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de Lannoy LH, Fuentes A, Santos PC, Coelho R, Miranda AE. HIV in pregnant woman and children: Mother-to-child transmission of HIV in the Brazilian land border from 2010 to 2021. Int J Gynaecol Obstet 2024; 166:90-98. [PMID: 38873738 DOI: 10.1002/ijgo.15737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 03/25/2024] [Accepted: 04/15/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVE The aim of the present study was to analyze the profile and trends of HIV mother-to-child transmission (MTCT) in the Brazilian land border strip (LBS). METHODS This was a quantitative, ecological, and cross-sectional study using secondary data available in the information systems of the Brazilian Ministry of Health. All cases reported in the Notifiable Diseases Information System between 2010 and 2021 were studied. RESULTS Between 2010 and 2021, 275 children were born infected through MTCT, and 6076 pregnant women were living with HIV in the Brazilian LBS. HIV detection rates in pregnant women increased in all border arcs. The northern arc experienced the highest increase (19.6%), followed by the central arc (11.4%), and the southern arc (6.1%). Despite historically high detection rates, the southern arc exhibited the smallest increase. While MTCT rate decreased by 37.7% in the border area, the central arc showed no statistically significant reduction. In 2021, the average age of pregnant women was 26.2 years, 25.7% had up to 8 years of schooling, and 55.8% identified as non-white. The majority (92.8%) received antenatal care, and 59.7% were diagnosed with HIV before prenatal care. The use of prophylactic antiretroviral therapy during prenatal care occurred in 69.6% of pregnant women, and infant prophylaxis was provided within first 24 h to 43.6% of live births. CONCLUSION The results indicate progress in reducing MTCT cases in Brazilian LBS. Disparities in HIV detection rates may be influenced by differences in testing uptake, despite mandatory testing for all babies. It is crucial to continue implementing strategies to reach these women and ensure equitable access to healthcare services for MTCT prevention.
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Affiliation(s)
- Leonor Henriette de Lannoy
- Programa de Pós-graduação em Doenças Infecciosas, Universidade Federal do Espirito Santo, Vitória, Brazil
- Departamento de HIV/Aids, Tuberculoses, Hepatites virais e Infecções Sexualmente Transmissíveis/SVSA/Ministério da Saúde, Brasília, Brazil
| | - Anderson Fuentes
- Programa de Pós-graduação em Saúde Pública, Universidade Federal do Ceará, Fortaleza, Brazil
| | - Patrícia C Santos
- Departamento de HIV/Aids, Tuberculoses, Hepatites virais e Infecções Sexualmente Transmissíveis/SVSA/Ministério da Saúde, Brasília, Brazil
| | - Ronaldo Coelho
- Departamento de HIV/Aids, Tuberculoses, Hepatites virais e Infecções Sexualmente Transmissíveis/SVSA/Ministério da Saúde, Brasília, Brazil
| | - Angélica Espinosa Miranda
- Programa de Pós-graduação em Doenças Infecciosas, Universidade Federal do Espirito Santo, Vitória, Brazil
- Departamento de HIV/Aids, Tuberculoses, Hepatites virais e Infecções Sexualmente Transmissíveis/SVSA/Ministério da Saúde, Brasília, Brazil
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Walters MK, Korenromp EL, Yakusik A, Wanyeki I, Kaboré A, Poimouribou A, Ki C, Dao C, Bambara P, Derme S, Ouedraogo T, Tang KH, Boily MC, Mahy M, Imai-Eaton JW. Guidance for triangulating data and estimates of HIV prevalence among pregnant women and coverage of PMTCT using the Spectrum AIDS Impact Module. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.29.24306862. [PMID: 38853976 PMCID: PMC11160824 DOI: 10.1101/2024.05.29.24306862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Background Most countries use the Spectrum AIDS Impact Module (Spectrum-AIM), antenatal care routine HIV testing, and antiretroviral treatment data to estimate HIV prevalence among pregnant women. Non-representative programme data may lead to inaccurate estimates HIV prevalence and treatment coverage for pregnant women. Setting 154 locations in 126 countries. Methods Using 2023 UNAIDS HIV estimates, we calculated three ratios: (1) HIV prevalence among pregnant women to all women 15-49y (prevalence), (2) ART coverage before pregnancy to women 15-49y ART coverage (ART pre-pregnancy), and (3) ART coverage at delivery to women 15-49y ART coverage (PMTCT coverage). We developed an algorithm to identify and adjust inconsistent results within regional ranges in Spectrum-AIM, illustrated using Burkina Faso's estimates. Results In 2022, the mean regional ratio of prevalence among pregnant women to all women ranged from 0.68 to 0.95. ART coverage pre-pregnancy ranged by region from 0.40 to 1.22 times ART coverage among all women. Mean regional PMTCT coverage ratios ranged from 0.85 to 1.51. The prevalence ratio in Burkina Faso was 1.59, above the typical range 0.62-1.04 in western and central Africa. Antenatal clinics reported more PMTCT recipients than estimated HIV-positive pregnant women from 2015 to 2019. We adjusted inputted PMTCT programme data to enable consistency of HIV prevalence among pregnant women from programmatic routine HIV testing at antenatal clinics with values typical for Western and central Africa. Conclusion These ratios offer Spectrum-AIM users a tool to gauge the consistency of their HIV prevalence and treatment coverage estimates among pregnant women with other countries in the region.
