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    Avaliação das medidas de profilaxia da transmissão vertical do vírus HIV e da sífilis
    (Universidade Federal de São Paulo (UNIFESP), 2018-12-20) Holzmann, Ana Paula Ferreira [UNIFESP]; Barbosa, Dulce Aparecida [UNIFESP]; Silva, Carla Silvana de Oliveira e; http://lattes.cnpq.br/5393988286775602; http://lattes.cnpq.br/1924137485244907; http://lattes.cnpq.br/2393906738746122; Universidade Federal de São Paulo (UNIFESP)
    Objective: To describe and evaluate actions aimed at preventing vertical transmission of HIV and morbidity and mortality of congenital syphilis. Methods: Retrospective cohort study performed at two maternity hospitals in the city of Montes Claros, MG. The population was composed by women diagnosed with syphilis and HIV infection during pregnancy, childbirth or puerperium, who received care at the maternity wards from 2014 to 2017 and their respective newborns. The variables of interest were mainly collected from clinical records and typed in a database created with Epidata version 3.0 program and later transferred to SPSS version 19.0, where a descriptive analysis of the data was performed. Results: A total of 250 parturients/ postpartum women diagnosed with syphilis and 46 with diagnosis of HIV were enrolled in the study, in addition to 233 live births exposed to syphilis and 46 exposed to HIV infection. The coefficient of HIV and syphilis detection in pregnant women during the period was 1.9 cases / 1000 and 10.4 / 1000 live births, respectively. The incidence rate of congenital syphilis was 11.9 / 1000 live births. The maternity hospitals care evaluation revealed that the management of syphilis was inadequate in 54% of the cases in parturients and 74,2% in newborns. The main reasons for inadequate management of puerperal women were the lack of referral for ambulatorial treatment continuity (65,2%), while for newborns, the reasons were lack of disease notification. Significant association with maternal management was found in the variables: case of syphilis reported during pregnancy (p = 0.036), parturient / puerperal VDRL titration (p <0.001), number of previous abortions (p = 0.006), treatment of partner prescribed at maternity (p <0.001) and duration of labor (p <0.001). Concerning the management of the newborn, the following independent variables were associated with the outcome: long bone RX realization (p = 0.001), Congenital Syphilis definition criterion (p = 0.006), case report (p <0.001), and length of birth (p <0.001). In regard to prevention of vertical HIV transmission, management was considered inadequate in 30 parturients / puerperae cases (65.2%) and in 14 newborns (30.4%). The main reasons for management inadequacy in women were nonachievement of lactation inhibition (53.3%) and the lack of counseling and consent for the HIV test (56,6%). On the other hand, neonate management failure was mainly due to late use of zidovudine oral solution (50.0%) and nonprescription of nevirapine, when there was such indication (28.6%). Conclusion: These results indicate that hospital health care professionals do not follow all Health Ministry recommendations. They also demonstrate the need for investments aimed at training and raising awareness among health professionals involved in care.