title: Cascade of access to interventions to prevent HIV mother to child transmission in the metropolitan area of Rio de Janeiro, Brazil.
abstract: OBJECTIVE
  To describe the access to the interventions for the prevention of Human Immunodeficiency Virus (HIV) mother to child transmission and mother to child transmission rates in the outskirts of Rio de Janeiro, from 1999 to 2009.
  
  
  METHODS
  This is a retrospective cohort study. Prevention of HIV mother to child transmission interventions were accessed and mother to child transmission rates were calculated.
  
  
  RESULTS
  The study population is young (median: 26 years; interquartile range: 22.0-31.0), with low monthly family income (40.4% up to one Brazilian minimum wage) and schooling (62.1% less than 8 years). Only 47.1% (n=469) knew the HIV status of their partner; of these women, 39.9% had an HIV-seronegative partner. Among the 1259 newborns evaluated, access to the antenatal, intrapartum and postpartum prevention of HIV mother to child transmission components occurred in 59.2%, 74.2%, and 97.5% respectively; 91.0% of the newborns were not breastfed. Overall 52.7% of the newborns have benefited from all the recommended interventions. In subsequent pregnancies (n=289), 67.8% of the newborns received the full package of interventions. The overall rate of HIV vertical transmission was 4.7% and the highest annual rate occurred in 2005 (7.4%), with no definite trend in the period.
  
  
  CONCLUSIONS
  Access to the full package of interventions for the prevention of HIV vertical transmission was low, with no significant trend of improvement over the years. The vertical transmission rates observed were higher than those found in reference services in the municipality of Rio de Janeiro and in the richest regions of the country.
authors.affiliation: Laboratório de Pesquisa em DST/AIDS, Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil; Hospital Geral de Nova Iguaçu, Serviço de DST/HIV/AIDS, Nova Iguaçu, Rio de Janeiro, RJ, Brazil. Electronic address: elainespiresba@yahoo.com.br.
authors.forename: Elaine S
authors.initials: ES
authors.lastname: Pires Araujo
authors.affiliation: Laboratório de Pesquisa em DST/AIDS, Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil.
authors.forename: Ruth
authors.initials: R
authors.lastname: Khalili Friedman
authors.affiliation: Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Escola Nacional de Saúde Publica, Fiocruz, Rio de Janeiro, RJ, Brazil.
authors.forename: Luis Antonio
authors.initials: LA
authors.lastname: Bastos Camacho
authors.affiliation: Laboratório de Pesquisa em DST/AIDS, Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil.
authors.forename: Monica
authors.initials: M
authors.lastname: Derrico
authors.affiliation: Laboratório de Pesquisa em DST/AIDS, Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil.
authors.forename: Ronaldo
authors.initials: R
authors.lastname: Ismério Moreira
authors.affiliation: Laboratório de Pesquisa em DST/AIDS, Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil.
authors.forename: Guilherme
authors.initials: G
authors.lastname: Amaral Calvet
authors.affiliation: Laboratório de Pesquisa em DST/AIDS, Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil.
authors.forename: Marília
authors.initials: M
authors.lastname: Santini de Oliveira
authors.affiliation: Laboratório de Pesquisa em DST/AIDS, Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil.
authors.forename: Valdilea
authors.initials: V
authors.lastname: Gonçalves Veloso
authors.affiliation: Hospital Geral de Nova Iguaçu, Serviço de DST/HIV/AIDS, Nova Iguaçu, Rio de Janeiro, RJ, Brazil; Laboratório de AIDS e Imunologia Molecular, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, RJ, Brazil.
authors.forename: José Henrique
authors.initials: JH
authors.lastname: Pilotto
authors.affiliation: Laboratório de Pesquisa em DST/AIDS, Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Grinsztejn
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D001938:Brazil; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control / Q000635:transmission*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014505:Urban Population
chemical_list: D019380:Anti-HIV Agents
keywords: Antiretroviral chemoprophylaxis; Brazil; Cohort studies; HIV; HIV vertical transmission