Abstract
Aimsto estimate the mother to child transmission (MTCT) of HIV among infected pregnant women identified in the "Birth in Brazil" study and to evaluate care practices provided in order to identify missed opportunities at preventing the MTCT of HIV infection in the country.MethodsDescriptive study using data obtained from the consultation of different databases: the “Birth in Brazil” study database and the Brazilian National Information Systems (NIS) databases. We used cases of pregnant women infected with HIV identified in the “Birth in Brazil” study, and cases of AIDS in children under 5 years old identified in the NIS, to estimate the MTCT of HIV infection in the country, with a 95% confidence interval. We also estimated the HIV cascade (HIV diagnosis; use of antiretroviral treatment (ART) during pregnancy, labour, and for the newborn; adequate care during childbirth considering viral load at birth; and no breastfeeding) using data from the same sources.ResultsMTCT of HIV of 2.0% (95% CI 0.3%-13.8%). At birth, 84.0% of HIV infected woman showed a positive HIV diagnosis, 74.9% received combined ART during pregnancy, 80.7% received ART during childbirth, 77.1% received adequate care during childbirth, 86.8% of newborns received ART within the first 24 hours after birth, and 2.8% of newborns were breastfed. Considering all steps, 61.3% of the women (95% CI 48.3%-72.8%) received all available medical interventions. In the analysis restricted to women identified in the NIS, 65.3% (95% CI 48.0%-79.3%) of HIV infected women received all available medical interventions.ConclusionBrazil has healthcare policies that guarantee free access to tests, ART and substitutes for maternal milk. However, missed opportunities to prevent MTCT of HIV were identified in at least one-third of women and may be making it difficult to reach HIV-elimination targets especially in the less developed country regions.
Highlights
The mother to child transmission (MTCT) of HIV infection during pregnancy, delivery and breastfeeding is the leading cause of HIV infection in children
We used cases of pregnant women infected with HIV identified in the “Birth in Brazil” study, and cases of AIDS in children under 5 years old identified in the National Information Systems (NIS), to estimate the MTCT of HIV infection in the country, with a 95% confidence interval
In the analysis restricted to women identified in the NIS, 65.3% of HIV infected women received all available medical interventions
Summary
The mother to child transmission (MTCT) of HIV infection during pregnancy, delivery and breastfeeding is the leading cause of HIV infection in children. In the absence of preventive measures, MTCT of HIV can reach 25–40%, but the use of prophylactic measures, mainly combined antiretroviral drugs, can reduce MTCT to rates below 2% [1]. In 2001, member states at the United Nations General Assembly Special Session on HIV and Aids committed to reducing HIV infection in children by 20% by 2005 and 50% by 2010 and ensuring 80% of pregnant women in antenatal care received information, preventive services and treatment to reduce MTCT of HIV [2]. In 2010, member countries of the Pan American Health Organisation (PAHO) adopted goals for eliminating vertical transmission of syphilis and HIV by the year 2015, with HIV elimination impact goals expressed as the reduction in the incidence of HIV cases in children to 0.3 cases per 1000 live births and a vertical transmission rate 2%. Changes included the elimination of hepatitis B and Chagas’ disease in the Americas [3]
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