Barriers to control syphilis and HIV vertical transmission in the health care system in the city of Sao Paulo.
OBJECTIVE
The objective of this study was to identify possible barriers to control vertical transmission of syphilis and HIV through the analysis of the orientation process of pregnant women from prenatal care to the obstetric center at an university hospital in Sao Paulo (Reference) and their return (with their exposed babies) for follow-up after hospital discharge (counter-reference).


METHODS
It is a retrospective cross-sectional study including interviews with healthcare personnel. Pregnant women with syphilis and/or HIV-infection admitted for labor or miscarriage were identified from August 2006 to August 2007. Routine care for mothers and babies were analyzed.


RESULTS
56 pregnant women were identified: 43 were HIV-infected, 11 had syphilis and two were coinfected (syphilis/HIV); 22 health care professionals were interviewed. Prenatal care was identified in 91.1% of these women: 7/11 (63.6%) with syphilis; 44/45 (97.8%) HIV-infected or coinfected. The reference for delivery was satisfactory for 57.7% of the syphilis-infected women and 97.7% of the HIV-infected ones. The counter-reference was satisfactory for all babies and mothers at hospital discharge, besides the non-adherence to this recommendation. Interviews with health care professionals showed there are better routines for assisting and following-up pregnant women, puerperal women and HIV-infected or exposed babies than for those infected with syphilis. The epidemiological report and surveillance system are also better for HIV-infected patients.


CONCLUSIONS
The difficulties in the reference and counter-reference system of these women and their babies are evident barriers to control the vertical transmission of these infectious diseases.
Hospital São Paulo, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Valdete Maria
VM
Ramos
Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Elisabeth Niglio de
EN
Figueiredo
Pediatrics Department, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Regina Célia de Menezes
RC
Succi
D000328:Adult; D001938:Brazil; D060085:Coinfection / Q000517:prevention & control / Q000635:transmission*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control / Q000635:transmission*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D011247:Pregnancy; D012189:Retrospective Studies; D013587:Syphilis / Q000517:prevention & control / Q000635:transmission*; D055815:Young Adult