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Siqueira PGBDS, Miranda GMD, Souza WVD, Silva GAPD, Mendes ADCG. Hierarchical analysis of determinants of HIV vertical transmission: a case-control study. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2020. [DOI: 10.1590/1806-93042020000400005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Abstract Objectives: to analyze the association of socioeconomic, obstetric, pediatric and prophylactic factors to the vertical transmission of HIV in children followed at a reference service in Recife between 2010 and 2015. Methods: case-control nested the cohort of children exposed to vertical transmission of HIV. A univariate and multivariate statistical analysis was performed on the association of socioeconomic, obstetric, pediatric and prophylactic measures with the outcome. We considered two multivariate approaches, conventional and hierarchical, the latter made it possible to consider different levels of determination. Results: 46.5% of the mothers had low schooling, 69.6% without work-related wages and 35.7% received a family grant. Women with postpartum diagnosis and less than 6 prenatal appointments had a greater chance of vertical transmission. Prophylactic measures were statistically associated with prevention of transmission (p<0.1%). Conclusions: vertical risk factors for HIV transmission were identified: no sewage system, at least six prenatal consultations, first care of the child with more than two months and no prophylaxis in pregnancy and childbirth. Determining factors for which specific policies and programs exist and their non-access social determination evidence of HIV vertical transmission.
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Gouvêa ADN, Trajano AJB, Monteiro DLM, Rodrigues NCP, Costa JTD, Cavalcante MB, Auar DF, Gouvea EFD, Taquette SR. Vertical transmission of HIV from 2007 to 2018 in a reference university hospital in Rio de Janeiro. Rev Inst Med Trop Sao Paulo 2020; 62:e66. [PMID: 33027390 PMCID: PMC7534406 DOI: 10.1590/s1678-9946202062066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/25/2020] [Indexed: 11/22/2022] Open
Abstract
The aim of the study was to assess the factors associated with mother-to-child transmission (MTCT) of HIV. The study design is a retrospective cohort. The population consisted of 323 HIV-positive mothers and their newborns, attended at the Perinatal Nucleus/HUPE-UERJ, municipality of Rio de Janeiro, in the period of 2007-2018. The average age of mothers was 27 years (14-44), with 12.7% (41) of adolescents. The majority (66.8%) knew they were infected during pregnancy: 39.4% in the current pregnancy and 27.4% in a previous pregnancy. The incidence of MTCT was 2.7% in 2007-2009, 1% in 2010-2015 and 0 in 2016-2018. The viral load in the 3rd trimester of pregnancy was > 1.000 copies/mL or unknown in all mothers with positive newborns and in 19% (42/221) of mothers with negative newborns (p=0.003). The duration of antiretroviral use was > 4 weeks in 92.3% (264/286) of mothers with HIV-negative newborns and in 2 in the HIV-positive group (p=0.004). One of the 4 infected newborns and 2 of the negative ones did not use oral zidovudine (p=0.04). There was no association between amniorrhexis and MTCT (p=0.99), with the Apgar score in the 5th minute of life (p=0.96), with marital status (p=0.54), ethnicity (p=0.65), adolescence (p=0.42), mode of delivery (p=0.99), beginning of prenatal care (p=0.44) or with maternal comorbidities (p=0.48). The conclusion of the study points out that the main factors associated with MTCT are the elevated maternal viral load in the 3rd trimester, the time of use of ART and the non-administration of zidovudine for the newborns.
