Mother-to-child Transmission of HIV From 1999 to 2011 in the Amazonas, Brazil

Andrade, Solange Dourado de; Sabidó, Meritxell; Monteiro, Wuelton Marcelo; Canellas, Luiz; Prazeres, Vania; Benzaken, Adèle Schwartz

doi:10.1097/inf.0000000000000966

Cited by 13 publications

(28 citation statements)

References 23 publications

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“…The geographical inequalities in testing coverage and in HIV prevalence are reflected in the MTCT rate for HIV, which varies across the country. The most recent estimates are higher for northern Brazil, ranging from 6.6% to 18.9%, [25][26][27] than for the south of the country, at 4.9%. 28 Only 38.2% of pregnant women underwent a second serological test for HIV.…”

Section: Discussionmentioning

confidence: 89%

HIV Prevalence among Pregnant Women in Brazil: A National Survey

Pereira

Sabidó

Caruso

et al. 2016

Rev Bras Ginecol Obstet

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Background This study was conducted to determine the seroprevalence of HIV among pregnant women in Brazil and to describe HIV testing coverage and the uptake of antenatal care (ANC). Methods Between October 2010 and January 2012, a probability sample survey of parturient women aged 15-49 years who visited public hospital delivery services in Brazil was conducted. Data were collected from prenatal reports and hospital records. Dried blood spot (DNS) samples were collected and tested for HIV. We describe the agespecific prevalence of HIV infection and ANC uptake with respect to sociodemographic factors. . 94% [0.28-3.10]). The HIV testing coverage during prenatal care was of 86.6% for one test and of 38.2% for two tests. Overall, 98.5% of women attended at least 1 ANC visit, 90.4% attended at least 4 visits, 71% attended at least 6 visits, and 51.7% received ANC during the 1st trimester. HIV testing coverage and ANC uptake indicators increased with increasing age and education level of education, and were highest in the Southern region. Conclusions Brazil presents an HIV prevalence of less than 1% and almost universal coverage of ANC. However, gaps in HIV testing and ANC during the first trimester challenge the prevention of the vertical transmission of HIV. More efforts are needed to address regional and social disparities.

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Section: Discussionmentioning

confidence: 89%

HIV Prevalence among Pregnant Women in Brazil: A National Survey

Pereira

Sabidó

Caruso

et al. 2016

Rev Bras Ginecol Obstet

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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%

“…Previous research in other regions of Brazil has shown similar percentages of pregnant women not completing aART. In the northern state of Amazonas, aART completion increased only 10% between 1999 and 2011, with 20% of women not completing ART in 2011 [ 8 ]. A similar situation was shown in the southern state of Rio Grande do Sul, where aART use grew 13% between 1998 and 2011, but over 25% of women still did not complete aART between 2005 and 2011 [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…Per Brazilian national guidelines, the series of interventions used to identify and treat HIV-infected pregnant women and their infants, known as the PMTCT cascade [ 7 ], begin with antenatal care, where a pregnant woman is tested for HIV and administered antiretroviral therapy (ART) if found to be infected. Starting in 1996, antenatal HIV-infected women were offered zidovudine (AZT); in 2007, all HIV-infected women with CD4 cell count of < 200 cells/mL and/or plasma viral load of > 1000 copies/mL were offered triple ARV prophylaxis; since 2010, all HIV-infected women have been offered triple ARV prophylaxis in the antenatal period [ 8 ]. During delivery, HIV-infected pregnant women receive intravenous infusion of AZT, and infants are delivered by Caesarean section if maternal viral load is > 1000 copies/mL or unknown.…”

Section: Introductionmentioning

confidence: 99%

“…Finally, during the postnatal period, HIV-exposed infants are treated with oral ARVs and fed a formula-only diet when possible. Supporting the PMTCT cascade, Brazil has offered free ART nationwide since 1996 [ 9 ], and has provided free formula for HIV-exposed infants since 2002 [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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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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