Challenges in preventing vertical HIV transmission in Petrolina, Pernambuco and Juazeiro, Bahia

Brandão, Mucio do Nascimento; Souza, Edvaldo da Silva; Brito, Rodrigo José Videres de; Guimarães, Cavalcanti, Martha Maria de Souza; Brandão, Maria de Fátima Ramos; Cavalcante, Magna Cavalcante e

doi:10.1590/1806-93042016000300006

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ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 16 (3) • Jul-Sep 2016 • https://doi.org/10.1590/1806-93042016000300006 copy

Challenges in preventing vertical HIV transmission in Petrolina, Pernambuco and Juazeiro, Bahia

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

to measure vertical HIV transmission rate (TTV) and describe the adoption of prophylactic measurements (MP) in infected pregnant women and exposed children in the cities of Petrolina, PE and Juazeiro, BA.

Methods:

a cross-sectional study was carried out on 76 mothers and children from January 2006 to December 2010. Data were collected from reported forms and medical records from the referral services. The Ministry of Health recommendations was followed to characterize an infected child. It was appropriately considered to adopt the five MP distributed in three stages of care: pregnancy (antiretroviral therapy), intrapartum (intravenous azidotimidina and by delivery preference as a function of the maternal viral load) and post natal (azidotimidina taken orally by children and no breastfeeding).

Results:

58 children investigated, five were HIV infected, revealing 8.6% of TTV. The MP was inadequate in 68.4% of the cases.

Conclusions:

high TTV of HIV and inadequate MP in most of the cases, the non-white patients and those who came from other cities received a lower proportion of adequate MP. Diagnostic failures and the three stages of care reflected on the TTV. Improve quick tests at pregnancy, integrate actions in cities, offer reproductive planning, maximize coverage of prenatal care and engage obstetric teams and Family Health are strategies to reduce TTV.

Key words:
HIV infections; Prenatal care; Vertical transmission of infectious diseases; Transmitted disease control; Brazil

Characteristics (N)^* * Diagnostic after pregnancy; SAE= Specialized Care Service; SUS= Unified Health System; PNM= Projeto Nascer Maternidades.	N	With information		X ± SD	Min-Max
		n	%
Maternal age in years	76	74		6.8 ± 26.8	15 - 41
Age (years)	76	74	100.0
15 to 25	33		44.6
26 to 35	35		47.3
35 to 41	6		8.1
Ignored	2		-
Schooling (years)	76	67	100.0
Up to 8	52		77.6
> 8	15		22.4
Ignored	9		-
Ethnicity	76	68	100.0
Non-white	60		88.2
White	8		11.8
Ignored	8		-
Where from:	76	76	100.0
Cities-polo	62		81.6
Cities surrounding	11		14.5
Other cities/Other States	3		3.9
Health care service	76	76	100.0
SAE Petrolina	46		60.5
SAE Juazeiro	30		39.5
Some prenatal care	76	69	100.0
Yes	67		97.1
No	2		2.9
Ignored	7		-
At the time of maternal diagnosis	76	76	100.0
At pre-conception	30		39.5
At Pregnancy	26		34.2
At Childbirth	15		19.7
At postpartum period	5		6.6
Gestational age in weeks in diagnosis	76	26	-	8.9 ± 28.0	20 - 40
Maternal viral load with 34 weeks	76	48	100.0
> 1,000 copies/mL	8		16.6
< 1,000 copies/mL	20		41.7
Inapplicable^* * Diagnostic after pregnancy; SAE= Specialized Care Service; SUS= Unified Health System; PNM= Projeto Nascer Maternidades.	20		41.7
Ignored	28		-
Maternity or place of birth	76	70	100.0
Reference (PNM)	39		55.7
Linked to (SUS)	25		35.7
Other hospitals/maternities	4		5.7
Home	2		2.9
Ignored	6		-

Characteristics	N	%
Investigated results on children (overall)	58	100.0

Infected (vertical transmission)	5	8.6
Criteria of two viral loads^* * Confirmed by serology.	2	3.5
Serological criteria	1	1.7
Clinical criteria (died of AIDS)	2	3.4
Non- Infected	53	91.4

Results in Petrolina	35	100.0

Infected (vertical transmission)	4	11.4
Criteria of two viral loads^* * Confirmed by serology.	2	5.7
Serological criteria	1	2.9
Clinical criteria (died of AIDS)	1	2.9
Non-Infected	31	88.6
Results in Juazeiro	23	100.0

Infected (vertical transmission)	1	4.4
Clinical criteria (died of AIDS)	1	4.4
Non-Infected	22	95.6

