Subscribe to RSS
DOI: 10.1055/s-0036-1592102
HIV Prevalence among Pregnant Women in Brazil: A National Survey
Prevalência de HIV em grávidas brasileiras: pesquisa nacionalPublication History
05 March 2016
14 July 2016
Publication Date:
08 September 2016 (online)
Abstract
Background This study was conducted to determine the seroprevalence of HIV among pregnant women in Brazil and to describe HIV testing coverage and the uptake of antenatal care (ANC).
Methods Between October 2010 and January 2012, a probability sample survey of parturient women aged 15–49 years who visited public hospital delivery services in Brazil was conducted. Data were collected from prenatal reports and hospital records. Dried blood spot (DNS) samples were collected and tested for HIV. We describe the age-specific prevalence of HIV infection and ANC uptake with respect to sociodemographic factors.
Results Of the 36,713 included women, 35,444 (96.6%) were tested for HIV during delivery admission. The overall HIV prevalence was of 0.38% (95% confidence interval [CI]: 0.31–0.48), and it was highest in: the 30 to 39 year-old age group (0.60% [0.40–0.88]), in the Southern region of Brazil (0.79% [0.59–1.04]), among women who had not completed primary (0.63% [0.30–1.31]) or secondary (0.67% [0.49–0.97]) school education, and among women who self-reported as Asian (0.94% [0.28–3.10]). The HIV testing coverage during prenatal care was of 86.6% for one test and of 38.2% for two tests. Overall, 98.5% of women attended at least 1 ANC visit, 90.4% attended at least 4 visits, 71% attended at least 6 visits, and 51.7% received ANC during the 1st trimester. HIV testing coverage and ANC uptake indicators increased with increasing age and education level of education, and were highest in the Southern region.
Conclusions Brazil presents an HIV prevalence of less than 1% and almost universal coverage of ANC. However, gaps in HIV testing and ANC during the first trimester challenge the prevention of the vertical transmission of HIV. More efforts are needed to address regional and social disparities.
Resumo
Introdução Este estudo foi realizado com o objetivo de determinar a soroprevalência do HIV entre as mulheres grávidas no Brasil e descrever a cobertura de exames de HIV e a integração dos cuidados pré-natais (CPN).
Métodos Entre outubro de 2010 e janeiro de 2012, foi realizada uma pesquisa de probabilidade por amostragem direcionada a mulheres grávidas com idade entre 15 e 49 anos, que utilizaram serviços de parto em hospitais públicos do Brasil. Os dados foram coletados a partir de relatórios pré-natais e registros hospitalares. Amostras de sangue foram coletadas e submetidas a exames de HIV. Descrevemos a prevalência da infecção pelo HIV específica de acordo com a idade e a absorção dos CPN em relação a fatores demográficos.
Resultados Das 36.713 mulheres incluídas, 35.444 (96,6%) foram submetidas a exames de HIV durante a admissão para o trabalho de parto. A prevalência global de HIV foi de 0,38% (intervalo de confiança [IC] de 95%: 0,31–0,48), e foi maior no grupo com a faixa etária entre 30 e 39 anos de idade (0,60% [0,40–0,88]), da região Sul (0,79% [0,59–1,04]), entre as mulheres com o ensino fundamental incompleto (0,63% [0,30–1,31]) ou ensino médio incompleto (0,67% [0,49–0,97]), e entre as mulheres que se identificam como asiáticas (0,94% [0,28–3,10]). A cobertura do exame de HIV durante os CPN foi de 86,6% para um exame e de 38,2% para dois exames. No geral, 98,5% das mulheres foram atendidas em pelo menos 1 consulta de CPN, 90,4% compareceram a pelo menos 4 consultas, 71% compareceram a pelo menos 6 visitas, e 51,7% receberam CPN durante o 1o trimestre. A cobertura de exames de HIV e os indicadores de captação de CPN aumentaram de forma proporcional ao aumento da idade e do nível de educação, e foram maiores na região Sudeste.
