title: Persistent operational challenges lead to non-reduction in maternal-infant transmission of HIV.
abstract: OBJECTIVE
  To determine impediments to the effective reduction of maternal-infant transmission of HIV in the municipality of Campos dos Goytacazes, RJ, Brazil.
  
  
  METHODS
  This is a cohort study, with medical follow-up, of pregnant women with confirmed diagnosis of HIV infection, and their infant children, assisted at the Municipal Specialized Service of Sexually Transmitted Diseases/AIDS from January 2004 to April 2007. Information regarding exposure and outcome variables was collected from their medical records. Frequencies of variables were determined and bivariate analysis performed for exposure factors and transmission of HIV. Relative risks of HIV transmission associated with exposure variables were calculated using 95% confidence intervals. Statistical significance of risk associations was evaluated.
  
  
  RESULTS
  Seventy-eight mother-child pairs were studied; the rate of maternal-infant transmission of HIV was 7.7%. Variables showing significant association with maternal-infant transmission of HIV were the non-utilization of antiretrovirals for prophylaxis or treatment during pregnancy (RR = 21.00; 95%CI 2.64-166.74, p = 0.001) and diagnosis of maternal disease after pregnancy (RR = 6.80; 95%CI 1.59-29.17, p = 0.025). New pregnancies in women with other children also exposed to HIV occurred in 19.12% (15/78) of cases.
  
  
  CONCLUSIONS
  There was no reduction in the rate of maternal-infant transmission of HIV in the period 2004-2007 in relation to the preceding triennium. The following were recognized as impediments to the effective reduction of maternal-infant transmission of HIV: low prenatal screening coverage of maternal HIV infection, impairing maternal treatment or prophylaxis; and the incorrect use of the rapid screening test at admission for delivery.
authors.affiliation: Faculdade de Medicina de Campos, Campos dos Goytacazes, RJ, Brazil. reg.fernandes@bol.com.br
authors.forename: Regina Célia de Souza Campos
authors.initials: RC
authors.lastname: Fernandes
authors.forename: Gustavo Fernandes
authors.initials: GF
authors.lastname: Ribas
authors.forename: Danielli
authors.initials: D
authors.lastname: Pires e Silva
authors.forename: Alexandre Machado
authors.initials: AM
authors.lastname: Gomes
authors.forename: Enrique
authors.initials: E
authors.lastname: Medina-Acosta
mesh_terms: D015492:AIDS Serodiagnosis / Q000706:statistics & numerical data*; D001938:Brazil; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000635:transmission*; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control* / Q000706:statistics & numerical data; D011247:Pregnancy; D011295:Prenatal Care / Q000592:standards*; D011314:Preventive Health Services / Q000379:methods / Q000592:standards*; D012307:Risk Factors