Subnational certification of elimination of mother-to-child transmission of HIV and/or syphilis: a Brazilian experience report.

OBJECTIVE: to describe the subnational implementation process of the certification for elimination of mother-to-child transmission of HIV and/or syphilis, its main barriers, challenges and opportunities. METHODS: in 2022, indicators from the last full year for impact targets and the last two full years for process targets, available in national information systems, were evaluated; descriptive reports were analyzed and actions were acknowledged within four thematic axes, according to PAHO/WHO recommendations. RESULTS: 43 municipalities ≥ 100,000 inhabitants were certified, covering 24.6 million inhabitants; one municipality achieved dual elimination (HIV-syphilis), 28 municipalities achieved elimination of HIV and 10 received silver tiers; regarding syphilis, one elimination was observed, along with 4 gold tiers, 13 silver tiers and 4 bronze tiers; a higher number of certifications was identified in the Southeast and South regions. CONCLUSION: barriers and challenges of the process were overcome through tripartite collaboration; the experience provided better integration of surveillance with care and improved actions aimed at preventing mother-to-child transmission. MAIN RESULTS: First experience of the sub-national process of certification of elimination of mother-to-child transmission (MTCT) of HIV and/or syphilis at a global level. In 2022, 43 municipalities ≥ 100,000 inhabitants were certified, covering 24.6 million inhabitants. IMPLICATIONS FOR SERVICES: The experience of sub-national certification of the EMTCT was important in mobilizing the municipalities that engaged in its initiatives, worked to improve the quality of care and surveillance and emerging as the main proponents in the process. PERSPECTIVES: Through this ongoing and dynamic initiative, there is an anticipation of over 100 municipalities and states joining in 2023. Sub-national certification aims to enhance comprehensive care for pregnant women, in order to achieve national certification of EMTCT.

Certificação subnacional da eliminação da transmissão vertical de HIV e/ou sífilis: relato da experiência brasileira / Subnational certification of elimination of mother-to-child transmission of HIV and/or syphilis: a Brazilian experience report / Certificación subnacional de la eliminación de la trasmisión vertical de VIH y/o sífilis: relato de la experiencia brasileña

Objective: to describe the subnational implementation process of the certification for elimination of mother-to-child transmission of HIV and/or syphilis, its main barriers, challenges and opportunities. Methods: in 2022, indicators from the last full year for impact targets and the last two full years for process targets, available in national information systems, were evaluated; descriptive reports were analyzed and actions were acknowledged within four thematic axes, according to PAHO/WHO recommendations. Results: 43 municipalities ≥ 100,000 inhabitants were certified, covering 24.6 million inhabitants; one municipality achieved dual elimination (HIV-syphilis), 28 municipalities achieved elimination of HIV and 10 received silver tiers; regarding syphilis, one elimination was observed, along with 4 gold tiers, 13 silver tiers and 4 bronze tiers; a higher number of certifications was identified in the Southeast and South regions. Conclusion: barriers and challenges of the process were overcome through tripartite collaboration; the experience provided better integration of surveillance with care and improved actions aimed at preventing mother-to-child transmission.

Objetivo: descrever o processo de implantação subnacional da certificação da eliminação da transmissão vertical de HIV e/ou sífilis, suas principais barreiras, desafios e oportunidades. Métodos: em 2022, foram avaliados indicadores do último ano completo para meta de impacto, e dos dois últimos anos completos para metas de processo, disponíveis nos sistemas nacionais de informações; foram analisados relatórios descritivos e reconhecidas ações em quatro eixos temáticos, conforme recomendações da OPAS/OMS. Resultados: 43 municípios ≥ 100 mil habitantes foram certificados, abrangendo 24,6 milhões de habitantes; um município alcançou dupla eliminação (HIV-sífilis), 28 alcançaram eliminação para HIV e 10, selos prata; para sífilis, houve uma eliminação, 4 selos ouro, 13 prata e 4 bronze; identificou-se maior número de certificações nas regiões Sudeste e Sul. Conclusão: barreiras e desafios do processo foram superados pela colaboração tripartite; a experiência proporcionou melhor integração da vigilância com a assistência e qualificação das ações para prevenção da transmissão vertical.

Objetivo: describir el proceso de implementación subnacional de la certificación de eliminación de la transmisión vertical (TV) de sífilis y/o VIH, barreras, oportunidades y desafíos. Métodos: en 2022, se evaluaron indicadores del último año completo para la meta de impacto y de los dos últimos años para las de proceso en los sistemas de información; se analizaron informes descriptivos y se reconocieron acciones de cuatro ejes, según las recomendaciones de la OPS/OMS. Resultados: se certificaron 43 municipios ≥ 100.000 mil habitantes, cubriendo 24,6 millones de habitantes; un municipio logró la doble eliminación (VIH-sífilis), 28 la eliminación del VIH y 10 sellos plata; para sífilis, hubo una eliminación, 4 sellos oro, 13 plata y 4 bronce; las regiones Sudeste y Sur obtuvieron más certificaciones. Conclusión: barreras y desafíos fueron superados mediante la colaboración tripartita; la experiencia permitió la integración de la vigilancia con la atención y la cualificación de acciones para la prevención de la TV.

Tendência e distribuição espacial da mortalidade por aids no município de São Paulo de 1996 a 2012 / Trend and spatial distribuition of mortality caused by HIV in São Paulo from 1996 to 2012

Desde a década de 80, quando surgiram os primeiros casos de aids, tem havido mudanças no perfil epidemiológico da doença. Em especial, houve importante declínio de mortalidade após a introdução da terapia antirretroviral de alta atividade. O presente estudo visa descrever a magnitude e a tendência da mortalidade por aids na cidade de São Paulo e analisar a associação desses indicadores com medidas de condição socioeconômica dos distritos da cidade. Foram obtidos dados oficiais de população e mortalidade para o cálculo dos coeficientes anuais de mortalidade, ajustados por sexo e idade, para cada distrito da cidade. As análises de dados espaciais e de séries temporais foram realizadas no Stata 12, 2011. Os resultados do estudo revelaram que o declínio da mortalidade por aids nos 96 distritos do município de São Paulo, não tiveram relação com o índice de desenvolvimento humano (IDH). A variação do declínio foi independente do IDH.

Since the 1980s, when the first HIV cases appear, there have been changes in this disease epidemiology. Particularly, there was a considerable decline in mortality after the insertion of antiretroviral therapy in high activity. This study aims to describe the magnitude and trends in mortality caused by HIV in Sao Paulo, also to analyze these indicators associated within socioeconomic status in Sao Paulos districts. Official population data and mortality rates for annual mortality rates calculation, adjusted by age and gender, for each city district were obtained. The analysis of spatial data and time series were performed in Stata 12, 2011. The results of the study revealed that the decline in mortality from AIDS in 96 districts of São Paulo, were not related to the human development index (HDI). The variation of the decline was independent of HDI.