Review of the missed opportunities for the prevention of vertical transmission of HIV in Brazil

Abstract

OBJECTIVE:The present literature review aims to highlight gaps in the treatment of preventative mother-to-child HIV transmission and the risk factors in Brazil.METHODS:Among the 425 articles identified in SciELO and PubMed searches, 59 articles published between 1994 and 2016 were selected for reading and data extraction, and 33 articles were included in the present review.RESULTS:The rates of vertical HIV transmission described in the studies varied widely, from 1.8% to 27.8%, with a significant reduction over the years. However, recent rates were also found to be variable in different regions of Brazil, and despite the significant reduction in mother-to-child transmission, many gaps remain in prevention services. A failure to attend prenatal care is the main factor associated with the increased risk of vertical transmission of HIV, hindering early maternal diagnosis and the completion of preventative measures during the prenatal period and, often, the peripartum and postnatal periods. A small number of studies discussed the sociodemographic factors, including a low level of education for pregnant women and the inadequacies of health services, such as difficulties scheduling appointments and undertrained staff, associated with vertical transmission. As such, the current challenge is to better define the sociodemographic and infrastructural factors that increase the risk of mother-to-child transmission of HIV to provide the necessary investments to promote an earlier inclusion of these populations in prevention services.CONCLUSIONS:This review may serve as a guide for future programs to focus efforts on the prevention of vertical HIV transmission.

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

“…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.…”

Missed opportunities of poor implementation of prevention with positives among HIV-positive women on treatment in Ekiti State, Southwest Nigeria

“…28,29 This will not promote adherence to PMTCT as it can cause an increase in mother-to-child transmission of HIV. 30 In all, we did not see any change in the prevalence of missed opportunities in prevention strategies and interventions for women living with HIV for over three decades of the HIV epidemic in Nigeria. Only 5.4% of WLHIV earned all the opportunities of prevention with positives intervention and strategies.…”

Prevalência do Vírus da Imunodeficiência Humana e fatores associados em gestantes no estado do Pará

“…A baixa escolaridade das gestantes é destacada como um possível fator limitante para a plena implementação das medidas preventivas, já que mulheres com menor escolaridade comumente dependem de serviços públicos de saúde e têm menor probabilidade de iniciar o pré-natal no começo da gravidez ou de completar o número recomendado de consultas pré-natais (32) . Pesquisa realizada na Zâmbia, África, mostrou uma forte associação entre o nível de escolaridade e a realização do teste de HIV quando ajustada com variáveis como idade, índice de riqueza e localização, resultados que se aproximam da análise do presente estudo.…”