与初级卫生保健中产前保健以及孕期 HIV 和梅毒检测相关的因素。
Factors associated with prenatal care and HIV and syphilis testing during pregnancy in primary health care.
机构信息
Universidade Federal da Paraíba. Departamento de Clínica e Odontologia Social. João Pessoa, PB, Brasil.
Universidade Federal do Rio Grande do Norte. Programa de Pós-Graduação em Saúde Coletiva. Natal, RN, Brasil.
出版信息
Rev Saude Publica. 2019 Sep 23;53:76. doi: 10.11606/s1518-8787.2019053001205. eCollection 2019.
OBJECTIVE
To evaluate the factors associated with HIV and syphilis testing during pregnancy in Brazil.
METHODS
This was an ecological study covering all Brazilian municipalities evaluated by the second cycle of the National Program for Access and Quality Improvement in Primary Care, 2013-2014. The dependent variables were based on prenatal care access: prenatal care appointments, and HIV and syphilis tests during prenatal care. The independent variables were compared with demographic and social characteristics. Bivariate analysis was performed assessing the three outcomes with the independent variables. Variables with significant associations in this bivariate analysis were fit in a Poisson multiple regression analysis with robust variance to obtain adjusted estimates.
RESULT
Poisson regression analysis showed a statistically significant association with the variables "less than eight years of study" [prevalence ratio (PR) = 1.31; 95%CI 1.19-1.45; p < 0.001] and "participants of the cash transfer program" (PR = 0.80; 95%CI 0.72-0.88; p < 0.001) for the outcome of "having less than six prenatal care appointments" and individual variables. A statistically significant association was found for "participants of the cash transfer program" (PR = 1.43; 95%CI 1.19-1.72; p < 0.001) regarding the outcome from the comparison between HIV testing absence during prenatal care and demographic and social characteristics. The absence of syphilis testing during prenatal care, and demographic and social characteristics presented a statistically significant association for the education level variable "less than eight years of study" (PR =1.75; 95%CI 1.56-1.96; p < 0.001) and "participants of the cash transfer program" (PR = 1.21, 95%CI 1.07-1.36; p < 0.001).
CONCLUSIONS
The individual factors were associated with prenatal care appointments and HIV and syphilis tests in Brazilian pregnant women. They show missed opportunities for diagnosing HIV and syphilis infection during prenatal care and indicate weaknesses in the quality of maternal health care services to eliminate mother-to-child transmission.
目的
评估巴西孕妇进行 HIV 和梅毒检测的相关因素。
方法
这是一项生态研究，涵盖了所有在 2013-2014 年接受国家初级保健准入和质量改善计划第二周期评估的巴西市政当局。因变量基于产前保健的可及性：产前保健预约以及产前保健期间的 HIV 和梅毒检测。将独立变量与人口统计学和社会特征进行比较。采用双变量分析，用泊松多项回归分析对三个结果进行了稳健方差分析，以获得调整后的估计值。
结果
泊松回归分析显示，“受教育程度不足 8 年”[流行率比（PR）=1.31；95%置信区间（CI）为 1.19-1.45；p<0.001]和“参与现金转移计划”（PR=0.80；95%CI 为 0.72-0.88；p<0.001）与“少于 6 次产前保健预约”这一结果具有统计学意义，个体变量也是如此。在“参与现金转移计划”（PR=1.43；95%CI 为 1.19-1.72；p<0.001）方面，HIV 检测在产前保健期间的缺失与人口统计学和社会特征具有统计学意义。梅毒检测在产前保健期间的缺失以及人口统计学和社会特征与教育程度变量“不足 8 年”（PR=1.75；95%CI 为 1.56-1.96；p<0.001）和“参与现金转移计划”（PR=1.21；95%CI 为 1.07-1.36；p<0.001）呈统计学意义。
结论
个体因素与巴西孕妇的产前保健预约以及 HIV 和梅毒检测相关。这些因素表明，在产前保健期间错过了诊断 HIV 和梅毒感染的机会，也表明消除母婴传播的孕产妇保健服务质量存在不足。
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