Double screening for syphilis and HIV in pregnant women in a priority municipality for the elimination of vertical transmission in Brazil: incidence, risk factors and spatial analysis

ABSTRACT Background The Brazilian Ministry of Health (MoH) recommends double screening (DS) for syphilis and HIV during the first and third trimesters of antenatal care (ANC) to mitigate vertical transmission. We surveyed DS outcomes and their associated factors in a priority Brazilian municipality...

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Published in:Transactions of the Royal Society of Tropical Medicine and Hygiene 2023-05, Vol.117 (5), p.336-348
Main Authors: Fava, Lidiane Martins Gonçalves, Guedes, Ana Lúcia de Lima, Ribeiro, Luiz Cláudio, Pinto, Carmen Perches Gomide, Souza e Guimarães, Ricardo José de Paula, Nogueira, Mário Círio, Alves, Márcio José Martins, Silva, Márcio Roberto
Format: Article
Language:English
Subjects:
Brazil - epidemiology
Female
HIV Infections - diagnosis
HIV Infections - epidemiology
HIV Infections - prevention & control
Humans
Incidence
Infectious Disease Transmission, Vertical - prevention & control
Pregnancy
Pregnancy Complications, Infectious - diagnosis
Pregnancy Complications, Infectious - epidemiology
Pregnancy Complications, Infectious - prevention & control
Pregnant Women
Risk Factors
Spatial Analysis
Syphilis - diagnosis
Syphilis - epidemiology
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Summary:ABSTRACT Background The Brazilian Ministry of Health (MoH) recommends double screening (DS) for syphilis and HIV during the first and third trimesters of antenatal care (ANC) to mitigate vertical transmission. We surveyed DS outcomes and their associated factors in a priority Brazilian municipality with >100 000 inhabitants who face challenges for both health problems. Methods A total of 399 women were followed up throughout pregnancy using medical records. Spatial and multinomial logistic analyses were performed. Results There was an incidence rate of 24.8%, 59.4% and 15.8% for ‘full DS’, ‘partial DS’ and ‘without DS’, respectively. Younger women and those with a history of both prematurity and multiparity were less likely to be in the ‘full DS’ category. There was an overlap of high-density clusters of ‘full DS’ and ‘ANC in better quality basic health units’, adherent to both the Family Health Strategy and the National Program for Access and Quality Improvement in Primary Care. Conclusions The poor DS outcomes presented in 75% of the cases were mostly linked to delays in starting ANC appointments or their discontinuity. Thus, the MoH recommendations, accompanied by ongoing training, technical assistance and the periodic evaluation of their implementation, need to effectively reach providers and promote counseling and awareness about the importance of DS for pregnant women.
ISSN:0035-9203
1878-3503
DOI:10.1093/trstmh/trac113