Prevention measures for vertical HIV transmission: monitoring infected pregnant women and exposed children

Vasconcelos, Cristina Silvana da Silva; Pereira, Renata Junqueira; Santos, Adiléia Fernandes Barros da Silva; Gratão, Lúcia Helena Almeida

doi:10.1590/1806-93042021000100011

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Revista Brasileira de Saúde Materno Infantil

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ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 21 (1) • Jan-Mar 2021 • https://doi.org/10.1590/1806-93042021000100011 copy

Prevention measures for vertical HIV transmission: monitoring infected pregnant women and exposed children

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

to present an analysis of the follow-up of exposed children and pregnant women living with HIV who are assisted in a reference public healthcare service of a Brazilian capital.

Methods:

this is a cross-sectional study with sociodemographic and clinical data obtainedfrom physical and electronic medical records of women living with HIV and exposed children, treated between 2000 and 2018, in a secondary healthcare service. For associations, the chi-square test at 5% significance was used.

Results:

the data about 183 pregnancies and 214 children from the capital or other municipalities in the state were analyzed. The women have low schooling, are brown or black, single, multiparous, diagnosed with HIV during prenatal care, with the start of follow-up from the third trimester of pregnancy and the use of prophylaxis during childbirth. As for children, the associations were significant for notification on SINAN, admission to the health service, use of prophylaxis indicating better monitoring for those who live in the state capital.

Conclusions:

the prevention measures recommended by the Ministry of Health, in general, were followed, but children and pregnant women who live in other cities were worse off than those ones in the capital. Unnotified cases were identified on SINAN. These issues may contribute to new cases of vertical transmission of HIV.

Key words:
Vertical transmission of infectious disease; HIV; Maternal health; Child health; Public health; Health services

Variables	N	%
Municipality of residence
Palmas	114	62.3
Others	69	37.7
Education
Illiterate	1	0.5
Incomplete elementary school	59	32.2
Complete primary education	25	13.7
Incomplete high school	26	14.2
Complete high school	56	30.6
Incomplete higher education	7	3.8
Complete higher education	5	2.7
No information	4	2.2
Self-declared color of skin
White	28	15.3
Black	42	23.0
Mixed	110	60.1
No information	3	1.6
Marital status
Married	64	35.0
Single	75	41.0
Stable union	39	21.3
Widowed	2	1.1
No information	3	1.6
Number of pregnancies ^a a Data regarding the last pregnancy followed up at the service;
Up to two	65	45.5
Three or more	76	52.5
No information	3	1.6
X̅ (SD)	2.0 (2.067)
Diagnosis of HIV infection ^b b Data regarding the first pregnancy of the pregnant woman monitored at the service; HIV = Human Immunodeficiency Virus; ARV = Antiretroviral; SINAN = Sistema de Informação de Agravos de Notificação; AF = Absolute Frequency; RF = Relative Frequency; N = Sampling; SD = Standard Deviation.
Before prenatal care	63	44.1
During prenatal care	69	48.3
Childbirth	5	3.5
No information	6	4.1
Admission to the reference health service
First trimester	29	15.8
Second trimester	47	25.7
Third trimester	59	32.2
No information	48	26.2
Use of prophylaxis (ARV) during pregnancy
During prenatal care	165	90.2
Only in delivery	2	1.1
Not used	5	2.7
No information	11	6.0
Use of prophylaxis (ARV) during delivery
Used	118	64.5
Not used	11	6.0
No information	54	29.5
Notification of pregnancy at SINAN
Yes	147	80.3
No	35	19.1
Not information	1	0.5

Variables	Palmas - TO (n=149)		Others cities (n=65)		p ^* * Chi-square.
Variables	n	%	n	%	p ^* * Chi-square.
Sex					0.766
Female	76	51.0	31	47.7
Male	73	49.0	34	52.3
Child notification on SINAN					0.000 ^a a Significant by the Chi-square test, at 5% significance;
Yes	129	86.6	34	52.3
No	5	3.4	5	7.7
No information	15	10.1	26	40.0
Admission at Secondary Health
Care Service (days)					0.000 ^a a Significant by the Chi-square test, at 5% significance;
Up to 15	74	49.7	23	35.4
Up to 30	34	22.8	12	18.5
Up to 60	22	14.8	6	9.2
Up to 120	14	9.4	19	29.2
Use of prophylaxis (ARV) during pregnancy					0.218
Yes	90	60.4	31	47.7
No	21	14.1	13	20.0
No information	38	25.5	21	32.3
Use of prophylaxis (AZT) by the child					0.003 ^a a Significant by the Chi-square test, at 5% significance;
Yes	121	81.2	40	61.5
No	3	2.0	6	9.2
No information	25	16.8	19	29.2
Realization molecular test (Viral Load) ^b b Data about children who completed 18 months (n= 194);					0.141
0	15	11.3	13	21.3
1	27	20.3	10	16.4
≥ 2	85	63.9	33	54.1
No information	6	4.5	5	8.2
Realization serology HIV after
18 months ^b b Data about children who completed 18 months (n= 194);					0.290
Yes	28	21.1	19	31.1
No	29	21.8	13	21.3
No information	76	57.1	29	47.5
Seroreversion ^b b Data about children who completed 18 months (n= 194);					0.131
Yes	23	17.3	12	19.7
No	5	3.8	7	11.5
No information	105	78.9	42	68.9
Departure from the Secondary Health
Care Service ^b b Data about children who completed 18 months (n= 194);					0.644
Discharge	67	50.4	29	47.5
Others reasons ^c c Death or transfer; HIV = Human Immunodeficiency Virus; ARV =Antiretroviral; AZT = azidothymidine; SINAN = Sistema de Informação de Agravos de Notificação; n = Sampling; SD = Standard Deviation;	29	21.8	17	27.9
No information	37	27.8	15	24.6

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[1] Authors' contribution

Vasconcelos, CSS and Gratão, LHA were responsible for conception and design of the work; data acquisition, analysis and interpretation; and elaboration of intellectual content. Santos, AFBS was responsible for data acquisition, analysis and interpretation. Pereira, RJ was responsible for development of intellectual content. All authors approved the final version of the article.