Missed opportunities for congenital syphilis and HIV perinatal transmission prevention

Abstract

Missed opportunities for congenital syphilis and HIV perinatal transmission preventionOportunidades perdidas na prevenção da sífi lis congênita e da transmissão vertical do HIV ABSTRACT OBJECTIVE: To estimate the prevalence of missed opportunities for congenital syphilis and HIV prevention in pregnant women who had access to prenatal care and to assess factors associated to non-testing of these infections. METHODS:Cross-sectional study comprising a randomly selected sample of 2,145 puerperal women who were admitted in maternity hospitals for delivery or curettage and had attended at least one prenatal care visit, in Brazil between 1999 and 2000. No syphilis and/or anti-HIV testing during pregnancy was a marker for missed prevention opportunity. Women who were not tested for either or both were compared to those who had at least one syphilis and one anti-HIV testing performed during pregnancy (reference category). The prevalence of missed prevention opportunity was estimated for each category with 95% confi dence intervals. Factors independently associated with missed prevention opportunity were assessed through multinomial logistic regression. RESULTS:The prevalence of missed prevention opportunity for syphilis or anti-HIV was 41.2% and 56.0%, respectively. The multivariate analysis showed that race/skin color (non-white), schooling (<8 years), marital status (single), income (<3 monthly minimum wages), having sex during pregnancy, history of syphilis prior to the current pregnancy, number of prenatal care visits (<6), and last prenatal visit before the third trimester of gestation were associated with an increased risk of missed prevention opportunity. A negative association with missed prevention opportunity was found between marital status (single), prenatal care site (hospital) and fi rst prenatal visit in the third trimester of gestation. CONCLUSIONS:High rates of non-tested women indicate failures in preventive and control actions for HIV infection and congenital syphilis. Pregnant women have been discontinuing prenatal care at an early stage and are failing to undergo prenatal screening for HIV and syphilis.

Incidence of congenital syphilis in the South Region of Brazil

“…A cross-sectional study that assessed 2,145 Brazilian puerperal women admitted to maternity hospitals for delivery or curettage from 1999 and 2000 investigated missed opportunities for preventing congenital syphilis as a consequence of having had no testing. That study found that congenital syphilis had a prevalence of 41.2%, that 15% of the women with a missed prevention opportunity attended fewer than four prenatal care visits, and that late onset and early discontinuation of prenatal care attendance were more common among the unscreened women (42% and 16%, respectively) 18 .…”

“…In a temporal study that included 2,145 Brazilian puerperal women admitted to maternity hospitals for delivery or curettage from 1999 to 2000, non-white ethnicity was associated with a greater risk of not being diagnosed during pregnancy 18 . One case-control study conducted in Porto Alegre in 1998-2000 disclosed the relevance of certain socioeconomic characteristics (black ethnicity and low maternal educational level) as risk factors for congenital syphilis following adjustment for the variables representing access to prenatal care.…”

“…This fi nding agrees with the results of a temporal study conducted in Brazil targeting the period from 1999 to 2000, in which women with less than eight years of education and income equivalent to less than three times the minimum wage and single women were less likely to be screened for congenital syphilis and for infection with the human immunodefi ciency virus (HIV) during pregnancy. These socio-demographic factors might denote greater vulnerability in the investigated population and represent markers of poor access to screening tests and healthcare services 18 . A cross-sectional study that included 702 pregnancies assisted at the General Hospital of University of Caxias do Sul, Brazil, from 2000 to 2001 found that the higher the maternal educational level, the earlier the onset of prenatal care and the larger the number of prenatal care visits attended 21 .…”

“…Disproportionate concentrations of congenital syphilis among the offspring of women belonging to the most vulnerable groups (blacks, individuals with low educational levels, and individuals with low socioeconomic levels) have been identifi ed not only in Brazil 18 but also in other countries, such as the United States 22,23 . These fi ndings might suggest inequalities in access to preventive measures.…”

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

“…Ações encadeadas, desde o acesso ao atendimento pré-natal e à testagem anti-HIV, até a finalização do seguimento da criança exposta, irão garantir o sucesso do programa para a redução da transmissão vertical do HIV 5,11 . Entretanto, relato de oportunidades perdidas para essa prevenção continuam a ser publicados no Brasil, como a alta prevalência de mulheres grávidas não testadas 12 , e o baixo acesso ao pacote de medidas preventivas para HIV 13 Na Tabela 2, encontram-se as distribuições proporcionais, com seus respectivos intervalos de 95% de confiança (IC95%), das oportunidades de redução da transmissão vertical do HIV a partir do momento do diagnóstico de HIV das gestantes. Os valores se referem à cascata de ações desenvolvidas para mulheres que foram diagnosticadas com HIV antes da gestação, durante o pré-natal ou na admissão para o parto.…”