Evaluation of the health attention to pregnant women with HIV: comparison between primary and specialized service

Kleinubing, Raquel Einloft; Eslava, Daniel Gonzalo; Padoin, Stela Maris de Mello; Paula, Cristiane Cardoso de

doi:10.1590/2177-9465-EAN-2018-0258

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RESEARCH • Esc. Anna Nery 23 (2) • 2019 • https://doi.org/10.1590/2177-9465-EAN-2018-0258 copy

Evaluation of the health attention to pregnant women with HIV: comparison between primary and specialized service^a a Article extracted from the Master Dissertation of authorship of Raquel Einloft Kleinubing, defended in 2015, Post-Graduate Program in Nursing. Federal University of Santa Maria, under the guidance of Cristiane Cardoso de Paula and co-orientation of Stela Maris de Mello Padoin. Full text available at: https://repositorio.ufsm.br/bitstream/handle/1/7441/KLEINUBING,%20RAQUEL%20EINLOFT.pdf?isAllowed=y&sequence=1

Evaluación de la atención de salud a mujeres embarazadas con VIH: comparación entre servicio primario y especializado

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The public network for health care of pregnant women with HIV, in Santa Maria, Rio Grande do Sul/Brazil, includes primary and specialized care services.

Objective:

Evaluating whether the type of service interferes in the quality score of the health care in the experience of the pregnant women with HIV.

Methods:

Cross-sectional study, with data collection from April-November/2014, with 78 participants. The Primary Care Assessment Tool-Brazil instrument was applied and the Pearson's Chi-square test and Fisher's exact test were used.

Results:

The quality of care received was evaluated as unsatisfactory both in primary care (6.50) and in specialized care (6.35).

Conclusion:

The type of service interferes with the quality of care, which can affect women's choice of service. It is necessary to improve the quality of both types of services and to search for the management of shared care to attend both the usual care of gestation and the specificity of infection.

Keywords:
Health Care; Health Services Research; Women's Health; Pregnant Women; HIV

			PHC (N=58)	Specialized Service (N=20)
Characteristics	Variables	Categories	N (%)	N (%)	P
Socio-demographic	Age				0.071^* * Pearson's Chi-square Test;
		Up to 20 years	8 (10.26)	0 (0.00)
		21 to 30 years	27 (34.62)	7 (8.97)
		> 30 years	23 (29.49)	13 (16.67)
	Housing city				*0.035^ * Pearson's Chi-square Test;**
		Santa Maria	38 (48.72)	18 (23.08)
		Other	20 (25.64)	2 (2.56)
	Marital status				0.359^* * Pearson's Chi-square Test;
		Married	37 (47.44)	15 (19.23)
		Single	21 (26.92)	5 (6.41)
	Schooling (N = 77)				0.563^ Fisher's Exact Test;
		Yes	54 (70.13)	20 (25.97)
		No	3 (3.90)	0 (0.00)
	Monthly income				0.077^* * Pearson's Chi-square Test;
		Up to R$1000	39 (50.00)	9 (11.54)
		> R$ 1000	19 (24.36)	11 (14.10)
	Occupation				0.982^* * Pearson's Chi-square Test;
		None	6 (7.69)	2 (2.56)
		Irregular employment	47 (60.26)	16 (20.51)
		Regular employment	5 (6.41)	2 (2.56)
Clinics	Year of notification SINAN^# # SINAN- Information of Diseases Notification System. - pregnancy (N = 76)				0.653^* * Pearson's Chi-square Test;
		Year 2012	10 (13.16)	3 (3.95)
		Year 2013	17 (22.37)	7 (9.21)
		Year 2014	18 (23.68)	4 (5.26)
		Notification not found	11 (14.47)	6 (7.89)
	Use of antirretroviral before pregnancy				*0.038^ * Pearson's Chi-square Test;**
		Yes	17 (21.79)	11 (14.10)
		No	41 (52.56)	9 (11.54)
	Use of antiretroviral during pregnancy				0.031^ Fisher's Exact Test;
		Yes	41 (52.56)	19 (24.36)
		No	17 (21.79)	1 (1.28)
	Route of HIV infection				0.294^* * Pearson's Chi-square Test;
		Sexual	36 (46.15)	15 (19.23)
		Unknown	22 (28.21)	5 (6.41)
	Moment of the diagnosis of the infection of HIV				0.261^* * Pearson's Chi-square Test;
		Before pregnancy	33 (42.31)	16 (20.51)
		During pregnancy	20 (25.64)	4 (5.13)
		During birth	4 (5.13)	0 (0.00)
		After birth	1 (1.28)	0 (0.00)
	Attending prenatal care				1.000^ Fisher's Exact Test;
		Yes	56 (71.79)	19 (24.36)
		No	2 (2.56)	1 (1.28)
	Number of prenatal consultations (N = 74)				1.000^ Fisher's Exact Test;
		Up to 14 consultations	51 (68.92)	18 (24.32)
		Above 14 consultations	4 (5.41)	1 (1.35)

Overall score for service	Mean	Standard Deviation	Median	Minimum	Maximum	p^ Mann-Whitney Test
PHC (N=58)^† † Asymmetrical distribution	6.50	2.27	7.36	1.58	9.57	0.698
Specialized^* * Normal distribution (N=18)	6.35	1.50	6.07	3.92	9.41	0.698

