Departamento Materno-Infantil, Faculdade de Medicina, Universidade Federal Fluminense, Niteroi, RJ, BR.
Infectious Diseases, Berkeley School of Public Health, University of California, California, US.
Clinics (Sao Paulo). 2019;74:e318. doi: 10.6061/clinics/2019/e318. Epub 2019 Sep 16.
The present literature review aims to highlight gaps in the treatment of preventative mother-to-child HIV transmission and the risk factors in Brazil.
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.
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.
This review may serve as a guide for future programs to focus efforts on the prevention of vertical HIV transmission.
本文献综述旨在强调巴西在预防母婴 HIV 传播治疗和风险因素方面存在的差距。
在 SciELO 和 PubMed 搜索中确定的 425 篇文章中，选择了 1994 年至 2016 年间发表的 59 篇文章进行阅读和数据提取，并将 33 篇文章纳入本综述。
研究中描述的垂直 HIV 传播率差异很大，从 1.8%到 27.8%，近年来显著下降。然而，最近在巴西不同地区发现的比率也存在差异，尽管母婴传播的显著减少，但预防服务仍存在许多差距。未能接受产前保健是与 HIV 垂直传播风险增加相关的主要因素，这阻碍了母亲的早期诊断和在产前期间完成预防措施，并且往往在围产期和产后期间也无法完成。少数研究讨论了社会人口因素，包括孕妇教育水平低以及卫生服务不足，如预约困难和培训不足的工作人员，这些都与垂直传播有关。因此，当前的挑战是更好地确定增加母婴 HIV 垂直传播风险的社会人口和基础设施因素，以便为促进这些人群更早地纳入预防服务提供必要的投资。
本综述可以作为未来计划的指南，重点关注预防垂直 HIV 传播的工作。
