Sociodemographic characteristics of children born to HIV-infected mothers in Western French Guiana.

BACKGROUND: French Guiana is the French department most affected by HIV. The situation in Western French Guiana is complicated by the transborder context and isolation of many patients. This study aims to describe the epidemiological characteristics of children born to mothers living with HIV followed in Western French Guiana. METHODS: This was a retrospective and descriptive study. All children born to HIV-infected mothers between 2014 and 2018 were included. Data were collected using a survey sheet to generate an Excel database. RESULTS: We recorded 177 newborns exposed to maternal HIV, four of whom (2.26 %) were infected. The majority of women (87 %) were of foreign origin, and only 7 % had conventional health insurance coverage. The infection was discovered during pregnancy in 20 % of women. Overall 21.71 % of newborns were preterm and 22.5 % hypotrophic. All neonates had received antiretroviral prophylaxis for four weeks, either as monotherapy (AZT) (67.43 %) or triple therapy (AZT/3TC/NVP) (25.71 %). Twenty-two neonates had at least one neonatal illness: transient respiratory distress (9 cases), asphyxia (3 cases), hyaline membrane disease (8 cases), and there were two cases with birth defects: clubfoot (1 case) and heart disease (1 case). The follow-up rate at 24 months was 65 % and 35 % of cases were lost to follow-up. The most common biological anomalies were anemia (69.14 %), hyperlacticaemia (23 %), and neutropenia (9.14 %). CONCLUSION: The prevalence of mother-to child transmission of HIV was high; a quarter of maternal infections were discovered during pregnancy. The mother's socio-economic situation was often precarious and follow-up interruptions common.

Factors associated with loss to follow up among HIV-exposed children: a historical cohort study from 2000 to 2017, in Porto Alegre, Brazil.

BACKGROUND: There are many inequalities in terms of prevention and treatment for pregnant women with HIV and exposed children in low and middle-income countries. The Brazilian protocol for prenatal care includes rapid diagnostic testing for HIV, compulsory notification, and monitoring by the epidemiological surveillance of children exposed to HIV until 18 months after delivery. The case is closed after HIV serology results are obtained. Lost to follow-up is defined as a child who was not located at the end of the case, and, therefore, did not have a laboratory diagnosis. Lost to follow-up is a current problem and has been documented in other countries. This study analyzed factors associated with loss to follow-up among HIV-exposed children, including sociodemographic, behavioral, and health variables of mothers of children lost to follow-up. METHODS: This historical cohort study included information on mothers of children exposed to HIV, born in Porto Alegre, from 2000 to 2017. The research outcome was the classification at the end of the child's follow-up (lost to follow-up or not). Factors associated with loss to follow-up were investigated using the Poisson regression model. Relative Risk calculations were performed. The significance level of 5% was adopted for variables in the adjusted model. RESULTS: Of 6,836 children exposed to HIV, 1,763 (25.8%) were classified as lost to follow-up. The factors associated were: maternal age of up to 22 years (aRR 1.25, 95% CI: 1.09-1.43), the mother's self-declared race/color being black or mixed (aRR 1.13, 95% CI: 1.03-1.25), up to three years of schooling (aRR 1.45, 95% CI: 1.26-1.67), between four and seven years of schooling (aRR 1.14, 95% CI: 1.02-1.28), intravenous drug use (aRR 1.29, 95% CI: 1.12-1.50), and HIV diagnosis during prenatal care or at delivery (aRR 1.37, 95% CI: 1.24-1.52). CONCLUSION: Variables related to individual vulnerability, such as race, age, schooling, and variables related to social and programmatic vulnerability, remain central to reducing loss to follow-up among HIV-exposed children.