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Luz PM, Spaeth H, Scott JA, Grinsztejn B, Veloso VG, Freedberg KA, Losina E. Variability in life expectancy among people with HIV in Brazil by gender and sexual orientation. Braz J Infect Dis 2024; 28:103722. [PMID: 38369294 PMCID: PMC10897846 DOI: 10.1016/j.bjid.2024.103722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/24/2023] [Accepted: 01/24/2024] [Indexed: 02/20/2024] Open
Abstract
INTRODUCTION In Brazil, though Antiretroviral Therapy (ART) is available to all, the benefits may not be experienced uniformly. We projected Life Expectancy (LE) for People Living with HIV (PLHIV) in care as currently observed and estimated the impact of guideline-concordant care. METHODS Using a microsimulation model, we projected LE for a cohort of PLHIV and for four population groups: cisgender Men who have Sex with Men (MSM), cisgender Men who have Sex with Women (MSW), Cisgender Women (CGW), and Transgender Women (TGW). Cohort data from Evandro Chagas National Institute of Infectious Diseases/Oswaldo Cruz Foundation (INI/Fiocruz) informed model parameters. We modeled five scenarios: 1) Current care: ART initiation, adherence, and retention in care as currently observed, 2) Guideline-concordant care: immediate ART initiation, full adherence to treatment, and consistent retention in care, 3) Immediate ART initiation with observed adherence to treatment and retention in care, 4) Full adherence to treatment with observed timing of ART initiation and retention in care, and 5) Consistent retention in care with observed timing of ART initiation and adherence. RESULTS With current care, LE from age 15 would be 45.9, 44.4, 54.2, and 42.3 years, for MSM, MSW, CGW, and TGW. With guideline-concordant care, LE would be 54.2, 54.4, 63.1, and 53.2 years, for MSM, MSW, CGW and TGW, with TGW experiencing the greatest potential increase in LE (10.9 years). When investigating the components of care separately, MSW and CGW would gain most LE with immediate ART initiation, whereas for MSM and TGW consistent retention in care would be most impactful. CONCLUSIONS In settings like INI/Fiocruz, MSW and CGW would benefit most from interventions focused on earlier diagnosis and linkage to care, whereas TGW and MSM would benefit from interventions to sustain engagement in care. Assessment of the HIV care continuum for specific populations should inform care priorities.
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Affiliation(s)
- Paula M Luz
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil.
| | - Hailey Spaeth
- Massachusetts General Hospital, Medical Practice Evaluation Center, Department of Medicine, Boston, MA, United States
| | - Justine A Scott
- Massachusetts General Hospital, Medical Practice Evaluation Center, Department of Medicine, Boston, MA, United States
| | - Beatriz Grinsztejn
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Valdilea G Veloso
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Kenneth A Freedberg
- Massachusetts General Hospital, Division of Infectious Diseases, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Massachusetts General Hospital, Division of General Internal Medicine, Boston, MA, United States; Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Elena Losina
- Harvard Medical School, Boston, MA, United States; Harvard University Center for AIDS Research, Harvard Medical School, Boston, MA, United States; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, United States; Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States; Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
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Miranda AE, Santos PC, Coelho RA, Pascom ARP, de Lannoy LH, Ferreira ACG, Gaspar PC, Maciel EL, Barreira D, Pereira GFM. Perspectives and challenges for mother-to-child transmission of HIV, hepatitis B, and syphilis in Brazil. Front Public Health 2023; 11:1182386. [PMID: 37663837 PMCID: PMC10470844 DOI: 10.3389/fpubh.2023.1182386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/21/2023] [Indexed: 09/05/2023] Open
Abstract
Background Eliminating mother-to-child transmission (MTCT) of HIV, hepatitis B, and syphilis is a challenge in Brazil. Many policies have been implemented since 1986, but important gaps remain. This study aimed to describe the trends of MTCT in Brazil and evaluate the gaps and perspectives in this scenario. Methods This is a descriptive study conducted with secondary data publicly available in the information systems of the Brazilian Ministry of Health regarding data on HIV, syphilis, and hepatitis B in pregnant women and children from 2011 to 2021. Results HIV and hepatitis B have had constant rates over the years in pregnant women, with the detection rates around 2.5/1,000 live birth (LB) and 0.5/1.000LB, respectively. The same did not happen with syphilis, which has shown an increasing line in the last decade. In 2011, the