Towards elimination of vertical transmission of HIV in São Paulo State, Brazil - analysis of the period 1984-2008
L.H. Matida1, A.N. Ramos Jr.2, M.H. Silva1, C.S.B. Domingues1, A. Tayra1, M.C. Gianna1, N. Hearst3, Study Group on MTCT of HIV/Syphilis, Sao Paulo-BRA
1State Program of STD/AIDS, São Paulo, Brazil, Sao Paulo, Brazil, 2Federal University of Ceara, Fortaleza, Brazil, 3University California San Francisco, San Francisco, United States
Background: São Paulo State has been a pioneer in adopting measures for prevention of mother-to-child transmission (MTCT) of HIV since the mid-1990s. Consequently, HIV infection in children has steadily diminished. Reported AIDS cases in children under five is a useful proxy for MTCT.
Methods: We studied incidence rates of AIDS in children under five in São Paulo State (southeast of Brazil) in the period 1984-2008. Cases were tabulated using the government reporting system (SINAN), with denominators from the Brazilian Institute of Geography and Statistics based on the census and inter-census estimates.
Results: In the period of 1984-1996, there was an increase in incidence rates from 0.03 to 12.77 per 100,000 population, an increase of 425-fold. After implementation of universal access to HAART (1996 to present), there was a significant reduction in incidence. The incidence rate fell 90.6%, from 12.77 to 1.20 cases per 100,000. This drop took place mainly after 2000, when routine diagnostic and preventive strategies were implemented for pregnant women and exposed children. The figure plots incidence by year, indicating when various preventive measures were adopted.
[pic_01] Conclusions: AIDS incidence in children is falling in São Paulo State due to adoption of effective control strategies. International goals (two cases per 100 infected women) for “eliminating” MTCT will certainly be met. Nevertheless, maintaining preventive activities and comprehensive care will remain a challenge in settings with broad social inequality. The 70 cases of AIDS in children under five diagnosed in São Paulo State in 2008 serve as a reminder of this.
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