Temporal trend and spatial distribution of cases of mother-to-child transmission of HIV in the state of Santa Catarina, Brazil, 2007-2017: an ecological study

Cunga, Ilda Vaica Armando; Bittencourt, Bianca; Rosa, Claudia Maria Augusto da; Iser, Betine Pinto Moehlecke; Parma, Gabriel Oscar Cremona; Schuelter-Trevisol, Fabiana

Ilda Vaica Armando Cunga

Universidade do Sul de Santa Catarina, Programa de Pós-Graduação em Ciências da Saúde, Tubarão, SC, Brazil

http://orcid.org/0000-0001-9973-1126

Bianca Bittencourt

Governo do Estado de Santa Catarina, Diretoria de Vigilância Epidemiológica, Florianópolis, SC, Brazil

http://orcid.org/0000-0002-8561-2158

Claudia Maria Augusto da Rosa

Governo do Estado de Santa Catarina, Diretoria de Vigilância Epidemiológica, Florianópolis, SC, Brazil

http://orcid.org/0000-0002-2027-0636

Betine Pinto Moehlecke Iser

Universidade do Sul de Santa Catarina, Programa de Pós-Graduação em Ciências da Saúde, Tubarão, SC, Brazil

http://orcid.org/0000-0001-6061-2541

Gabriel Oscar Cremona Parma

Universidade do Sul de Santa Catarina, Programa de Pós-Graduação em Ciências da Saúde, Tubarão, SC, Brazil

http://orcid.org/0000-0001-9540-6908

Fabiana Schuelter-Trevisol

Universidade do Sul de Santa Catarina, Programa de Pós-Graduação em Ciências da Saúde, Tubarão, SC, Brazil

http://orcid.org/0000-0003-0997-1594

Correspondence: Fabiana Schuelter-Trevisol E-mail: fastrevisol@gmail.com

Associate editor: Isis Polianna Silva Ferreira de Carvalho - https://orcid.org/0000-0002-0734-0783

AuthorS’ contribution

Cunga IVA and Schuelter-Trevisol F were responsible for the concept and design of the study, data retrieval, analysis and interpretation, and drafting the first version of the manuscript. Schuelter-Trevisol F guided and supervised all stages of the study. Bittencourt B and Rosa CMA assisted with the study design, accessing and interpreting data, and critically reviewing the manuscript’s scientific contents. Iser BPM contributed to data analysis and interpretation and critically reviewing contents of the manuscript. Parma GOC contributed to data analysis and interpretation and was the statistician responsible for geoprocessing, besides contributing to critically reviewing the contents of the manuscript. All the authors have approved the final version of the manuscript, and are responsible for all aspects of the study, including the guarantee of its accuracy and integrity.

CONFLICTS OF INTEREST

The authors declared that they have no conflicts of interest.

Figures (2)
Tables (3)

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Figure 1
Temporal trend of the rate of HIV-infected pregnant women (A), rate of children exposed to HIV during pregnancy (B) and seroconversion rate of children exposed to HIV/AIDS during pregnancy (C), Santa Catarina, 2007-2017

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Figure 2
Spatial distribution of HIV cases per municipality of residence among pregnant women and children exposed to and infected with HIV, Santa Catarina, 2007-2017 A) Santa Catarina Macro-Regions; B) Distribution of the rate of HIV-infected pregnant women; C) Distribution of the rate of children exposed to HIV during pregnancy; e D) Distribution of the seroconversion rate of children exposed to HIV/AIDS during pregnancy

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Study contributions Main results Despite the stable infection rates, we identified a larger number of infected pregnant women and children exposed to risk of mother-to-child HIV transmission, especially in areas of greater population density. There was, however, a reduction in the number of infected children. Implications for services The data of this study indicate possible shortcomings in prenatal follow-up and mother and child care, with regard to vertical HIV transmission in municipalities in the state of Santa Catarina. Perspectives There is a need for reflection on the strategies used to address the disease and prevention measures that could be better structured in order to achieve the international goal of eradicating mother-to-child HIV transmission.

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Table 1
Distribution of infected pregnant women, children exposed to HIVa during pregnancy and seroconversion rate of children exposed to HIV/AIDSb during pregnancy, among live births with follow-up, Santa Catarina, 2007-2017

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Table 2
Temporal trend of rates of HIV-infecteda pregnant women, children exposed to HIV during pregnancy and seroconversion of children exposed to HIV/AIDSb during pregnancy, Santa Catarina, 2007-2017

Study contributions
Main results	Despite the stable infection rates, we identified a larger number of infected pregnant women and children exposed to risk of mother-to-child HIV transmission, especially in areas of greater population density. There was, however, a reduction in the number of infected children.
Implications for services	The data of this study indicate possible shortcomings in prenatal follow-up and mother and child care, with regard to vertical HIV transmission in municipalities in the state of Santa Catarina.
Perspectives	There is a need for reflection on the strategies used to address the disease and prevention measures that could be better structured in order to achieve the international goal of eradicating mother-to-child HIV transmission.

Year of notification	HIV+ pregnant women (n)	Live births born to HIV+ pregnant women (n)	Live births (n)	Rate of HIV-infected pregnant women/1,000 live births^a	Rate of children exposed to HIV/1,000 live births^b	Seroconversion^c		Seroconversion rate/100,000 live births^d
Year of notification	HIV+ pregnant women (n)	Live births born to HIV+ pregnant women (n)	Live births (n)	Rate of HIV-infected pregnant women/1,000 live births^a	Rate of children exposed to HIV/1,000 live births^b	n	%	Seroconversion rate/100,000 live births^d
2007	428	355	82,530	5.2	4.3	17	4.8	20.6
2008	470	512	85,744	5.5	6.0	26	5.1	30.3
2009	490	492	84,010	5.8	5.9	7	1.4	8.3
2010	476	546	85,091	5.6	6.4	14	2.6	16.5
2011	509	413	87,975	5.8	4.7	25	6.1	28.4
2012	475	398	89,295	5.3	4.5	14	3.5	15.7
2013	477	362	90,547	5.3	4.0	8	2.2	8.8
2014	540	395	94,049	5.7	4.2	5	1.3	5.3
2015	585	395	98,192	6.0	4.0	11	2.8	11.2
2016	558	424	96,159	5.8	4.4	1	0.2	1.0
2017	536	267	99,222	5.4	2.7	2	0.7	2.0
2007-2017	5,554	4,559	992,814	5.6	4.6	130	2.9	13.5

Rates	Mean (95%CI^c)	Beta coefficient (95%CI)	p-value	R^{2 d} (%)	APC^e	Trend^f
Rate of HIV-infected pregnant women^g	5.6 (5.4;5.8)	0.02 (-0.05;0.09)	0.528	63.9	0.00 (-10.9;23.0)	→
Rate of children exposed to HIV during pregnancy^g	4.6 (3.9;5.4)	-0.21 (-0.51;0.08)	0.139	38.0	-38.3 (-69.1;21.1)	→
Seroconversion rate of children exposed to HIV/AIDS during pregnancy^h	13.5 (6.8;20.1)	-2.25 (-3.34;-1.16)	0.001	63.5	-99.4 (-99.9;-93.1)	↓

[1] Correspondence: Fabiana Schuelter-Trevisol E-mail: fastrevisol@gmail.com

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Temporal trend and spatial distribution of cases of mother-to-child transmission of HIV in the state of Santa Catarina, Brazil, 2007-2017: an ecological study

Abstract

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Methods

Results

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