Estudo sobre o uso do teste rápido para o HIV em parturientes em maternidades de Fortaleza

Abstract

The objective of this study was to identify HIV-positive pregnant women using a rapid test and to describe the experience of using this test in maternity hospitals in Fortaleza, from September 2000 to February 2001. It consisted of a cross-sectional study where 2,483 pregnant women with unknown or negative HIV serology were tested (Determine®, Abbott) after counseling by previously trained physicians and nurses. Concurrently with the test, a form was completed with the pregnant woman's socioeconomic and clinical information. The selection of maternity hospitals included those with more than 150 deliveries per month and that agreed to participate in the research. Patients with previously known positive HIV serology were included only for prevalence calculation. All information and medication related to the prophylaxis of vertical transmission were given to the attending physicians of the institutions. Main results found: predominance of young women in labor, with low education and low income; approximately 94.0% of patients underwent prenatal care, however, HIV testing was performed on only 16.4%, and of these, 30.1% arrived at the time of delivery with unknown results. In total, eleven HIV-positive women in labor were found: six identified by rapid testing and five who already had positive serology prior to delivery, resulting in a prevalence of 0.4%. The average monthly testing rate in public maternity hospitals was significantly higher than in maternity hospitals affiliated with the SUS (24.0% versus 7.0%, respectively, with p <0.05). The acceptance rate for the test was 88.5%. Among the six HIV-positive mothers who gave birth using the rapid test, three were detected at delivery and did not use intravenous AZT; the others were detected during labor, and only two used the medication; all newborns of HIV-positive mothers received AZT syrup before 24 hours of life and were not breastfed. Despite receiving guidance, only three mothers returned to the referral service for follow-up. The main difficulties encountered were related to trained personnel, the timing of the test, and the mother's fear of the test (technique). It was concluded that the prevalence rate of HIV-positive mothers was 0.4%; prenatal care was inadequate according to the rate of HIV testing; the application of rapid HIV testing in pregnant women with unknown serological status is an important procedure for implementing prophylactic measures against vertical transmission, especially when the professional performing the test is better trained.