			PHC Service (N=56)		Specialized Service (N=18)
	Variables	Categories	High score (≥ 6.6)	Low score (≥ 6.6)	p	High score (≥ 6.6)	Low score (≥ 6.6)	P
			N (%)	N (%)		N (%)	N (%)
Sociodemographic characteristics	Age				0.903^* * Pearson's Chi-square Test			0.354^* * Pearson's Chi-square Test
		Up to 20 years	5 (8.62)	3 (5.17)		- (-)	- (-)
		21 to 30 years	15 (25.86)	12 (20.69)		1 (5.00)	6 (30.00)
		> 30 years	14 (24.14)	9 (15.52)		5 (25.00)	8 (40.00)
	Skin color (self-reported)				0.176^* * Pearson's Chi-square Test			0,612^ Fisher's Exact Test
		White	11 (18.97)	12 (20.69)		5 (25.00)	9 (45.00)	.
		Not white	23 (39.66)	12 (20.69)		1 (5.00)	5 (25.00)
					0,877^* * Pearson's Chi-square Test			0,078^ Fisher's Exact Test
	Housing City	Santa Maria	22 (37.93)	16 (27.59)		4 (20.00)	14 (70.00)
	Housing City	Other	12 (20.69)	8 (13.79)		2 (10.00)	0 (0.00)
					0.348^* * Pearson's Chi-square Test			1.000^ Fisher's Exact Test
	Marital Status	Married	20 (34.48)	17 (29.31)		5 (25.00)	10 (50.00)
	Marital Status	Single	14 (24.14)	7 (12.07)		1 (5.00)	4 (20.00)
					0,069^ Fisher's Exact Test			-
	Instruction (N=77)	Yes	33 (57.89)	21 (36.84)		6 (30.00)	14 (70.00)
	Instruction (N=77)	No	0 (0.00)	3 (5.26)		- (-)	- (-)
					0,902^* * Pearson's Chi-square Test			0.342^* * Pearson's Chi-square Test
	Occupation	None	3 (5.17)	3 (5.17)		0 (0.00)	2 (10.00)
		Irregular employment	28 (48.28)	19 (32.76)		6 (30.00)	10 (50.00)
		Regular employment	3 (5.17)	2 (3.45)		0 (0.00)	2 (10.00)
					0.941^* * Pearson's Chi-square Test			0.165^* * Pearson's Chi-square Test
Clinical Characteristics	Year of notification SINAN^§ § SINAN- Information of Diseases Notification System. -pregnancy (N=76)	Year 2012	6 (10.71)	4 (7.14)		2 (10.00)	1 (5.00)
		Year 2013	9 (16.07)	8 (14.29)		3 (15.00)	4 (20.00)
		Year 2014	11 (19.64)	7 (12.50)		1 (5.00)	3 (15.00)
		No found	7 (12.50)	4 (7.14)		0 (0.00)	6 (30.00)
					0.983^* * Pearson's Chi-square Test			1.000^ Fisher's Exact Test
	Use of antiretroviral before pregnancy	Yes	10 (17.24)	7 (12.07)		3 (15.00)	8 (40.00)
	Use of antiretroviral before pregnancy	No	24 (41.38)	17 (29.31)		3 (15.00)	6 (30.00)
					0.983^* * Pearson's Chi-square Test			1.000^ Fisher's Exact Test
	Use of antiretroviral during pregnancy	Yes	24 (41.38)	17 (29.31)		6 (30.00)	13 (65.00)
	Use of antiretroviral during pregnancy	No	10 (17.24)	7 (12.07)		0 (0.00)	1 (5.00)
					0.622^* * Pearson's Chi-square Test			0.612^ Fisher's Exact Test
	HIV route of infection	Sexual	22 (37,93)	14 (24,14)		4 (20,00)	11 (55,00)
	HIV route of infection	Unknown	12 (20.69)	10 (17.24)		2 (10.00)	3 (15.00)
					0.803^* * Pearson's Chi-square Test			0.060^ Fisher's Exact Test
	Moment of the diagnosis of the infection of HIV	Before pregnancy	20 (34.48)	13 (22.41)		3 (15.00)	13 (65.00)
		During pregnancy	11 (18.97)	9 (15.52)		3 (15.00)	1 (00)
		During birth	2 (3.45)	2 (3.45)		- (-)	- (-)
		After birth	1 (1.72)	0 (0.00)		- (-)	- (-)
					1.000^ Fisher's Exact Test			1.000^ Fisher's Exact Test
	Attending prenatal care	Yes	33 (56.90)	23 (39.66)		6 (30.00)	13 (65.00)
	Attending prenatal care	No	1 (1.72)	1 (1.72)		0 (0.00)	1 (5.00)
					1.000^ Fisher's Exact Test			1.000^ Fisher's Exact Test
	Number of prenatal consultations (N=74)	Up to 14 consultations	30 (54.55)	21 (38.18)		6 (31.58)	12 (63.16)
	Number of prenatal consultations (N=74)	> 14 consultations	2 (3.64)	2 (3.64)		0 (0.00)	1 (5.26)

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[1] Corresponding author: Cristiane Cardoso de Paula E-mail: cristiane.paula@ufsm.br