Surveillance of mother-to-child HIV transmission: socioeconomic and health care coverage indicators.
OBJECTIVE
To identify clustering areas of infants exposed to HIV during pregnancy and their association with indicators of primary care coverage and socioeconomic condition.


METHODS
Ecological study where the unit of analysis was primary care coverage areas in the city of Porto Alegre, Southern Brazil, in 2003. Geographical Information System and spatial analysis tools were used to describe indicators of primary care coverage areas and socioeconomic condition, and estimate the prevalence of liveborn infants exposed to HIV during pregnancy and delivery. Data was obtained from Brazilian national databases. The association between different indicators was assessed using Spearman's nonparametric test.


RESULTS
There was found an association between HIV infection and high birth rates (r=0.22, p<0.01) and lack of prenatal care (r=0.15, p<0.05). The highest HIV infection rates were seen in areas with poor socioeconomic conditions and difficult access to health services (r=0.28, p<0.01). The association found between higher rate of prenatal care among HIV-infected women and adequate immunization coverage (r=0.35, p<0.01) indicates that early detection of HIV infection is effective in those areas with better primary care services.


CONCLUSIONS
Urban poverty is a strong determinant of mother-to-child HIV transmission but this trend can be fought with health surveillance at the primary care level.
Barcellos
Christovam
C
Laboratório de Informações em Saúde, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Avenida Brasil 4365-Manguinhos, Rio de Janeiro, RJ, Brazil. xris@fi ocruz.br
Acosta
Lisiane Morelia Weide
LM
Lisboa
Eugenio
E
Bastos
Francisco Inácio
FI
D001938:Brazil / Q000453:epidemiology; D016000:Cluster Analysis; D005260:Female; D040362:Geographic Information Systems; D015658:HIV Infections / Q000453:epidemiology / Q000635:transmission*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006305:Health Status Indicators; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control / Q000706:statistics & numerical data*; D050498:Live Birth / Q000453:epidemiology; D011203:Poverty / Q000706:statistics & numerical data; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000592:standards*; D018571:Sentinel Surveillance; D012959:Socioeconomic Factors; D018709:Statistics, Nonparametric