detection rate of syphilis in pregnancy was 4.7/1,000LB, and in 2021 it reached 27.1/1,000LB. Regarding the trends in children, an important decrease was observed in HIV/AIDS (incidence rate from 0.18/1,000 in 2011 to 0.04/1,000 in 2021) and Hepatitis B (incidence rate from 0.9/1,000LB in 2011 to 0.5/1,000LB in 2021). For congenital syphilis, there is a continuous increase, being 3.3/1,000LB in 2011 and 9.9/1,000LB in 2021. Data from the HIV clinical monitoring showed that antiretroviral treatment coverage among pregnant women identified increased slightly between 2011 and 2021, in Brazil, from 92.3% to 94.3%. For syphilis, 82.5% of pregnant women were treated with benzathine penicillin, and 88.7% in 2011. The historical series of hepatitis B vaccination coverage in children has decreased over the years; it was 96% in 2013 and 76% in 2021. Conclusion These data show many gaps and some perspectives in the MTCT program in Brazil. The country is close to reaching MTCT HIV elimination, but there are many challenges regarding HBV and syphilis. These data can be used to organize the strategies to improve the Brazilian response to MTCT elimination of HIV, hepatitis B, and syphilis.
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Affiliation(s)
- Angelica E. Miranda
- Post-graduation Program in Infectious Diseases, Federal University of Espirito Santo, Vitória, Brazil
- Department of HIV/AIDS, Tuberculosis, Viral Hepatitis and Sexually Transmitted Infections, Ministry of Health, Brasília, Brazil
| | - Patricia C. Santos
- Department of HIV/AIDS, Tuberculosis, Viral Hepatitis and Sexually Transmitted Infections, Ministry of Health, Brasília, Brazil
| | - Ronaldo A. Coelho
- Department of HIV/AIDS, Tuberculosis, Viral Hepatitis and Sexually Transmitted Infections, Ministry of Health, Brasília, Brazil
| | - Ana Roberta P. Pascom
- Department of HIV/AIDS, Tuberculosis, Viral Hepatitis and Sexually Transmitted Infections, Ministry of Health, Brasília, Brazil
| | - Leonor Henriette de Lannoy
- Post-graduation Program in Infectious Diseases, Federal University of Espirito Santo, Vitória, Brazil
- Department of HIV/AIDS, Tuberculosis, Viral Hepatitis and Sexually Transmitted Infections, Ministry of Health, Brasília, Brazil
| | - Ana Cristina Garcia Ferreira
- Department of HIV/AIDS, Tuberculosis, Viral Hepatitis and Sexually Transmitted Infections, Ministry of Health, Brasília, Brazil
| | - Pamela Cristina Gaspar
- Department of HIV/AIDS, Tuberculosis, Viral Hepatitis and Sexually Transmitted Infections, Ministry of Health, Brasília, Brazil
- Post-graduation Program in Public Health, University of Brasilia, Brasília, Brazil
| | - Ethel Leonor Maciel
- Post-graduation Program in Infectious Diseases, Federal University of Espirito Santo, Vitória, Brazil
- Department of HIV/AIDS, Tuberculosis, Viral Hepatitis and Sexually Transmitted Infections, Ministry of Health, Brasília, Brazil
| | - Draurio Barreira
- Department of HIV/AIDS, Tuberculosis, Viral Hepatitis and Sexually Transmitted Infections, Ministry of Health, Brasília, Brazil
| | - Gerson Fernando Mendes Pereira
- Department of HIV/AIDS, Tuberculosis, Viral Hepatitis and Sexually Transmitted Infections, Ministry of Health, Brasília, Brazil
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Figueredo VSL, Monteiro DLM, Batista RFL, Gama MEA, Campos ASF, Pinto AGCF. Vertical transmission of HIV to neonates in a reference hospital in Northeastern Brazil from 2013 to 2017. Rev Inst Med Trop Sao Paulo 2023; 65:e34. [PMID: 37283409 DOI: 10.1590/s1678-9946202365034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/06/2023] [Indexed: 06/08/2023] Open
Abstract
The aim of this study was to estimate the rate of Mother-to-child Transmission (MTCT) of HIV to neonates in a reference university hospital in Sao Luis city, the capital of Maranhao State (MA), evaluating MTCT-associated factors. A retrospective cohort study based on data from the Notifiable Diseases Data System (SINAN) was carried out and included all HIV-exposed neonates notified from 2013 to 2017 by the university hospital. The study population comprised 725 HIV-exposed neonates, of whom 672 neonates were exposed and uninfected, and 53 were exposed and infected. The estimated rate of MTCT in the period of 2013 to 2017 was 7.3%. Most pregnant women were ≥ 20 years old (86.9%), reported ≥ 8 years of schooling (53.2%), reported full-time or independent paid work (46.9%) and were residents in other cities of the state (61.7%). Regarding healthcare, 86.3% received prenatal care, 74.6% received Antiretroviral Therapy (ART) as prophylaxis during pregnancy, 81.8% received ART prophylaxis during childbirth and 78.1% underwent cesarean section. Among the neonates, 92.8% received ART prophylaxis and 94.3% were not breastfed. Despite these variables, the 7.3% MTCT rate found in this study makes it clear that the interventions recommended by the Ministry of Health were not fully adopted.
