD4+/CD8+ Lymphocyte Count and HIV Viral Load Network, and the Logistics Control System for Medications. We used the OpenRecLink software for the linkage of databases. We estimated the notification coverage, with the respective confidence interval, of the evaluated Brazilian health information systems.RESULTS:We estimated the coverage of the reporting of HIV-infected pregnant women in the Information System of Notifiable Diseases as 57.1% (95%CI 42.9–70.2), and we located 89.3% of the HIV-infected pregnant women (95%CI 81.2–94.2) in some of the Brazilian health information systems researched. The search in other national health information systems would result in an increase of 57.1% of the reported cases. We identified no missed opportunities for the diagnosis of HIV+ in pregnant women in the maternity hospitals evaluated by the “Nascer no Brasil” study.CONCLUSIONS:The routine search for information in other Brazilian health information systems, a procedure carried out by the Ministry of Health for cases of AIDS in adults and children, should be adopted for cases of HIV in pregnancy.

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Avaliação da cascata de cuidado na prevenção da transmissão vertical do HIV no Brasil

Cited by 25 publications

References 21 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

Men’s sexual and reproductive health in the situation of HIV-serodiscordance

Notificação da infecção pelo HIV em gestantes: estimativas a partir de um estudo nacional

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