Characteristics	N=76	%	Median	Min-Max	IQ
TARV
Yes	43	56.6
No	8	10.5
Inapplicable^* * Diagnosis after the stage recommended for application of the MP; TV= vertical transmission; HIV= human immunodeficiency virus; TARV= antiretroviral therapy; AZT= azidotimidina.	20	26.3
Ignored	5	6.6
Time of application of TARV in weeks (38 cases)			13.5	2-29	8-24
AZT venous in mother intrapartum
Yes	47	61.8
No	10	13.2
Inapplicable^* * Diagnosis after the stage recommended for application of the MP; TV= vertical transmission; HIV= human immunodeficiency virus; TARV= antiretroviral therapy; AZT= azidotimidina.	5	6.6
Ignored	14	18.4
Acceptable delivery type
Yes	40	52.6
No	30	39.5
Inapplicable^* * Diagnosis after the stage recommended for application of the MP; TV= vertical transmission; HIV= human immunodeficiency virus; TARV= antiretroviral therapy; AZT= azidotimidina.	5	6.6
Ignored	1	1.3
Oral AZT in children
Yes	48	63.1
No	12	15.8
Ignored	16	21.1
No breastfeeding
Not breastfed	60	79.0
Breastfed	8	10.5
Ignored	8	10.5
Stage 1 (pregnancy): TARV
Yes	43	56.6
No/ Inapplicable^* * Diagnosis after the stage recommended for application of the MP; TV= vertical transmission; HIV= human immunodeficiency virus; TARV= antiretroviral therapy; AZT= azidotimidina. /Ignored	33	43.4
Stage 2 (labor): AZT venosus in mother + acceptable delivery type
Yes	34	44.7
No/ Inapplicable^* * Diagnosis after the stage recommended for application of the MP; TV= vertical transmission; HIV= human immunodeficiency virus; TARV= antiretroviral therapy; AZT= azidotimidina. /Ignored	42	55.3
Stage 3 (post-natal): oral AZT in children + No breastfeeding
Yes	46	60.5
No/ Ignored	30	39.5
Adoption altogether (three stages complete)
Adequate	24	31.6
Inadequate	52	68.4

Characteristics	SAE		SAE		Age range (74)^* * Cases with variable information; SAE= Specialized Care Service; HIV= human immunodeficiency virus; TARV= antiretroviral therapy; AZT= azidotimidina.				Schooling (67)^* * Cases with variable information; SAE= Specialized Care Service; HIV= human immunodeficiency virus; TARV= antiretroviral therapy; AZT= azidotimidina.				Ethnicity (68)^* * Cases with variable information; SAE= Specialized Care Service; HIV= human immunodeficiency virus; TARV= antiretroviral therapy; AZT= azidotimidina.				Where from (76)^* * Cases with variable information; SAE= Specialized Care Service; HIV= human immunodeficiency virus; TARV= antiretroviral therapy; AZT= azidotimidina.
	Petrolina		Juazeiro		15 - M5 years		M6 - 41 years		Up to 8 years		>8 years		White		Non- White		City polo		Surr../Other
	46	%	30	%	33	%	41	%	52	%	15	%	8	%	60	%	62	%	14	%
TARV
Yes	25	54.4	18	60.0	19	57.6	24	58.6	32	61.5	9	60.0	7	87.5	35	58.3	37	59.7	5	35.7
AZT venous intrapartum
Yes	24	52.2	23	76.7	24	72.7	23	56.1	34	65.4	9	60.0	7	87.5	38	63.3	25	40.3	5	35.7
Acceptable f delivery type
Yes	25	54.4	15	50.0	19	57.6	21	51.2	29	55.8	9	60.0	6	75.0	32	53.3	34	54.8	5	35.7
Oral AZT in children
Yes	27	58.7	21	70.0	23	69.7	25	61.0	34	65.4	8	53.3	8	100.0	35	58.3	40	64.5	7	50.0
No breastfeeding
Not breastfed	35	76.1	25	83.3	29	87.9	20	48.8	42	80.8	11	73.3	7	87.5	46	76.7	59	95.2	8	57.1
Adoption
Adequate	12	26.1	12	40.0	12	36.4	12	29.3	17	32.7	5	33.3	6	75.0	18	30.0	22	35.5	2	14.3
Inadequate	34	73.9	18	60.0	21	63.6	29	70.7	35	67.3	10	66.7	2	25.0	42	70.0	40	64.5	12	85.7

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[TFN1] ^*
Diagnostic after pregnancy; SAE= Specialized Care Service; SUS= Unified Health System; PNM= Projeto Nascer Maternidades.