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Affiliation(s)
- Vaneça Santos Leal Figueredo
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
- Universidade Federal do Maranhão, São Luís, Maranhão, Brazil
| | - Denise Leite Maia Monteiro
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
- Centro Universitário Serra dos Órgãos, Teresópolis, Rio de Janeiro, Brazil
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Quadros Santos MM, Gomes do Carmo BA, Barbosa Rodrigues T, Leite Dias BR, Abreu Martins C, Oliveira Naiff Ferreira GR, Tavares Parente A, Yollete Urbano Pauxis Aben-Atha C, Isse Polaro SH, Pinheiro Botelho E. Spatial variability of mother-to-child human immunodeficiency virus transmission in a province in the Brazilian Rainforest: An ecological study. GEOSPATIAL HEALTH 2022; 17. [PMID: 36468599 DOI: 10.4081/gh.2022.1101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/10/2022] [Indexed: 06/17/2023]
Abstract
The mother-to-child transmission (MTCT) of the human immunodeficiency virus (HIV) remains a serious public health problem in the Brazilian Rainforest. This study aimed to spatially analyze this type of infection between 2007 and 2018 in Pará, which is the second-largest Brazilian state in the Brazilian Rainforest and also has the highest MTCT of HIV in Brazil. We analyzed the incidence rates of HIV (including the acquired immunodeficiency syndrome (AIDS) by MTCT as the main route of infection in children younger than 13 years old and whose mothers live in Pará. We employed spatial autocorrelation, spatial scanning, and geographic-weighted spatial regression techniques. In the period of this study, 389 new HIV/AIDS were noted, with territorial expansion of the incidence rates in the municipalities in northern and southern Pará having the highest rates. São Francisco do Pará had high spatial risk and high-spatiotemporal risk clusters comprising municipalities in western and south-western Pará between 2013 and 2016. The spatial variability of HIV/AIDS incidence rates was found to be common in the number of men and women with formal jobs; unemployed ≥18 years old people; elementary school pupils; and families enrolled in the "Single Registry for Social Programs". The social equity approach in Pará guarantee pregnant women access to preventive, diagnostic and treatment health services and their children should be supported to eliminate the MTCT of HIV in Pará.
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Affiliation(s)
| | | | | | | | - Cleyton Abreu Martins
- Graduate Nursing Program, Federal University of Pará, Complexo da Saúde - Guamá, Belém, Pará.
| | | | | | | | | | - Eliã Pinheiro Botelho
- Graduate Nursing Program, Federal University of Pará, Complexo da Saúde - Guamá, Belém, Pará.