Conclusões O Brasil apresenta uma prevalência de menos de 1% e cobertura praticamente universal de CPN. No entanto, as lacunas nos exames de HIV e CPN durante o primeiro trimestre representam um desafio à prevenção contra a transmissão vertical do HIV. São necessários mais esforços a fim de reduzir as disparidades regionais e sociais.
-
References
- 1 Brazilian Ministry of Health. Secretariat of Health Surveillance. Department of STI, Aids and Viral Hepatitis [Internet]. The Brazilian response to HIV and AIDS: global AIDS response progress reporting: narrative report. Brasília (DF): Ministry of Health; 2015 [cited 2016 Apr 02]. Available from: http://www.unaids.org/sites/default/files/country/documents/BRA_narrative_report_2015.pdf
- 2 Ministry of Health. Secretariat of Health Surveillance. Department of STI, AIDS, and Viral Hepatitis. [Internet][Epidemiological Bulletin AIDS and STI]. Brasília (DF): Ministry of Health; 2015 [cited 2016 Apr 02]; Available from: http://www.aids.gov.br/sites/default/files/anexos/publicacao/2015/58534/boletim_aids_11_2015_web_pdf_19105.pdf . Portuguese
- 3 Murray CJ, Ortblad KF, Guinovart C , et al. Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384 (9947) 1005-1070
- 4 Ministry of Health. Secretariat of Health Surveillance. Department of STI, AIDS, and Viral Hepatitis. [Internet][Epidemiological Bulletin AIDS and STI]. Brasília (DF): Ministry of Health; 2014 [cited 2016 Apr 02]; Available from: http://www.aids.gov.br/sites/default/files/anexos/publicacao/2014/56677/boletim_2014_final_pdf_15565.pdf . Portuguese
- 5 Ministry of Health. Secretariat of Health Surveillance. Department of STI, AIDS, and Viral Hepatitis. [Internet][Epidemiological Bulletin AIDS and STI] Brasília (DF): Ministry of Health; 2013 [cited 2016 Apr 02]; Available from: http://www.aids.gov.br/sites/default/files/anexos/publicacao/2013/55559/_p_boletim_2013_internet_pdf_p__51315.pdf . Portuguese
- 6 Connor EM, Sperling RS, Gelber R , et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. Pediatric AIDS Clinical Trials Group Protocol 076 Study Group. N Engl J Med 1994; 331 (18) 1173-1180
- 7 Brazil. Ministry of Health [Internet]. [Guide of therapeutic approaches in HIV/AIDS– 1996]. Brasília (DF): Ministry of Health; 1996 [cited 1996 Oct 31]. Available from: http://www.aids.gov.br/sites/default/files/GUIA_DE_CONDUTAS_TERAPEUTICAS_EM_HIV_AIDS_-_1996.pdf . Portuguese
- 8 Brazilian Ministry of Health. Secretariat of Health Surveillance. National Program of STI and AIDS [Internet]. [Protocol for the prevention of vertical transmission of HIV and syphilis]. Brasília (DF): Ministry of Health; 2007 [cited 2014 Nov 16]. Available from: http://bvsms.saude.gov.br/bvs/publicacoes/protocolo_prevencao_transmissao_verticalhivsifilis_manualbolso.pdf . Portuguese
- 9 Brazilian Ministry of Health. Secretariat of Health Surveillance. Department of STI, Aids and Viral Hepatitis [Internet]. [Recommendations for the prevention of vertical transmission of HIV and antiretroviral therapy in pregnant women]. Brasília (DF): Ministry of Health; 2010 [cited 2010 Nov 16]. Available from: http://www.aids.gov.br/publicacao/consenso-recomendacoes-para-profilaxia-da-transmissao-vertical-do-hiv-e-terapia-antirretr . Portuguese
