AEGiS-13IAC: Implementation of interventions to reduce HIV vertical transmission in Brazil.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Implementation of interventions to reduce HIV vertical transmission in Brazil.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. WeOrC548)

Veloso V, Sudo EC, Vasconcelos A, Sakita K, Cunha CS, Chequer P;;; V.Veloso, Brazilian STD/AIDS Program - MOHA, Esplanada dos Ministerios - Bl. G - Sobreloja, 70.058-900 - Brasilia - DF, Brazil, Tel.: +55 61 315 2140, Fax: +55 61 315 2519, E-mail: aids@aids.gov.br

ISSUE: A marked decrease in pediatric AIDS cases occurred in many developed countries after the implementation of protocol 076. The Brazilian MoH adopted a policy in 1995 for HIV vertical transmission (VT) prevention that includes: (1)counseling and testing for all pregnant women; (2) the full 076 regimen and (3) substitution of breast-feeding (HIV+ women). To date however we have been unable to detect any significant effect of this policy on the number of reported pediatric AIDS cases.

DESCRIPTION: Oral AZT has been made available free of charge to pregnant women in Brazil since 95 and IV AZT since July/96 and since then any shortage have occurred. Despite this, the number of women treated with IV AZT in 98 accounts for only 19.5% of the estimated number of HIV+ women delivering in that year (12,898). The main reasons identified for this level of implementation were the low quality of prenatal care and the limited availability of HIV testing. Training programs, use of rapid HIV testing and public campaigns are among the interventions being implemented in Brazil to overcame these problems Where these interventions were implemented the offer and uptake of HIV test increased significantly but the high cost of HIV tests emerged as an additional obstacle. In spite of all difficulties, data from the MoH indicates that the number of HIV positive pregnant women receiving IV AZT has increased annually (1364 in 97, 2512 in 98, 3.211 in 99).

CONCLUSION: (1) In Brazil, the low quality of prenatal care significantly hampered the implementation of interventions to reduce HIV VT; (2) Despite problems the level of implementation is increasing annually; (3) Lowering the cost of HIV diagnostic tests is one of the main challenges to be faced and the introduction of technology to manufacture HIV diagnostic kits in Brazil will be crucial; (4) Multifaceted interventions tailored to each health system are needed to establish an effective program of HIV VT prevention.

Keywords: AEGIS, Disease Transmission, Vertical, HIV, HIV Infections, Zidovudine, Anti-HIV Agents, Prenatal Care, HIV Seropositivity, Counseling, Breast Feeding, Mass Screening, Acquired Immunodeficiency Syndrome, Brazil, Human, Female, Child, Pregnancy, nursing, transmission
000709
WeOrC548