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Menegotto M, Magdaleno AM, da Silva CLO, Friedrich L, da Silva CH. Mother-to-Child HIV Transmission among Pregnant Women in a City with the Highest Rates of HIV in Brazil. Am J Perinatol 2022; 39:1418-1425. [PMID: 33477174 DOI: 10.1055/s-0040-1722605] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Most of the HIV pediatric infections are acquired through mother-to-child transmission (MTCT). Porto Alegre is a state capital of Brazil that had a HIV MTCT rate of 4.1% in 2013 and the highest rate of HIV-infected pregnant women in the country during 2018. Zidovudine and nevirapine have been used in Brazil for high-risk newborns since 2012. The aim of the study was to investigate HIV MTCT rate and the factors associated with HIV transmission at a hospital that is a reference center for HIV-infected mothers in Porto Alegre, after the introduction of this policy. STUDY DESIGN This retrospective cohort study included all HIV-exposed infants born between February 2013 and December 2016 at the Hospital de Clínicas de Porto Alegre. Student's t-test or Fisher's exact test was used to compare variables between HIV-infected and uninfected groups of newborns. Poisson's regression with robust variance was used to determine the factors associated with HIV MTCT. RESULTS A total of 375 newborns were exposed to HIV, with an outpatient loss of 14.4% (n = 54). The HIV MTCT rate was 2.18% (n = 7), with four infected during the intrauterine period. The risk factors for MTCT were no prenatal care (relative risk [RR] = 9.4; 95% confidence interval [CI]: 2.0-44.3), late maternal HIV diagnosis in the peripartum period (RR = 16.3; 95% CI: 3.6-73.0), syphilis infection during pregnancy (RR = 9.3; 95% CI: 2.1-40.3), maternal viral load >1,000 copies/mL in the third trimester or peripartum period (RR = 9.5; 95% CI: 1.7-50.5), and lack of or inappropriate antiretroviral therapy during pregnancy (RR = 8.2; 95% CI: 1.6-41.4). CONCLUSION MTCT rate was 2.18%. With the institution of two-drug prophylaxis for high-risk newborns, persistent cases HIV MTCT were predominantly found among women with absence of antenatal care, late HIV diagnosis, syphilis coinfection, high viral load, and inadequate ARV therapy during pregnancy. Although zidovudine and nevirapine were administered postnatally to high-risk newborns, this regimen could not prevent transplacental transmission. KEY POINTS · Most of the HIV pediatric infections are acquired through mother-to-child transmission.. · The study investigated HIV MTCT rate and the factors associated with HIV transmission in Brazil.. · HIV MTCT rate was 2.18% and most of them were infected during the intrauterine period..
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Affiliation(s)
- Mariana Menegotto
- Graduate Program in Child and Adolescent Health, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Amanda M Magdaleno
- Pediatrics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Carmem L O da Silva
- Pediatrics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,AIDS Assistance Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Luciana Friedrich
- AIDS Assistance Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Neonatology Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Department of Pediatrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Clécio H da Silva
- Graduate Program in Child and Adolescent Health, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Pediatrics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Department of Pediatrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Cunga IVA, Bittencourt B, da Rosa CMA, Iser BPM, Parma GOC, Schuelter-Trevisol F. 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. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2022; 31:e2021877. [PMID: 35830006 PMCID: PMC9887967 DOI: 10.1590/s2237-96222022000100009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 04/11/2022] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To analyze the temporal trend and spatial distribution of mother-to-child HIV transmission in Santa Catarina between 2007 and 2017. METHODS This was a mixed ecological study with data from the Notifiable Health Conditions Information System. Linear regression was performed for time series analysis and the mean rates in the period and mean annual percentage changes in the rates of HIV-infected pregnant women were calculated, children exposed to HIV during pregnancy, and seroconversion of children exposed to HIV/AIDS during pregnancy, in addition to data geoprocessing. RESULTS There were 5,554 records of HIV-infected pregnant women, with a rate of 5.6 pregnant women per 1,000 live births. The mean seroconversion rate was 13.5/100,000 live births (95%CI 6.8;20.1) and it showed a falling trend (APC = -99.4%; 95%CI -99.9;-93.1). The seroconversion rate was more expressive in small towns. CONCLUSION The rate of HIV-infected pregnant women was stable in the period, whereas the number of children infected with HIV through mother-to-child transmission decreased.
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Affiliation(s)
- Ilda Vaica Armando Cunga
- Universidade do Sul de Santa Catarina, Programa de Pós-Graduação em
Ciências da Saúde, Tubarão, SC, Brazil
| | - Bianca Bittencourt
- Governo do Estado de Santa Catarina, Diretoria de Vigilância
Epidemiológica, Florianópolis, SC, Brazil
| | | | | | | | - Fabiana Schuelter-Trevisol
- Universidade do Sul de Santa Catarina, Programa de Pós-Graduação em
Ciências da Saúde, Tubarão, SC, Brazil
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Lima ACMACC, Pinho SMED, Lima SAFCC, Chaves AFL, Vasconcelos CMT, Oriá MOB. Booklet for knowledge and prevention of HIV mother-to-child transmission: a pilot study of a randomized clinical trial. Rev Esc Enferm USP 2022; 56:e20210560. [PMID: 36427269 PMCID: PMC10116881 DOI: 10.1590/1980-220x-reeusp-2021-0560en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 09/21/2022] [Indexed: 12/05/2022] Open
Abstract
ABSTRACT Objective: To test the effectiveness of the booklet, compared to the usual service care, in the increase of the knowledge of pregnant/puerperal women living with HIV, for the prevention of HIV-VT. Method: Pilot study of a randomized controlled clinical trial, initially with 104 pregnant women living with HIV, with a final sample of 45 women. It was held in three public maternity hospitals in Fortaleza-CE, from January/2017 to May/2018. The control group received regular care from the service and the intervention group had access to the booklet as an additive. The research was carried out in three phases: baseline; evaluation 2, in prenatal care; and evaluation 3, in the postpartum period. Results: There was no intergroup difference in the women’s mean knowledge score (short-term p = 0.473; long-term p = 0.151). However, in the intragroup analysis, the booklet proved to be effective in improving the pregnant women’s knowledge in the intervention group, in the short term (p = 0.002) and long term (p = 0.033). Conclusion: There was an improvement in knowledge within the intervention group over time, but there was no difference in women’s knowledge in the intergroup analysis. Thus, based on this pilot, a broader study on the use of booklet is required to prove its effectiveness (ReBEC: UTN: U1111-1191-9954).
