Prenatal testing and prevalence of HIV infection during pregnancy: data from the “Birth in Brazil” study, a national hospital-based study

Abstract

BackgroundThe rate of vertical HIV transmission has decreased in Brazil, but regional inequalities suggest problems in implementing control measures during pregnancy and delivery. The aims of this study were to ascertain the coverage of HIV testing during prenatal care and estimate the prevalence of HIV infection during pregnancy in Brazil.MethodsThis was a national hospital-based study of 23,894 women that was conducted in 2011–2012. The data came from interviews with mothers during postpartum hospitalization, from hospital medical files and from prenatal cards. All the pregnant women with reactive serological results for HIV infection marked on their cards or with diagnoses of HIV infection during the hospital stay for delivery were considered cases of HIV infection. Univariate and multivariable logistic regression were performed to investigate factors associated with the prevalence of HIV infection and with performing at least one HIV test during pregnancy.ResultsAmong participating women, the coverage of testing for HIV infection was 81.7% among those who presented with prenatal card and the prevalence of HIV infection among pregnant women was 0.4% (95% CI: 0.32-0.51%). In the adjusted analysis, there was higher coverage of testing among women living in the South and Southeast regions; of women aged 35 years and over; with greater schooling levels; who self-reported as white; with prenatal care provided in private services; with an early start to prenatal care; and with an adequate number of consultations, defined as a minimum of six for a term pregnancy. In the adjusted analyses there was a greater odds ratio of HIV infection among women living in the South region, aged 35 years and over, with schooling of less than 8 years, who self-reported race as black, without a partner, with syphilis coinfection and who were attended by public services.ConclusionsThe prevalence of HIV infection among pregnant women in Brazil remains below 1% and the coverage of testing for HIV infection is over 80%. However, the regional and social inequalities in access to healthcare services and the missed opportunities for diagnoses of HIV infection indicate the importance of strengthening HIV infection control programs during pregnancy.

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

“…O presente estudo aponta alta cobertura de pré-natal entre as gestantes in- fectadas pelo HIV (variando de 79 a 91%), abaixo da relatada por Domingues et al 10 , com quase 99% com pelo menos uma consulta. Esses autores encontraram 81,7% de realização de teste anti-HIV no pré-natal, com uma prevalência de 0,4% de HIV nas gestantes.…”

“…Quase 20% das mulheres no Amazonas chegaram ao parto sem saber seu status HIV, concordando com outro estudo nacional, em que 29% das mulheres não foram testadas durante o pré-natal 12 . As regiões Norte e Nordeste apresentaram as menores prevalências de realização do primeiro teste anti-HIV no pré-natal, respectivamente, 69,9% e 68,4%, apontando para uma menor adesão aos protocolos de redução de transmissão vertical do HIV 10 . Em nenhuma das seis Unidades de Federação foi possível identificar o uso de TARV durante o pré-natal em proporção superior a 90% das mulheres notificadas, mesmo entre aquelas que já se sabiam portadoras do HIV.…”

“…Em novo estudo nacional, com mais de 23 mil puér-peras entre 2011 e 2012, a prevalência de HIV encontrada foi de 0,4% 10 , muito semelhante à anterior.…”

Fatores associados ao aleitamento cruzado em duas cidades do Sudeste do Brasil

“…Essa prática cultural pode estar beneficiando mães que se apoiam mutuamente e bebês que recebem leite humano. Além disso, a prevalência de HIV em gestantes no contexto brasileiro é baixa (0,4%) 24 , e a proporção de mães não testadas para o HIV na gestação e no momento do parto foi inferior a 1% em estudo recente 25 . Portanto, amplo debate sobre o aleitamento cruzado deve ser promovido envolvendo o meio acadêmico, o setor saúde e a sociedade em geral, e investigações devem avaliar a relação entre os benefícios e os riscos inerentes ao aleitamento cruzado.…”

Characterization of the Epidemiological Profile and Survival of Children with AIDS in Santa Catarina, Brazil, 1988 - 2013

“…Data show that this route of transmission has been responsible for 90% of cases in children aged under 13 years in Brazil (3).…”