As práticas de saúde para redução da Transmissão Vertical do HIV em Unidades de Atenção Básica: realidades e determinantes / The practice of health to reduction the mother to child transmission of HIV in Unit Basic Care: reality and determine

Nos últimos anos tem-se registrado um aumento de casos de aids entre populações mais vulneráveis, especialmente entre mulheres. O impacto desse crescimento é evidenciado no aumento de casos de aids por meio da transmissão vertical. Para entender esse aumento é necessário compreender a complexidade do processo que envolve a epidemia, que alcança com mais intensidade os seguimentos menos privilegiados social e economicamente. A crescente ocorrência de casos de transmissão vertical do HIV, apesar da existência de meios para a sua prevenção, diagnóstico e tratamento, despertam a necessidade em avaliar a operacionalização das políticas em UBS. Nesse sentido, o estudo teve por objetivo identificar os componentes da dimensão programática da vulnerabilidade à infecção pelo HIV, na perspectiva da Transmissão Vertical em UBS, com a finalidade de fornecer subsídios para controle da aids no segmento materno-infantil. Adotou-se como referencial teórico o conceito de vulnerabilidade e a determinação social do processo saúde-doença. É um estudo descritivo, desenvolvido a partir de prontuários clínicos e de entrevistas com 79 gestantes e com profissionais em UBS da Coordenadoria de Saúde de Santana, em São Paulo. Para os dados de prontuários e das entrevistas, utilizou-se questionário cujas respostas foram analisadas qualitativamente. As gestantes estudadas apresentam um perfil de mulheres com baixa escolaridade, dependentes economicamente e pertencentes a segmentos sociais menos privilegiados, o que as tornam mais vulneráveis ao HIV/AIDS. A análise dos dados aponta falhas na operacionalização das ações para a prevenção da TV do HIV nas UBS. Embora a maioria das gestantes tenha sido testada, o aconselhamento pré e pós-teste nem sempre foi realizado, e as gestantes desconhecem sua finalidade. Não houve solicitação de testagem para todas, tão pouco se garantiu a voluntariedade. O fluxo laboratorial implica no aumento da ) vulnerabilidade, sendo evidenciado um retardo para a realização da coleta e de retorno dos resultados, levando a intervalos longos entre a entrada das gestantes na unidade e o resultado do HIV. Quanto aos profissionais, destaca-se insegurança no trato de questões ligadas a DST/AIDS, e sua relação com a gestação. Conclui-se que as UBS deveriam ser um espaço privilegiado para a prevenção da Transmissão Vertical do HIV, porém as falhas encontradas para a operacionalização das ações impactam negativamente no controle da Transmissão Vertical. Reconhece-se também que as ações de saúde reprodutiva e da política de DST/AIDS refletem uma interface ainda limitada, carente de ações sinérgicas, que respondam efetivamente às demandas expostas

Lately we have been registering an increase of AIDS cases among most vulnerable populations, specially among women. The impact of this growth is showed in the increase of AIDS cases by mother to child transmission. To understand this increase it is necessary to comprehend the complexity of the process which involves the epidemy, that reachs with more intensity the social and economically less privileged segments. The crescent number of HIV cases in Mother to Child Transmission, despite of the existence of prevention, diagnosis and treatment, awakes the need to make these Basic Health Units policy operable. In that sense, the purpose of the study was identify the components of HIV infection by Mother to Child Transmission in Basic Health Units (BHU). Hoping to provide resources to AIDS control in maternal-childish. We adopted as a theoretical reference the vulnerability concept and social determination in the health-disease process. This is a descriptive study, developed from clinical promptuaries and interviews with 79 pregnant women and BHU professionals in the Santana district, São Paulo. To gather information from promptuary and from theinterview we utilized a questionary , whose the answers were qualitativelly analized. The pregnant women studied showed a profite of low school age, and economic dependence also belonging to less privileged social segments. That made them more vulnerable to HIV/AIDS. The data analysis shows failures in actions to Mother to Child Transmission prevention in the Basic Health Units. Although the majority of pregnant women had been tested, the counseling was not always done, and they didan´tt know the purpose of these tests. There was no asking to test the women, and no choice was given to them. The laboratorial work flow increases vulnerability since has been showing a delay between testing and test result testing, huge gaps between pregnant women entrance in the basic unit and the HIV exams results. Regarding professionals, we could point out their insecurity to deal with those questions linked to STD/AIDS, and its relation with pregnancy. We can conclude that BHU should be a privileged space for HIV in mother to child transmission prevention, therefore the failures that we found agaisnt go the control mother to child transmission. We also recognise the health actions and the STD/AIDS politics as a poor interface, wich should give an effective answer to the exposed demands