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Lima ACMACC, Pinho SMED, Lima SAFCC, Chaves AFL, Vasconcelos CMT, Oriá MOB. Cartilha para conhecimento e prevenção da transmissão vertical do HIV: estudo piloto de ensaio clínico randomizado. Rev Esc Enferm USP 2022. [DOI: 10.1590/1980-220x-reeusp-2021-0560pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
RESUMO Objetivo: Testar efetividade de cartilha, em comparação ao atendimento habitual do serviço, no aumento do conhecimento de gestantes/puérperas que vivem com HIV, para prevenção da TV-HIV. Método: Piloto de ensaio clínico randomizado controlado, inicialmente com 104 gestantes que vivem com HIV, com amostra final de 45 mulheres. Realizado em três maternidades públicas de Fortaleza-CE, de janeiro/2017 a maio/2018. O grupo controle recebeu atendimento habitual do serviço e o grupo intervenção teve como aditivo acesso à cartilha. A pesquisa foi realizada em três fases: linha de base; avaliação 2, no pré-natal; e avaliação 3, no pós-parto. Resultados: Não houve diferença intergrupos na média da pontuação do conhecimento das mulheres (curto prazo p = 0,473; longo prazo p = 0,151). Porém, na análise intragrupo, a cartilha se mostrou efetiva para melhorar o conhecimento das gestantes do grupo intervenção, em curto prazo (p = 0,002) e longo prazo (p = 0,033). Conclusão Houve melhora do conhecimento dentro do grupo intervenção, ao longo do tempo, porém não foi evidenciada diferença quanto ao conhecimento das mulheres na análise intergrupos. Assim, a cartilha carece da realização de estudo mais amplo, a partir deste piloto, para comprovação de sua efetividade (ReBEC: UTN: U1111-1191-9954).
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Aschengrau A, Mussi-Pinhata MM, Moye J, Chakhtoura N, Patel K, Williams PL, Karalius B, Garvie PA, Monte D, Whalen F, Lebov J, Seage GR. An International Prospective Cohort Study of HIV and Zika in Infants and Pregnancy (HIV ZIP): Study Protocol. Front Glob Womens Health 2021; 2:574327. [PMID: 34816174 PMCID: PMC8594009 DOI: 10.3389/fgwh.2021.574327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
Zika virus (ZIKV) infection may adversely affect pregnancies of women living with HIV (WLHIV). Because no study to date has focused on maternal and child effects of HIV and ZIKV co-infection in pregnant women, we undertook the International Prospective Cohort Study of HIV and Zika in Infants and Pregnancy (HIV ZIP). The aims of this two-phase study of pregnant women and their infants are to compare the incidence of ZIKV infection among pregnant women with and without HIV infection and to determine the risk of adverse maternal and child outcomes associated with ZIKV/HIV co-infection at clinical sites in Brazil, Puerto Rico, and the continental United States. Phase I was designed to enroll pregnant women/infant pairs who were: (1) infected with HIV only, (2) infected with ZIKV only, (3) infected with HIV and ZIKV, and (4) not infected with either HIV or ZIKV. A key goal of this phase was to assess the feasibility of enrolling 200 women/infant pairs within a year, with a target of 150 WLHIV, 50 HIV-uninfected women, and a minimum of 20 who were co-infected with HIV and ZIKV. If the feasibility of Phase I proved successful, Phase II would enroll up to 1,800 additional pregnant women/infant pairs to the same four groups. Enrolled women in both phases were to be followed throughout their pregnancy and up to 6 weeks post-partum. Infants were also to be followed for 1 year after birth. To date, Phase 1 data collection and follow-up have been completed. Delineation of possible harmful effects of HIV/ZIKV co-infection will allow the formulation of standard-of-care recommendations to minimize adverse effects but enable the continuation of preventive HIV therapy. Furthermore, while the prospective HIV ZIP study was developed before the COVID pandemic, it is especially relevant today since it can be easily adapted to provide critically important information on the impact of COVID-19 infection or other still unrecognized new agents among pregnant women and their offspring worldwide.
