STI-HIV/AIDS Program Area, Public Health Ministry, Montevideo, Uruguay.
Latin American Center of Perinatology, Women and Reproductive Health, Montevideo, Uruguay.
BMC Pregnancy Childbirth. 2019 Nov 4;19(1):400. doi: 10.1186/s12884-019-2516-z.
In Uruguay it is mandatory to review all cases of positive HIV or reactive syphilis tests in pregnancy and peripartum. We compared the rates of mother-to-child transmission of syphilis and HIV detected by case reviews to those obtained from the usual surveillance system and described the characteristic of vertical transmission cases.
This is a cross-sectional study performed with secondary data obtained from official government sources, for all the country cases of maternal to child transmission of HIV and syphilis from 2012 to 2017, with descriptive analyses. For congenital syphilis analyses, the following pregnancy characteristics were investigated: number of antenatal checks, gestational age at pregnancy diagnosis, gestational age at syphilis test and diagnosis, adequate treatment, and treatment of partners. Sociodemographic characteristics included type of health care (public/private), maternal age, distribution of ethnic minorities, maximum educational attainment, presence of partner, planned pregnancy, drug and alcohol use, domestic violence, previous maternal diagnosis of syphilis, and previous children with congenital syphilis.
Coverage of syphilis case reviews increased from 82% in 2014 to 97.4% in 2017. For HIV, this coverage reached 100% in 2017 and elimination of mother to child transmission was achieved. A marked decline in congenital syphilis was noted in the public health care sector, especially in the capital Montevideo, whereas the private sector has remained below the elimination target. Variables related with congenital syphilis in exposed children were late pregnancy diagnosis, < 5 antenatal checks, delayed diagnosis of gestational syphilis, lower rate of correct treatment for gestational syphilis, untreated partner, low maternal schooling, unplanned pregnancy, history of syphilis, and having other children with syphilis.
The use of case reviews provided knowledge regarding the accurate number of mother-to-child transmission cases and the evolution of elimination of mother to child transmission in the country. The results suggest that rates must be adjusted, providing an opportunity to improve the reliability of surveillance data, and point the need to address specific gaps in order to improve the quality of care during pregnancy, delivery, and the neonatal period.
在乌拉圭，对所有妊娠和围产期 HIV 阳性或梅毒反应性检测的病例进行审查是强制性的。我们将病例审查中发现的梅毒和 HIV 母婴传播率与常规监测系统获得的传播率进行了比较，并描述了垂直传播病例的特征。
这是一项使用从官方政府来源获得的二级数据进行的横断面研究，研究对象为 2012 年至 2017 年期间全国所有 HIV 和梅毒母婴传播的病例，采用描述性分析。对于先天性梅毒分析，调查了以下妊娠特征：产前检查次数、妊娠诊断时的孕龄、梅毒检测和诊断时的孕龄、充分治疗以及配偶治疗。社会人口学特征包括医疗类型（公立/私立）、产妇年龄、少数民族分布、最高教育程度、伴侣存在、计划妊娠、药物和酒精使用、家庭暴力、既往梅毒产妇诊断和既往先天性梅毒儿童。
梅毒病例审查的覆盖率从 2014 年的 82%增加到 2017 年的 97.4%。2017 年，HIV 的覆盖率达到 100%，实现了母婴传播的消除。在公共医疗保健部门，尤其是首都蒙得维的亚，先天性梅毒的发生率显著下降，而私立部门仍低于消除目标。暴露儿童中与先天性梅毒相关的变量包括妊娠晚期诊断、<5 次产前检查、妊娠梅毒诊断延迟、妊娠梅毒正确治疗率低、未治疗的配偶、母亲受教育程度低、非计划妊娠、梅毒病史和其他患有梅毒的儿童。
病例审查的使用提供了关于母婴传播病例的准确数量以及该国消除母婴传播的进展情况的知识。结果表明，必须调整这些比率，从而为提高监测数据的可靠性提供机会，并指出需要解决特定差距，以改善妊娠、分娩和新生儿期的护理质量。
