Efetividade do pré-natal especializado para o controle da Infecção pelo HIV na gestação, no puerpério e na transmissão vertical, em um serviço de referência de Salvador – Bahia

Abstract

Introduction: The transmission of HIV infection from mother to child during pregnancy, labor, birth and breastfeeding is still a severe public health problem in Brazil. The adherence to antiretroviral treatment (ART), during pregnancy and in the post partum period, is essential for strengthening the prevention of vertical transmission (VT), as well as for the health care of women and newborns. The general objective of this study was to investigate the effectiveness of prenatal and postpartum follow-up, adherence and retention to treatment in controlling HIV infection, in a reference service in Salvador (BA), as well as analyzing the factors that influence access, retention and adherence to treatment, in 2015 and 2018. Method – This doctoral thesis was based on a real-world study, in a center specialized in assisting pregnant women living with HIV in Bahia, and was structured as follows: chapters of literature review and exposition of the general methodology of the work constitute sections that precede the presentation of the results, in the form of two articles. Results – The first article presents a longitudinal retrospective study, collecting data from pregnant women over 18 years old, undergoing prenatal care at CEDAP, in the year 2015 and 2018, with follow-up of up to 12 months postpartum. In addition, newborns exposed to HIV were evaluated until the VT outcome. 235 women aged 18 to 41, who were living with HIV, participate in it. Most of the pregnant women had a low level of education, were single, black and came from Salvador. The majority were diagnosed before the current pregnancy, and were experienced with antiretroviral treatment. There was an undetectable viral load rate higher than 60% in the period closest to birth, and more than 90% of these pregnant women were assessed as complying with the recommendations of the TV prevention protocol. However, was observed a reduction in the rates of adherence and retention, considering the pre- and postpartum periods. The vertical transmission rate was 2.6%, and the viral load of undetectable delivery was considered a protective factor for TV. Conclusions – We conclude that the complying with the recommendations of the TV prevention protocol during prenatal follow-up was effective in preventing vertical transmission, especially for those with viral load not-detected at the closest moment of delivery and for retaining women in the postnatal period. In the research process presented in the second article, questionnaires were applied to postpartum women during postnatal follow-up consultation, to assess difficulties regarding access, adherence and retention in the service. The findings showed a good evaluation regarding the quality of the service and the report of difficulties regarding socioeconomic characteristics of the puerperal women. Prenatal consultations, pediatric consultations and other services are opportune moments for listening, encouragement and access to information that may impact on postpartum compliance and retention.