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Affiliation(s)
- Ann Aschengrau
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Marisa M Mussi-Pinhata
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - John Moye
- Maternal Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Nahida Chakhtoura
- Maternal Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Kunjal Patel
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Paige L Williams
- Departments of Biostatistics and Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Brad Karalius
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Patricia A Garvie
- Research Department, Children's Diagnostic and Treatment Center, Fort Lauderdale, FL, United States
| | | | | | - Jill Lebov
- Research Triangle Institute International, Research Triangle Park, NC, United States
| | - George R Seage
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States
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12
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Yohannes NT, Jenkins CA, Clouse K, Cortés CP, Mejía Cordero F, Padgett D, Rouzier V, Friedman RK, McGowan CC, Shepherd BE, Rebeiro PF. Timing of HIV diagnosis relative to pregnancy and postpartum HIV care continuum outcomes among Latin American women, 2000 to 2017. J Int AIDS Soc 2021; 24:e25740. [PMID: 34021715 PMCID: PMC8140191 DOI: 10.1002/jia2.25740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 04/05/2021] [Accepted: 04/26/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND HIV incidence among women of reproductive age and vertical HIV transmission rates remain high in Latin America. We, therefore, quantified HIV care continuum barriers and outcomes among pregnant women living with HIV (WLWH) in Latin America. METHODS WLWH (aged ≥16 years) enrolling at Caribbean, Central and South America network for HIV epidemiology (CCASAnet) sites from 2000 to 2017 who had HIV diagnosis, pregnancy and delivery dates contributed. Logistic regression produced adjusted odds ratios (aOR) and 95% confidence intervals (CI) for retention in care (≥2 visits ≥3 months apart) and virological suppression (viral load <200 copies/mL) 12 months after pregnancy outcome. Cumulative incidences of loss to follow-up (LTFU) postpartum were estimated using Cox regression. Evidence of HIV status at pregnancy confirmation was the exposure. Covariates included pregnancy outcome (born alive vs. others); AIDS diagnosis prior to delivery; CD4, age, HIV-1 RNA and cART regimen at first delivery and CCASAnet country. RESULTS Among 579 WLWH, median postpartum follow-up was 4.34 years (IQR 1.91, 7.35); 459 (79%) were HIV-diagnosed before pregnancy confirmation, 445 (77%) retained in care and 259 (45%) virologically suppressed at 12 months of postpartum. Cumulative incidence of LTFU was 21% by 12 months and 40% by five years postpartum. Those HIV-diagnosed during pregnancy had lower odds of retention (aOR = 0.58, 95% CI: 0.35 to 0.97) and virological suppression (aOR = 0.50, 95% CI: 0.31 to 0.82) versus those HIV-diagnosed before. CONCLUSION HIV diagnosis during pregnancy was associated with poorer 12-month retention and virological suppression. Young women should be tested and linked to HIV care earlier to narrow these disparities.