- 10 Brazilian Ministry of Health. Secretariat of Health Surveillance. Department of STI, Aids and Viral Hepatitis [Internet]. [Progress report on the Brazilian response to HIV/AIDS (2010–2011)]. Brasília (DF): Ministry of Health; 2012 [cited 2015 Aug 03]. Available from: http://www.aids.gov.br/sites/default/files/anexos/publicacao/2012/51906/ungass_2012_portugues_rev_08jun_pdf_51895.pdf . Portuguese
- 11 Souza Júnior PR, Szwarcwald CL, Barbosa Júnior A, Carvalho MF, Castilho EA. [HIV infection during pregnancy: the Sentinel Surveillance Project, Brazil, 2002]. Rev Saude Publica 2004; 38 (6) 764-772 . Portuguese
- 12 Szwarcwald CL, Barbosa Júnior A, Souza-Júnior PR , et al. HIV testing during pregnancy: use of secondary data to estimate 2006 test coverage and prevalence in Brazil. Braz J Infect Dis 2008; 12 (3) 167-172
- 13 Szwarcwald CL, Souza Júnior PRB. [Estimate of HIV prevalence among Brazilian population aged 15–49 years, 2004]. Epidemiol Bull AIDS DST [Internet]. 2006 [cited 2015 Aug 03];3(1). Available from: http://www.aids.gov.br/sites/default/files/BOLETIM2006internet_0.pdf . Portuguese
- 14 Szwarcwald CL, Castilho EA. [Estimated number of HIV-infected individuals aged 15-49 years in Brazil, 1998]. Cad Saude Publica 2000; 16 (#, Suppl 1) 135-141 . Portuguese
- 15 Szwarcwald CL, Carvalho CH. [Estimate of the number of people infected aged 15–49 years infected by HIV, Brazil, 2000]. Epidemiol Bull AIDS [Internet]. 2001 [cited 2015 Aug 03];14(1). Available from: http://www.aids.gov.br/sites/default/files/Boletim_Epidemiologico_2001_I_Aids.pdf . Portuguese
- 16 Asamoah-Odei E, Garcia Calleja JM, Boerma JT. HIV prevalence and trends in sub-Saharan Africa: no decline and large subregional differences. Lancet 2004; 364 (9428) 35-40
- 17 Schwartländer B, Stanecki KA, Brown T , et al. Country-specific estimates and models of HIV and AIDS: methods and limitations. AIDS 1999; 13 (17) 2445-2458
- 18 Brown T, Bao L, Eaton JW , et al. Improvements in prevalence trend fitting and incidence estimation in EPP 2013. AIDS 2014; 28 (Suppl. 04) S415-S425
- 19 World Health Organization. Joint United Nations Programme on HIV/AIDS [Internet]. Guidelines for second-generation HIV surveillance: the next decade. Geneva: UNAIDS/WHO; 2000 [cited 2015 Apr 14]. (UNAIDS/WHO document WHO/CDS/CSR/EDC/2000.5, UNAIDS/00.03E). Available from: http://www.who.int/hiv/pub/surveillance/en/cds_edc_2000_5.pdf
- 20 United Nations General Assembly Special Sessions on HIV/AIDS [Internet]. Monitoring the Declaration of Commitment on HIV/AIDS: guidelines on construction of core indicators. Geneva: Joint United Nations Program on HIV/AIDS; 2002 [cited 2015 May 15]. Available from: http://www.who.int/hiv/strategic/me/en/isbn9291732389.pdf
- 21 Zaba B, Boerma T, White R. Monitoring the AIDS epidemic using HIV prevalence data among young women attending antenatal clinics: prospects and problems. AIDS 2000; 14 (11) 1633-1645
- 22 Brazilian Ministry of Health. Health Surveillance Secretariat. Department of DST, AIDS, and Viral Hepatitis [Internet]. [PCAP: Knowledge, Attitudes and Practices among Brazilian Population aged 15 to 64 years - 2008]. Brasília: Ministry of Health; 2011 [cited 2016 Jan 20]. Available from: http://www.aids.gov.br/sites/default/files/anexos/publicacao/2009/40352/pcap_2008_f_pdf_13227.pdf . Portuguese
- 23 Pan American Health Organization [Internet]. 2014 update: elimination of mother-to-child transmission of HIV and syphilis in the Americas. Washington (DC): PAHO; 2014 [cited 2014 Dec 20]. Available from: http://www.unicef.org/lac/Elimination_MTCT_in_the_Americas_2014_ENG.pdf
