Transmissão vertical do HIV em uma maternidade pública de referência no nordeste do Brasil

Abstract

This thesis aimed to estimate the Vertical Transmission (VT) rate of HIV in a reference university hospital in São Luís, in addition to evaluating the factors related to VT. For this, two studies were developed. The first was a retrospective cohort study with the objective of estimating the vertical transmission rate of HIV in university hospital in the period from 2013 to 2017. Retrospective cohort study based on data from the notification/investigation forms of children exposed to HIV from the Notifiable Diseases Information System (SINAN). The analysis considered all HIV-exposed children reported from 2013 to 2017 at the university hospital. The study variables were described as proximal, intermediary and distal, according to the weight on the outcome variable found in the literature. Factors associated with VT were evaluated using Chi-square and crude and adjusted prevalence ratios obtained by Poisson regression. The study population consisted of 725 children exposed, of which 672 children were exposed and not infected and 53 were infected. Therefore, the estimated rate of VT in the period from 2013 to 2017 was 7.3% (53/725). Most pregnant women were ≥20 years old (86.9%), schooling ≥8 years of study (53.2%), black race (92.7%), paid/autonomous work (46.9%) and resident in another municipality in Maranhão (61.7%). Regarding assistance, 86.3% had prenatal care, 74.6% had prophylaxis with Antiretroviral Therapy (ART) during pregnancy, 81.8% used prophylaxis with ART during childbirth and 78.1% had a cesarean delivery. Among Newborns (NB) 92.8% underwent prophylaxis with HAART and 94.3% were not breastfed. Among the distal variables, maternal education (p-value=0.048) and maternal ethnicity (p-value=0.017) were associated with VT; Among the intermediate variables, prenatal care (p-value=<0.001) and antiretroviral therapy prophylaxis during prenatal care (p-value=<0.001) were associated with VT and in relation to the proximal variables, intravenous ART prophylaxis at labor and delivery (p- value=0.042), prophylaxis in the neonate (p-value=0.002) and prophylaxis duration in the neonate (p-value=<0.001) were associated with VT. The second article was also a retrospective cohort study with the objective of evaluating the use of prophylactic measures recommended by the Ministry of Health (MS) to reduce vertical transmission. The analysis considered children exposed to HIV who were notified between 2013 and 2017 at the university hospital and who gave birth at the institution and residence in São Luís. The study population consisted of 205 children exposed during that period. Regarding the prophylactic measures of the ACTG protocol, the majority (85.8%) took prophylaxis during pregnancy, the majority (92.7%) took prophylaxis at birth and had a cesarean section (86.8%). Regarding the NB, the majority (99.0%) underwent prophylaxis and were not breastfed (99.5%). It is concluded that the estimated VT rate in this study was 7.3%, showing that there are still weaknesses in adopting the interventions recommended in the Ministry of Health protocols in their entirety to achieve the reduction and/or elimination of vertical HIV transmission