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Affiliation(s)
| | - Cathy A Jenkins
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTNUSA
| | - Kate Clouse
- Division of Infectious DiseasesDepartment of MedicineVanderbilt University Medical CenterNashvilleTNUSA
- Vanderbilt University School of NursingNashvilleTNUSA
| | | | - Fernando Mejía Cordero
- Instituto de Medicina Tropical Alexander von HumboldtUniversidad Peruana Cayetano HerediaLimaPeru
| | - Denis Padgett
- Instituto Hondureño de Seguridad Social & Hospital Escuela UniversitarioTegucigalpaHonduras
| | - Vanessa Rouzier
- Groupe Haitien d'Etudes du Sarcome de Kaposi et des Infections OpportunistesPort‐au‐PrinceHaiti
| | - Ruth K Friedman
- Instituto Nacional de Infectologia Evandro Chagas (INI)Fundação Oswaldo CruzRio de JaneiroBrazil
| | - Catherine C McGowan
- Division of Infectious DiseasesDepartment of MedicineVanderbilt University Medical CenterNashvilleTNUSA
| | - Bryan E Shepherd
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTNUSA
| | - Peter F Rebeiro
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTNUSA
- Division of Infectious DiseasesDepartment of MedicineVanderbilt University Medical CenterNashvilleTNUSA
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13
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Baker Z, Gorbach P, de Melo MG, Varela I, Sprinz E, Santos B, de Melo Rocha T, Simon M, Almeida M, Lira R, Chaves MC, Kerin T, Nielsen-Saines K. The Effect of Partnership Presence and Support on HIV Viral Suppression Among Serodiscordant Partnered and Single Heterosexual HIV-Positive Individuals in Brazil. AIDS Behav 2021; 25:1946-1953. [PMID: 33389326 PMCID: PMC7778561 DOI: 10.1007/s10461-020-03124-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 01/31/2023]
Abstract
HIV-negative individuals in serodiscordant partnerships experience reduced risk of HIV acquisition when their partners adhere to ART and achieve undetectable viral loads. Partnership support may encourage ART adherence, reducing viral load and the risk of HIV transmission. This study aims to determine whether HIV viral suppression is associated with partnership status and partnership support among 201 HIV positive (HIV+ individuals in serodiscordant partnerships and 100 HIV+ unpartnered individuals receiving care at Hospital Nossa Senhora da Conceição in Porto Alegre, Brazil between 2014 and 2016. Clinical data and patient-reported questionnaire data were assessed, and propensity scores were used to control for confounding variables in adjusted logistic regression models. Viral suppression did not significantly differ between HIV+ partnered (78.5% virally suppressed) and unpartnered (76.0% virally suppressed) individuals. Among individuals in partnerships, viral suppression was significantly associated with having a partner who attended monthly clinic visits (AOR 2.99; 95% CI 1.00-8.93). Instrumental social support-attending monthly visits-may improve the odds of viral suppression among HIV+ individuals in serodiscordant relationships.
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Affiliation(s)
- Zoë Baker
- grid.239546.f0000 0001 2153 6013Division of Urology, Children’s Hospital Los Angeles, 4650 W. Sunset Blvd, MS #114, Los Angeles, CA 90027 USA
| | - Pamina Gorbach
- grid.19006.3e0000 0000 9632 6718Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA USA
| | | | - Ivana Varela
- grid.414914.dHospital Nossa Senhora da Conceição, Porto Alegre, Brazil
| | - Eduardo Sprinz
- grid.414914.dHospital Nossa Senhora da Conceição, Porto Alegre, Brazil
| | - Breno Santos
- grid.414914.dHospital Nossa Senhora da Conceição, Porto Alegre, Brazil
| | | | - Mariana Simon
- grid.414914.dHospital Nossa Senhora da Conceição, Porto Alegre, Brazil
| | - Marcelo Almeida
- grid.414914.dHospital Nossa Senhora da Conceição, Porto Alegre, Brazil
| | - Rita Lira
- grid.414914.dHospital Nossa Senhora da Conceição, Porto Alegre, Brazil
| | | | - Tara Kerin
- grid.19006.3e0000 0000 9632 6718Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA USA
| | - Karin Nielsen-Saines
- grid.19006.3e0000 0000 9632 6718Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA USA
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14
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Cruz Zonenschein AC, João Filho EC, Cruz MLS, Gouvea MI, Teixeira MDLB, Fuller T, Dias MAB. Treatment dropout after pregnancy: a study of women living with HIV in Rio de Janeiro. AIDS Care 2020; 32:1283-1289. [PMID: 32338056 DOI: 10.1080/09540121.2020.1755011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Despite the investment in prevention of mother-to-child transmission of HIV, there is still little data about the proportion of women that are retained in treatment after pregnancy in Brazil. Research worldwide shows that a significant proportion of women drop out of treatment after pregnancy. The aim of this study was to identify factors associated with treatment dropout of women that received prenatal care at a federal hospital in Rio de Janeiro between 2016 and 2017 and abandoned treatment after pregnancy. This was a retrospective cohort study using data on prescription refills and hospital medical records. Cross-sectional analysis of data from 454 women showed that 18% were not on cART after pregnancy. Illicit drug use during pregnancy, being less than 35 years old, and being aware of HIV diagnosis before conceiving but not taking cART were factors associated with treatment interruption postpartum. The high prevalence of interruption of HIV treatment after pregnancy suggests that there is a need for better post-natal care to increase adherence in this population.
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Affiliation(s)
- Ana Clara Cruz Zonenschein
- Infectious Diseases Department, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil.,Instituto Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Esaú Custódio João Filho
- Infectious Diseases Department, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
| | | | - Maria Isabel Gouvea
- Infectious Diseases Department, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil.,Instituto Nacional de Infectologia, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Maria de Lourdes Benamor Teixeira
- Infectious Diseases Department, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil.,Instituto Nacional de Infectologia, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Trevon Fuller
- Institute of the Environment and Sustainability, University of California, Los Angeles, CA, USA
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