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Affiliation(s)
| | - Alexandre José B Trajano
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.,Universidade do Grande Rio, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Denise L M 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
| | - Nádia Cristina P Rodrigues
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.,Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública, Rio de Janeiro, Rio de Janeiro, Brazil
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Moimaz SAS, Rós DDT, Saliba TA, Saliba NA. [A quantitative and qualitative study of exclusive breastfeeding intention by high-risk pregnant women]. CIENCIA & SAUDE COLETIVA 2020; 25:3657-3668. [PMID: 32876255 DOI: 10.1590/1413-81232020259.30002018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 01/18/2019] [Indexed: 11/21/2022] Open
Abstract
The scope of this research was to assess the breastfeeding intention among high-risk pregnant women and related factors. It is a cross-sectional, qualitative and quantitative study, with 1,118 high-risk pregnant women who attended the prenatal care unit at a specialized center of the Unified Health System. The dependent variables were exclusive breastfeeding intention, intended duration and conditions that might interfere with breastfeeding. The Epi Info 7.4.1, Bioestat 5.3 and IRAMUTEQ 0.7.2.0 programs were used for data processing. The results showed that 8.76% of the pregnant women had conditions that could affect lactation. Among the women, 93.83% affirmed having exclusive breastfeeding intention, of which 69.86% intended to breastfeed until the child was six months old, revealing an association with sociodemographic variables (p<0.05). The intended breastfeeding duration was related to the age (p=0.0041), marital status (p=0.0053) and level of education (p=0.0116). The main reasons reported for not providing exclusive breastfeeding were the following: HIV, use of medications, work and lack of information. This research concluded that a small cohort of high-risk pregnant women presented conditions that could interfere with breastfeeding. Most of them intended to breastfeed exclusively for six months.
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Affiliation(s)
- Suzely Adas Saliba Moimaz
- Departamento de Odontologia Preventiva e Social, Faculdade de Odontologia de Araçatuba, Universidade Estadual Paulista Júlio de Mesquita Filho, Araçatuba, SP, Brazil,
| | - Denise de Toledo Rós
- Departamento de Odontologia Preventiva e Social, Faculdade de Odontologia de Araçatuba, Universidade Estadual Paulista Júlio de Mesquita Filho, Araçatuba, SP, Brazil,
| | - Tania Adas Saliba
- Departamento de Odontologia Preventiva e Social, Faculdade de Odontologia de Araçatuba, Universidade Estadual Paulista Júlio de Mesquita Filho, Araçatuba, SP, Brazil,
| | - Nemre Adas Saliba
- Departamento de Odontologia Preventiva e Social, Faculdade de Odontologia de Araçatuba, Universidade Estadual Paulista Júlio de Mesquita Filho, Araçatuba, SP, Brazil,
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Holzmann APF, Silva CSDOE, Soares JAS, Vogt SE, Alves CDR, Taminato M, Barbosa DA. Preventing vertical HIV virus transmission: hospital care assessment. Rev Bras Enferm 2020; 73:e20190491. [PMID: 32321146 DOI: 10.1590/0034-7167-2019-0491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 10/30/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES assess the implementation of actions to prevent vertical transmission of HIV. METHODS 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.
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Affiliation(s)
| | | | | | | | | | - Mônica Taminato
- Universidade Federal de São Paulo. São Paulo, São Paulo, Brazil
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Guimarães MF, Lovero KL, de Avelar JG, Pires LL, de Oliveira GRT, Cosme EM, de Morais Salviato C, de Oliveira TRD, Cabrera NB, Cardoso CAA. Review of the missed opportunities for the prevention of vertical transmission of HIV in Brazil. Clinics (Sao Paulo) 2019; 74:e318. [PMID: 31531571 PMCID: PMC6735274 DOI: 10.6061/clinics/2019/e318] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 06/17/2019] [Indexed: 11/18/2022] Open
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.
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Affiliation(s)
| | - Kathryn Lynn Lovero
- Infectious Diseases, Berkeley School of Public Health, University of California, California, US
| | | | - Laís Lopes Pires
- Departamento Materno-Infantil, Faculdade de Medicina, Universidade Federal Fluminense, Niteroi, RJ, BR
| | | | - Estela Magalhães Cosme
- Departamento Materno-Infantil, Faculdade de Medicina, Universidade Federal Fluminense, Niteroi, RJ, BR
| | - Camila de Morais Salviato
- Departamento Materno-Infantil, Faculdade de Medicina, Universidade Federal Fluminense, Niteroi, RJ, BR
| | | | - Natália Beatriz Cabrera
- Departamento Materno-Infantil, Faculdade de Medicina, Universidade Federal Fluminense, Niteroi, RJ, BR
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