Abstract
While the annual incidence of HIV diagnosis in pregnancy in Brazil remains relatively stable, rates of maternal syphilis increased over six-fold in the past decade. We hypothesized that maternal HIV and syphilis are two distinct epidemics. Data on all cases of maternal HIV or syphilis detected in pregnancy between January 1, 2010 to December 31, 2018 were requested from the Brazilian Ministry of Health. In order to evaluate how the epidemics evolved over the time period, ArcGIS software was used to generate spatiotemporal maps of annual rates of detection of maternal HIV and syphilis in 2010 and 2018. We utilized Euclidean-distance hot spot analysis to identify state-specific clusters in 2010 and 2018. From 2010 to 2018, there were 66,631 cases of maternal HIV, 225,451 cases of maternal syphilis, and 150,414 cases of congenital syphilis in Brazil. The state of Rio Grande do Sul had the highest rate of maternal HIV detection in both 2010 and 2018. Hot spots of maternal HIV were identified in the three most Southern states in both 2010 and 2018 (99% confidence, z-score >2.58, p <0.01). While syphilis incidence >30 per 1,000 live births in 2018 in four states, only the two coastal states of Rio de Janeiro and Espirito Santo in Southeastern Brazil were significant hot spots (90% confidence, z-score 1.65-1.95, p <0.10). Contrary to the general assumption, HIV and syphilis epidemics in Brazil are not syndemic in pregnant women. There is a spatial cluster of maternal HIV in the South, while syphilis is increasing throughout the country, more recently on the coast. Focusing on maternal HIV hot spots in the Southern states is insufficient to curtail the maternal and congenital syphilis epidemics throughout the country. New strategies, including ongoing hot spot analysis, are urgently needed to monitor, identify and treat maternal syphilis.
Highlights
Mother-to-child transmission (MTCT) of both HIV and syphilis remain significant challenges in Brazil despite increased public health efforts [1,2,3,4]
Data were provided by the Sistema de Informacão de Agravos de Notificacão (SINAN), the national reporting system for notifiable diseases of the Brazilian Ministry of Health, for all pregnant women with HIV or syphilis detected between January 1, 2010 to December 31, 2018 [17,18,19]
During the same time period, there were 225,451 cases of maternal syphilis, and 150,414 neonates were treated for presumed congenital syphilis
Summary
Mother-to-child transmission (MTCT) of both HIV and syphilis remain significant challenges in Brazil despite increased public health efforts [1,2,3,4]. Index.aspx 2.https://falabr.cgu.gov.br/publico/ Usuarios/AutoCadastroUsuarioCidadao.aspx The Citizen Information Service (SIC) of the Ministry of Health was established by Ordinance No 1,583, of 19 July 2012, which refers to the application of the Law on Access to Information within the scope of the Ministry of Health. Information to the Citizen (SIC) has been active since May 2012 and Law No 12,527 regulates the constitutional guideline the data access. Anyone can register and request data through this platform. The authors did not have special access privileges
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