Please use this identifier to cite or link to this item:
Type: Artigo de periódico
Title: [timely Implementation Of Interventions To Reduce Vertical Hiv Transmission: A Successful Experience In Brazil].
Author: Amaral, Eliana
Assis-Gomes, Francisco
Milanez, Helaine
Cecatti, José Guilherme
Vilela, Maria Marluce
Pinto E Silva, João Luiz
Abstract: To describe the impact, at the public maternity facility of a university hospital in Brazil, of the rapid implementation of new guidelines recommended by national consensus panels concerning the prevention of vertical HIV transmission. We performed a retrospective study of deliveries by HIV-infected women at the public maternity facility of a university hospital in the city of Campinas, São Paulo, Brazil, from 1990 through 2000. The guidelines utilized at the facility during this period were: (1) from 1990 through 1994, contraindication to breast-feeding and no use of antiretroviral drugs; (2) 1995 and 1996, use of zidovudine (AZT) by the pregnant woman and the newborn; (3) 1997 and 1998, use of AZT according to the ACTG 076 protocol; and (4) 1999 and 2000, multiple antiretroviral agents and elective cesarean delivery. All the antiretroviral drugs were provided for free by Brazil's public health care system. The vertical transmission rate was calculated for each of the four stages, and the risk ratio for congenital transmission was calculated for each stage and for each prophylactic intervention separately (breast-feeding, type of antiretroviral drug, type of delivery). We studied 197 deliveries at the public maternity facility over that 1990-2000 period. Over the four stages, the rate of vertical transmission decreased: it was 32.3% in the first stage, 25.7% in the second, 2.2% in the third, and 2.9% in the fourth. The most pronounced decrease, observed from the second to the third stage, occurred after introduction of the full ACTG 076 regimen. The use of combined antiretroviral agents increased from 0% in the first stage to 46.4% in the fourth stage. There were no cases of vertical transmission in pregnant women treated with multiple drugs. The risk of vertical HIV transmission was 5 times as great with breast-feeding vs. no breast-feeding (risk ratio = 5.06), 5 times as great with no antiretroviral therapy vs. the full ACTG 076 regimen (risk ratio = 5.29), and 4 times as great with forceps delivery vs. elective cesarean delivery (risk ratio = 4.13). The timely adoption of up-to-date interventions recommended by national consensus panels, along with the free provision of antiretroviral drugs, was effective in reducing congenital HIV transmission in this public maternity facility. The interaction between the university hospital health service and the public health service reduced the time needed for implementation of proven, effective interventions, and this experience could serve as an example for other maternal and perinatal health situations.
Subject: Adult
Anti-hiv Agents
Anti-retroviral Agents
Breast Feeding
Cesarean Section
Cohort Studies
Drug Therapy, Combination
Hiv Infections
Infant, Newborn
Infectious Disease Transmission, Vertical
Odds Ratio
Practice Guidelines As Topic
Pregnancy Complications, Infectious
Retrospective Studies
Citation: Revista Panamericana De Salud Pública = Pan American Journal Of Public Health. v. 21, n. 6, p. 357-64, 2007-Jun.
Rights: fechado
Date Issue: 2007
Appears in Collections:Unicamp - Artigos e Outros Documentos

Files in This Item:
File SizeFormat 
pmed_17761047.pdf83.46 kBAdobe PDFView/Open

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.