HIV rapid testing as a key strategy for prevention of mother-to-child transmission in Brazil

Authors

  • Valdiléa G Veloso Fundação Oswaldo Cruz; Instituto de Pesquisa Clínica Evandro Chagas; Laboratório de Pesquisa em DST/AIDS
  • Francisco I Bastos Fiocruz; Instituto de Comunicação e Informação Científica e Tecnológica em Saúde; Laboratório de Informação em Saúde
  • Margareth Crisóstomo Portela Fiocruz; Escola Nacional de Saúde Publica; Departamento de Administração e Planejamento em Saúde
  • Beatriz Grinsztejn Fundação Oswaldo Cruz; Instituto de Pesquisa Clínica Evandro Chagas; Laboratório de Pesquisa em DST/AIDS
  • Esau Custodio João Hospital dos Servidores do Estado do Rio de Janeiro.; Serviço de Doenças Infecciosas e Parasitárias
  • Jose Henrique da Silva Pilotto Fundação Oswaldo Cruz; Instituto de Pesquisa Clínica Evandro Chagas; Laboratório de Pesquisa em DST/AIDS
  • Ana Beatriz Busch Araújo Secretaria Municipal de Saúde do Rio de Janeiro
  • Breno Riegel Santos Hospital Nossa Senhora da Conceição. Grupo Hospitalar Conceição; Departamento de Doenças Infecciosas
  • Rosana Campos da Fonseca Hospital Fêmina
  • Regis Kreitchmann Irmandade da Santa Casa de Misericórdia de Porto Alegre
  • Monica Derrico Fundação Oswaldo Cruz; Instituto de Pesquisa Clínica Evandro Chagas; Laboratório de Pesquisa em DST/AIDS
  • Ruth Khalili Friedman Fundação Oswaldo Cruz; Instituto de Pesquisa Clínica Evandro Chagas; Laboratório de Pesquisa em DST/AIDS
  • Cynthia B Cunha Fundação Oswaldo Cruz; Instituto de Pesquisa Clínica Evandro Chagas; Laboratório de Pesquisa em DST/AIDS
  • Mariza Gonçalves Morgado Fiocruz; Departamento de Imunologia; Laboratório de AIDS e Imunologia Molecular
  • Karin Nielsen Saines University of California; David Geffen School of Medicine; Department of Pediatrics
  • Yvonne J Bryson University of California; David Geffen School of Medicine; Department of Pediatrics

DOI:

https://doi.org/10.1590/S0034-89102010005000034

Keywords:

Pregnant Women, Prenatal Care, Breast Feeding, AIDS Serodiagnosis, HIV Infections^i1^sdiagno, Infectious Disease Transmission, Vertical, Acquired Immunodeficiency Syndrome^i1^sprevention & cont

Abstract

OBJECTIVE: To assess the feasibility of HIV rapid testing for pregnant women at maternity hospital admission and of subsequent interventions to reduce perinatal HIV transmission. METHODS: Study based on a convenience sample of women unaware of their HIV serostatus when they were admitted to delivery in public maternity hospitals in Rio de Janeiro and Porto Alegre, Brazil, between March 2000 and April 2002. Women were counseled and tested using the Determine HIV1/2 Rapid Test. HIV infection was confirmed using the Brazilian algorithm for HIV infection diagnosis. In utero transmission of HIV was determined using HIV-DNA-PCR. There were performed descriptive analyses of sociodemographic data, number of previous pregnancies and abortions, number of prenatal care visits, timing of HIV testing, HIV rapid test result, neonatal and mother-to-child transmission interventions, by city studied. RESULTS: HIV prevalence in women was 6.5% (N=1,439) in Porto Alegre and 1.3% (N=3.778) in Rio de Janeiro. In Porto Alegre most of women were tested during labor (88.7%), while in Rio de Janeiro most were tested in the postpartum (67.5%). One hundred and forty-four infants were born to 143 HIV-infected women. All newborns but one in each city received at least prophylaxis with oral zidovudine. It was possible to completely avoid newborn exposure to breast milk in 96.8% and 51.1% of the cases in Porto Alegre and Rio de Janeiro, respectively. Injectable intravenous zidovudine was administered during labor to 68.8% and 27.7% newborns in Porto Alegre and Rio de Janeiro, respectively. Among those from whom blood samples were collected within 48 hours of birth, in utero transmission of HIV was confirmed in 4 cases in Rio de Janeiro (4/47) and 6 cases in Porto Alegre (6/79). CONCLUSIONS: The strategy proved feasible in maternity hospitals in Rio de Janeiro and Porto Alegre. Efforts must be taken to maximize HIV testing during labor. There is a need of strong social support to provide this population access to health care services after hospital discharge.

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Published

2010-10-01

Issue

Vol. 44 No. 5 (2010)

Section

Original Articles

How to Cite

Veloso, V. G., Bastos, F. I., Portela, M. C., Grinsztejn, B., João, E. C., Pilotto, J. H. da S., Araújo, A. B. B., Santos, B. R., Fonseca, R. C. da, Kreitchmann, R., Derrico, M., Friedman, R. K., Cunha, C. B., Morgado, M. G., Saines, K. N., & Bryson, Y. J. (2010). HIV rapid testing as a key strategy for prevention of mother-to-child transmission in Brazil . Revista De Saúde Pública, 44(5), 803-811. https://doi.org/10.1590/S0034-89102010005000034