Dupla triagem para sífilis e HIV em gestantes de um município prioritário para eliminação da transmissão vertical no Brasil: incidência, fatores de risco e análise espacial

Abstract

The World Health Organization established, in 2010, criteria for the elimination of vertical transmission of Human Immunodeficiency Virus (HIV) and congenital syphilis (CS) in an integrated way. From then on, the Ministry of Health (MS) in Brazil recommends double testing for syphilis and HIV during antenatal care (AC) in the first and third trimesters of pregnancy. This study aims to assess the incidence of pregnant women assisted in primary care in the city of Juiz de Fora, MG who did not undergo double testing in the periods recommended during AC and which factors are associated with non-compliance with these tests. This is a prospective observational cohort study that followed 399 pregnant women interviewed from July to December 2018. As participants, they performed the antenatal care exclusively at the Basic Health Unit in Juiz de Fora and, at the time of the interview, they were in reserved postpartum accommodation care or abortion in Health Unic System hospitals. Univariate and multivariate multinomial logistic regressions were evaluated to assess associations between possible explanatory variables and the incidences of the three defined outcome categories. The spatial analysis related the degree of compliance of the double testing with the types of Basic Health Unit (BHU) and the most vulnerable regions of the city. This study found an incidence of 24.8% (95%CI, 21 - 29), 59.4% (95%CI, 55 - 64) and 15.8% (95%CI, 12 - 19) of pregnant women who complied completely, partially and did not complete a double test. Younger pregnant women, with a history of prematurity and with a higher number of pregnancies have a higher risk of not complying with the double test as recommended by the MS. According to georeferencing, the clusters for full service and non-compliance with double testing were concentrated in the south of the city. On the other hand, partial care took place homogeneously throughout the territory, demonstrating failures in the quality of antenatal care in general in all BHU. We conclude that testing for syphilis and HIV took place in only a quarter of the pregnant women in the study according to the Ministry of Health protocol. Defining the risk factors involved in non-compliance with double testing and the correlation of regions of non-compliance with areas of greater vulnerability in the municipality can be useful to direct programs for the control of vertical transmission of syphilis and HIV and to focus on strategies that reach women from the most exposed group in order to improve the quality of healthcare and the elimination of these problems.