Preventing vertical HIV virus transmission: hospital care assessment

a retrospective cohort study conducted in two maternity hospitals in the city of Montes Claros, State of Minas Gerais. All women admitted for childbirth diagnosed with HIV and their respective newborns were included from 2014 to 2017. Data were collected from medical records and analyzed descriptively.

Results:

population consisted of 46 pairs of mothers and newborns. Management was considered inadequate in 30 cases of parturient/postpartum women (65.2%) and 14 cases of newborns (30.4%). The main reasons for inadequate maternal management were lack of pharmacological inhibition of lactation (53.3%) and counseling/consent for HIV testing (43.3%). For newborns, late onsetoffirst dose ofZidovudine (50.0%) and no prescriptionofNevirapine (28.6%).

Conclusions:

important prevention opportunities were missed, pointing to the need for improved care.

Descriptors:
Infectious Disease Transmission, Vertical; HIV; Prevention and Control; Health Services Research; Hospitals

Variables	n ^* Note: *Valid data; RT: rapid test; AZT: Zidovudine; NB: newborns.	%
Rapid HIV test (RT) (n=46)
Yes	16	34.7
No	20	65.3
RT time (n=16)
At pre-delivery	15	93.8
At postpartum	1	6.2
RT counseling and consent registry (n=16)
Yes	3	18.8
No	13	81.2
Examination of viral load available at delivery (n=40)
Yes	25	62.5
No	15	37.5
Viral Load Value (n=25)
Undetectable	11	44.0
Less than 1,000 copies	8	32.0
Equal or greater than 1,000 copies	6	24.0
Use of intravenous AZT in labor/delivery (n=46)
Yes	40	87.0
No	6	13.0
AZT infusion time until delivery (n=40)
Lessthan3 hours	7	17.5
3 hours or more	33	82.5
Type of delivery (n=46)
Vaginal	11	23.9
Cesarean	35	76.1
Indication for cesarean section (n=35)
HIV elective	24	68.6
Labor in women HIV +	4	11.4
Other obstetric indication	7	20.0
Performance of mechanical inhibition of lactation (n=45)
Yes	41	91.1
No	4	8.9
Performance of chemical inhibition of lactation (n=44)
Yes	30	68.2
No	14	31.8
Referenced postpartum (n=46)
Yes	44	95.6
No	2	4.4
Reported cases (HIV in pregnant women) (n=46)
Yes	45	97.8
No	1	2.2
Prescription drug for NB (n=46)
Oral AZT	20	43.5
Oral AZT + Nevirapine	26	56.5
Beginning of oral AZT administration (n=44)
Up to 4 hours of life	37	84.1
4 hours or more of life	7	15.9
Beginning of Nevirapine administration (n=26)
Up to 48 hours of life	26	100.0
Reported Cases (HIV-exposed NB) (n=46)
Yes	45	97.8
No	1	2.2
NB referenced (n=46)
Yes	45	97.8
No	1	2.2

Inadequate Management	n^* Note: *Valid data; IV: Intravenous; AZT: Zidovudine; RT: rapid test.	%
Parturient/postpartum women (n=30; 65.2%)
Insufficient IV AZT time during labor/delivery (<3hs)	7	23.3
IV AZT prophylaxis during unperformed labor/delivery	6	20.0
Pharmacological inhibition of lactation not performed	16	53.3
Counseling not accomplished/registered	13	43.3
Consent to RT unsolicited/registered HIV	13	43.3
Postpartum rapid HIV test	1	3.3
Inadequate type of delivery	1	3.3
Case not referred for outpatient follow-up	1	3.3
Casenotreported	1	3.3
Newborns (n=14; 30.4%)
Late start of AZT (> 4 hrs)	7	50.0
Nevirapine prophylaxis required but not performed	4	28.6
Nevirapine prophylaxis performed, but unnecessary	2	14.3
Case not referred for outpatient follow-up	1	7.1
Case not reported	1	7.1

Variables	Management
	Maternal		NB
	Adequaten^* Note: *Valid data. (%)	Inadequaten^* Note: *Valid data. (%)	Adequaten^* Note: *Valid data. (%)	Inadequaten^* Note: *Valid data. (%)
Maternal age (n=46)
<25 years	6(46.2)	7(53.8)	9(69.2)	4(30.8)
≥25 years	10(30.3)	23(69.7)	23(69.7)	10(30.3)
Marital status (n=46)
Married	9(30.0)	21(70.0)	21(70.0)	9(30.0)
Single	7(43.8)	9(56.2)	11(68.8)	5(31.2)
Education (n=42)
> 8 years	7(30.4)	16(69.6)	13(68.4)	6(31.6)
≤8years	7(36.8)	12(63.2)	17(73.9)	6(26.1)
Race/Color (n=43)
White	1(100.0)	0 (0.0)	1(100.0)	0(0.0)
Non-white	13(31.0)	29(69.0)	29(69.0)	13(31.0)
Diagnosis time (n=46)
Before pregnancy	6(24.0)	19(76.0)	18(72.0)	7(28.0)
During pregnancy	10(66.7)	5(33.3)	11(73.3)	4(26.7)
Birth/postpartum	0(100.0)	6(100.0)	3(50.0)	3(50.0)
Prenatal care(n=46)
Yes	16(36.4)	28(63.6)	30(68.2)	14(31.8)
No	0(0.0)	2(100.0)	2(100.0)	0(0.0)
Examination available viral load (n=40)
Yes	12(48.0)	13(52.0)	17(68.0)	6(32.0)
No	4(26.7)	11(73.3)	12(80.0)	3(20.0)
Cervical dilation (n=44)
<4 cm	13(43.3)	17(56.7)	18(60.0)	12(40.0)
4to 6 cm	2(22.2)	7(77.8)	9(100.0)	0(0.0)
7-10 cm	1(20.0)	4(80.0)	4(80.0)	1(20.0)
Water bag (n=45)
Full	14(45.2)	17(54.8)	21(67.7)	10(32.3)
Route	2(14.3)	12(85.7)	10(71.4)	4(28.6)
Type of delivery (n=46)
Vaginal	3(27.3)	8(72.7)	8(72.7)	3(27.3)
Cesarean	13(37.1)	22(62.9)	24(68.6)	11(31.4)

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[1] Corresponding author: Ana Paula Ferreira Holzmann. E-mail: apaulah@uol.com.br