Review of the missed opportunities for the prevention of vertical transmission of HIV in Brazil

Mariana Fernandes Guimarães,Kathryn Lynn Lovero,Juliana Gregório De Avelar,Laís Lopes Pires,Giovanna Rodrigues Teixeira De Oliveira,Estela Magalhães Cosme,Camila De Morais Salviato,Thais Raquelly Dourado De Oliveira,Natália Beatriz Cabrera,Claudete Aparecida Araújo Cardoso

doi:10.6061/clinics/2019/e318

Abstract

OBJECTIVE:The present literature review aims to highlight gaps in the treatment of preventative mother-to-child HIV transmission and the risk factors in Brazil.METHODS:Among the 425 articles identified in SciELO and PubMed searches, 59 articles published between 1994 and 2016 were selected for reading and data extraction, and 33 articles were included in the present review.RESULTS:The rates of vertical HIV transmission described in the studies varied widely, from 1.8% to 27.8%, with a significant reduction over the years. However, recent rates were also found to be variable in different regions of Brazil, and despite the significant reduction in mother-to-child transmission, many gaps remain in prevention services. A failure to attend prenatal care is the main factor associated with the increased risk of vertical transmission of HIV, hindering early maternal diagnosis and the completion of preventative measures during the prenatal period and, often, the peripartum and postnatal periods. A small number of studies discussed the sociodemographic factors, including a low level of education for pregnant women and the inadequacies of health services, such as difficulties scheduling appointments and undertrained staff, associated with vertical transmission. As such, the current challenge is to better define the sociodemographic and infrastructural factors that increase the risk of mother-to-child transmission of HIV to provide the necessary investments to promote an earlier inclusion of these populations in prevention services.CONCLUSIONS:This review may serve as a guide for future programs to focus efforts on the prevention of vertical HIV transmission.

Highlights

The world has committed to ending the AIDS epidemic by 2030 (1)
Articles were identified in PubMed using the following search terms: ‘‘Risk Factors Vertical Transmission Brazil’’, ‘‘Risk Factors Mother-to-Child Transmission’’, ‘‘Vertical Transmission HIV Brazil’’ and ‘‘Mother-to-Child Transmission HIV Brazil.’’ We searched for articles in SciELO using the following terms: ‘‘Transmissão vertical HIV Brasil’’, ‘‘Fatores de risco transmissão vertical Brasil’’, ‘‘Transmissão materno infantil HIV Brasil’’ and ‘‘Fatores de risco transmissão materno infantil Brasil.’’ Articles published between 1994 and 2016 in English and Portuguese were considered for inclusion in the review
We found that the reported rates of mother-to-child transmission (MTCT) varied considerably across different regions of Brazil, ranging from 1.8% in a cohort from the northeast region to 28.8% in a cohort from the central-west region

Summary

Introduction

The world has committed to ending the AIDS epidemic by 2030 (1). To achieve this goal, increased investments in strategies (1) to prevent new cases of the disease and adequate treatments for individuals already infected with the virus are required (2). Among these strategies, it is critical that substantial efforts be made to reduce vertical transmission of HIV, as this is the main route by which children under 5 become infected (3). In the absence of adequate prophylaxis, mother-to-child transmission (MTCT) occurs in 20-45% of children born to HIVinfected mothers (4).

Methods

Results

Conclusion