- 24 Pan American Health Organization [Internet]. Field guide for implementation of the strategy and plan of action for elimination of mother-to-child transmission of HIV and congenital syphilis in the Americas. Washington (DC): PAHO; 2014 [cited 2015 Feb 18]. Available from: http://iris.paho.org/xmlui/bitstream/handle/123456789/6080/index.pdf?sequence=1&isAllowed=y
- 25 da Cruz Gouveia PA, da Silva GA, de Fatima Pessoa Militão de Albuquerque M. Factors associated with mother-to-child transmission of the human immunodeficiency virus in Pernambuco, Brazil, 2000-2009. Trop Med Int Health 2013; 18 (3) 276-285
- 26 de Lemos LM, Lippi J, Rutherford GW , et al. Maternal risk factors for HIV infection in infants in northeastern Brazil. Int J Infect Dis 2013; 17 (10) e913-e918
- 27 de Andrade SD, Sabidó M, Marcelo Monteiro W, Canellas L, Prazeres V, Schwartz Benzaken A. Mother-to-child transmission of HIV from 1999 to 2011 in the Amazonas, Brazil: risk factors and remaining gaps in prevention strategies. Pediatr Infect Dis J 2016; 35 (2) 189-195
- 28 Tornatore M, Gonçalves CV, Mendoza-Sassi RA , et al. HIV-1 vertical transmission in Rio Grande, Southern Brazil. Int J STD AIDS 2010; 21 (5) 351-355
- 29 Brazilian Ministry of Health. Secretariat of Health Surveillance. Department of STI, Aids and Viral Hepatitis [Internet]. [Recommendations for the prevention of vertical transmission of HIV and antiretroviral therapy in pregnant women– 2006] [cited 2015 Sep 15]. Brasília (DF): Ministry of Health; 2007. Available from: http://bvsms.saude.gov.br/bvs/publicacoes/consenso_gestantes_2007.pdf . Portuguese
- 30 Domingues RM, Szwarcwald CL, Souza Jr PR, Leal MdoC. Prenatal testing and prevalence of HIV infection during pregnancy: data from the “Birth in Brazil” study, a national hospital-based study. BMC Infect Dis 2015; 15: 100
- 31 Saphonn V, Hor LB, Ly SP, Chhuon S, Saidel T, Detels R. How well do antenatal clinic (ANC) attendees represent the general population? A comparison of HIV prevalence from ANC sentinel surveillance sites with a population-based survey of women aged 15-49 in Cambodia. Int J Epidemiol 2002; 31 (2) 449-455
- 32 Kharsany AB, Frohlich JA, Yende-Zuma N , et al. Trends in HIV prevalence in pregnant women in rural South Africa. J Acquir Immune Defic Syndr 2015; 70 (3) 289-295
- 33 do Carmo Leal M, da Silva AA, Dias MAB , et al. Birth in Brazil: national survey into labour and birth. Reprod Health 2012; 9: 15
- 34 Eaton JW, Rehle TM, Jooste S , et al. Recent HIV prevalence trends among pregnant women and all women in sub-Saharan Africa: implications for HIV estimates. AIDS 2014; 28 (Suppl. 04) S507-S514
- 35 Mujugira A, Heffron R, Celum C, Mugo N, Nakku-Joloba E, Baeten JM ; Partners PrEP Study Team. Fertility intentions and interest in early antiretroviral therapy among East African HIV-1-infected individuals in serodiscordant partnerships. J Acquir Immune Defic Syndr 2013; 63 (1) e33-e35
- 36 Eaton JW, Johnson LF, Salomon JA , et al. HIV treatment as prevention: systematic comparison of mathematical models of the potential impact of antiretroviral therapy on HIV incidence in South Africa. PLoS Med 2012; 9 (7) e1001245
- 37 Glynn JR, Buvé A, Caraël M , et al; Study Group on Heterogeneity of HIV Epidemics in African Cities. Factors influencing the difference in HIV prevalence between antenatal clinic and general population in sub-Saharan Africa. AIDS 2001; 15 (13) 1717-1725