Evaluation of public policies to reduce mother-to-child transmission of HIV in the State of São Paulo, Brazil, 1987-2008
C.S.B. Domingues, M.A. Silva, A. Tayra, L.H. Matida, M.H. Silva, V. Cervantes, M.C. Gianna
State Program of STD/AIDS, São Paulo, Brazil
Background: In Brazil, the National policy for idividuals with HIV/AIDS is based on the principles of universal access to comprehensive health, including prevention and free treatment. In relation to mother-to-child transmission (MTCT) of HIV, important preventive measures were implemented to reduce the transmission in the country:
(i) in 1997 - introduction of antiretroviral therapy (ART) during pregnancy and delivery, and for newborns,
(ii) in 2001 - implementation of rapid HIV testing at maternities,
(iii) in 2003 - free distribution of commercial infant formula for children exposed to HIV, during the first six months.
Between 1987-2008, in the State of São Paulo, 4,584 AIDS cases by MTCT were reported among children under the age of 13, corresponding almost to 40% of Brazil's total. Purpose is to assess results of preventive measures on the reduction of MTCT in the State of São Paulo.
Methods: Descriptive analysis of cases of MTCT in children under 13 years of age, reported to the State of São Paulo AIDS Surveillance System, in the 1987-2008 period.
Results: Incidence rates of MTCT increased before 1997 (from 0.31/100,000 in 1987 to 4.46/100,000 children in 1996). Incidence rates declined dramatically after the implementation of each measure:
(i) from 5.26/100,000 in 1997 to 3.94/100,000 children in 1998;
(ii) from 3.66/100,000 in 2001 to 2.79/100,000 children in 2002;
(iii) from 2.41/100,000 in 2003 to 1.81/100,000 children in 2004.
In 2008, incidence rate was 0.72/100,000 children under 13 years of age.
Conclusion: In the 1997-2008 period, incidence rates declined by 7.3 times and reflect continued improvement in actions, such as: better access to prenatal care and to HIV diagnosis; introduction of ART for treatment or prophylaxis in due time; and monitoring of children exposed to HIV in specialized outpatient clinics since the first days of life, with a multidisciplinary team and diagnostic tests.
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