Factors associated with loss to follow up among HIV-exposed children: a historical cohort study from 2000 to 2017, in Porto Alegre, Brazil.

BACKGROUND: There are many inequalities in terms of prevention and treatment for pregnant women with HIV and exposed children in low and middle-income countries. The Brazilian protocol for prenatal care includes rapid diagnostic testing for HIV, compulsory notification, and monitoring by the epidemiological surveillance of children exposed to HIV until 18 months after delivery. The case is closed after HIV serology results are obtained. Lost to follow-up is defined as a child who was not located at the end of the case, and, therefore, did not have a laboratory diagnosis. Lost to follow-up is a current problem and has been documented in other countries. This study analyzed factors associated with loss to follow-up among HIV-exposed children, including sociodemographic, behavioral, and health variables of mothers of children lost to follow-up. METHODS: This historical cohort study included information on mothers of children exposed to HIV, born in Porto Alegre, from 2000 to 2017. The research outcome was the classification at the end of the child's follow-up (lost to follow-up or not). Factors associated with loss to follow-up were investigated using the Poisson regression model. Relative Risk calculations were performed. The significance level of 5% was adopted for variables in the adjusted model. RESULTS: Of 6,836 children exposed to HIV, 1,763 (25.8%) were classified as lost to follow-up. The factors associated were: maternal age of up to 22 years (aRR 1.25, 95% CI: 1.09-1.43), the mother's self-declared race/color being black or mixed (aRR 1.13, 95% CI: 1.03-1.25), up to three years of schooling (aRR 1.45, 95% CI: 1.26-1.67), between four and seven years of schooling (aRR 1.14, 95% CI: 1.02-1.28), intravenous drug use (aRR 1.29, 95% CI: 1.12-1.50), and HIV diagnosis during prenatal care or at delivery (aRR 1.37, 95% CI: 1.24-1.52). CONCLUSION: Variables related to individual vulnerability, such as race, age, schooling, and variables related to social and programmatic vulnerability, remain central to reducing loss to follow-up among HIV-exposed children.

Prevalência de sífilis em mulheres / The prevalence of syphilis in women

Objetivo: verificar a prevalência de sífilis em mulheres que realizaram o teste rápido em um serviço de referência de Porto Alegre/RS. Metodologia: estudo quantitativo, descritivo, transversal, realizado com 1300 prontuários de mulheres que realizaram o teste rápido no período de julho de 2012 a abril de 2014. Os dados foram analisados a partir de estatística descritiva. As variáveis categóricas foram expressas em número absoluto e percentual e aquelas com distribuição normal expressas como média ± desvio padrão. Resultados: 103 (7,9%) apresentaram sífilis. A idade variou de 16 a 76 anos, a média foi de 38,9 ±12,8 anos, 46 (45,1%) possuía acima de 11 anos de estudo, 31,0 (30,4%) possuíam parceria fixa, 35 (34,3%) já apresentou algum tipo de IST. Conclusões: entende-se que, para o controle da doença, o diagnóstico precoce é fundamental e o atendimento deve ser realizado de imediato na atenção primária em saúde, visando uma maior integração e vínculo com a unidade/comunidade/equipe de saúde.

Objective: To verify the prevalence of syphilis in women who performed the rapid check up at a referral service in Porto Alegre. Methodology: A quantitative, descriptive, cross-sectional study of 103 records of women who performed the rapid check up from July 2012 to April 2014. Data were analyzed using descriptive statistics, categorical variables were expressed in absolute number and Percentage and those with normal distribution expressed as average ± standard deviation. Results: 103 (35.6%) had syphilis. The age ranged from 16 to 76 years, the average was 38.9 ± 12,8 years, 46 (45.1%) had completed secondary education, 31 (30,4%) had a fixed partnership, 35 (34.3 %) already had some type of STD. Conclusions: It is understood that for the control of the disease, the early diagnosis is fundamental and the assistance should be performed immediately in the primary care, aiming at a greater integration and bond with the unit /community/health/team.

Objetivo: Determinar el predominio de sífilis en mujeres que se sometieron a la prueba rápida en un servicio de referencia en Porto Alegre. Metodología: cuantitativa, estudio descriptivo transversal realizado con 103 registros de mujeres que se sometieron a la prueba rápida de julio de 2012 hasta abril de 2014. Los datos fueron analizados utilizando estadística descriptiva, las variables categóricas se expresan en números absolutos y porcentaje y los que tienen distribución normal expresaron como media ± desviación estándar. Resultados: 103 (35,6%) presentaron sífilis. La edad varió de 16 a 76 años, el promedio fue de 38,9± 12,8 años, 46 (45,1%) habían completado la escuela secundaria, 31 (30,4%) tenían pareja estable, 35 (34,3 %) ya tenía algún tipo de enfermedad de transmisión sexual. Conclusiones: Se entiende que para controlar la enfermedad, el diagnóstico precoz es importante y el servicio debe realizarse inmediatamente en la atención primaria, con el objetivo de una mayor integración y vínculo con el servicio de salud/comunidad/equipo de salud.