Instituto Nacional de Infectologia Evandro Chagas (INI/Fiocruz), Av. Brasil, 4365-Manguinhos, Rio de Janeiro, CEP: 21040-360, Brasil.
Instituto de Comunicação e Informação Científica e Tecnológica em Saúde (Icict/Fiocruz), Av. Brasil, 4.365 - Pavilhão Haity Moussatché-Manguinhos, Rio de Janeiro, CEP: 21045-360, Brasil.
BMC Infect Dis. 2015 Feb 26;15:100. doi: 10.1186/s12879-015-0837-8.
The rate of vertical HIV transmission has decreased in Brazil, but regional inequalities suggest problems in implementing control measures during pregnancy and delivery. The aims of this study were to ascertain the coverage of HIV testing during prenatal care and estimate the prevalence of HIV infection during pregnancy in Brazil.
This was a national hospital-based study of 23,894 women that was conducted in 2011-2012. The data came from interviews with mothers during postpartum hospitalization, from hospital medical files and from prenatal cards. All the pregnant women with reactive serological results for HIV infection marked on their cards or with diagnoses of HIV infection during the hospital stay for delivery were considered cases of HIV infection. Univariate and multivariable logistic regression were performed to investigate factors associated with the prevalence of HIV infection and with performing at least one HIV test during pregnancy.
Among participating women, the coverage of testing for HIV infection was 81.7% among those who presented with prenatal card and the prevalence of HIV infection among pregnant women was 0.4% (95% CI: 0.32-0.51%). In the adjusted analysis, there was higher coverage of testing among women living in the South and Southeast regions; of women aged 35 years and over; with greater schooling levels; who self-reported as white; with prenatal care provided in private services; with an early start to prenatal care; and with an adequate number of consultations, defined as a minimum of six for a term pregnancy. In the adjusted analyses there was a greater odds ratio of HIV infection among women living in the South region, aged 35 years and over, with schooling of less than 8 years, who self-reported race as black, without a partner, with syphilis coinfection and who were attended by public services.
The prevalence of HIV infection among pregnant women in Brazil remains below 1% and the coverage of testing for HIV infection is over 80%. However, the regional and social inequalities in access to healthcare services and the missed opportunities for diagnoses of HIV infection indicate the importance of strengthening HIV infection control programs during pregnancy.
巴西的垂直 HIV 传播率有所下降，但区域不平等表明在怀孕期间和分娩期间实施控制措施存在问题。本研究的目的是确定产前保健中 HIV 检测的覆盖率，并估计巴西怀孕期间 HIV 感染的流行率。
这是一项全国性的基于医院的研究，共纳入 23894 名女性，研究于 2011-2012 年进行。数据来自母亲产后住院期间的访谈、医院病历和产前卡。所有产前卡上标记有 HIV 感染血清学反应阳性或在分娩期间住院时被诊断为 HIV 感染的孕妇均被视为 HIV 感染病例。采用单因素和多因素逻辑回归分析调查与 HIV 感染流行率以及怀孕期间至少进行一次 HIV 检测相关的因素。
在参与研究的女性中，携带产前卡的孕妇中 HIV 感染检测覆盖率为 81.7%，孕妇中 HIV 感染的流行率为 0.4%（95%CI：0.32-0.51%）。在调整分析中，南部和东南部地区、35 岁及以上、教育程度较高、自报为白人、在私立服务机构接受产前护理、早期开始产前护理以及接受足够数量的咨询（对于足月妊娠，最低为 6 次）的女性检测覆盖率较高。在调整分析中，南部地区、35 岁及以上、受教育程度低于 8 年、自报为黑人、没有伴侣、合并梅毒感染以及在公立服务机构接受治疗的女性 HIV 感染的比值比更高。
巴西孕妇 HIV 感染的流行率仍低于 1%，HIV 检测覆盖率超过 80%。然而，获得医疗保健服务的地区和社会不平等以及错失 HIV 感染诊断的机会表明，加强怀孕期间 HIV 感染控制计划的重要性。
