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The cascade of care to prevent mother-to-child transmission in Rio de Janeiro, Brazil, 1996-2013: improving but still some way to go.

The cascade of care to prevent mother-to-child transmission in Rio de Janeiro, Brazil, 1996-2013: improving but still some way to go.
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Hofer CB, Egger M, Davies MA, Frota ACC, de Oliveira RH, Abreu TF, Araújo LE, Witthlin BB, Carvalho AW, Cordeiro JR, Lima GP, Keiser O,


Hofer CB, Egger M, Davies MA, Frota ACC, de Oliveira RH, Abreu TF, Araújo LE, Witthlin BB, Carvalho AW, Cordeiro JR, Lima GP, Keiser O, (click to view)

Hofer CB, Egger M, Davies MA, Frota ACC, de Oliveira RH, Abreu TF, Araújo LE, Witthlin BB, Carvalho AW, Cordeiro JR, Lima GP, Keiser O,

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Tropical medicine & international health : TM & IH 2017 07 14() doi 10.1111/tmi.12925

Abstract
OBJECTIVE
To describe the cascade of care to HIV mother-to-child-transmission (PMTCT) in a Rio de Janeiro reference pediatric clinic, and evaluate the main factors possibly associated with HIV transmission.

METHODS
Data on antenatal care, perinatal and neonatal assistance to HIV-infected and HIV-exposed but uninfected children assisted in the clinic from 1996-2013 were collected. The cascade of care was graphically demonstrated, and possible factors associated with HIV infection were described using regression models for bivariate and multivariate analysis. We imputed missing values of explanatory variables for the final model.

RESULTS
989 children were included in the analysis: 211were HIV and 778 HEU. Graphically the HIV PMTCT cascade of care improved from 1996/2000 to the later periods, but not from 2001/2006 to 2007/2013. The main factor independently associated with the HIV infection over time was breastfeeding. In the period 1996/2000 the lack of antiretroviral use during labor was associated HIV transmission. While in 2001/2007, other modes of delivery but elective cesarean section, and lack of maternal antiretroviral use during antenatal care were associated with HIV transmssion. In the last period, the main factor associated with transmission was the lack of maternal antenatal care.

CONCLUSIONS
The HIV PMTCT cascade improved over time, but HIV vertical transmission remains a problem, and better access to antenatal care is needed. This article is protected by copyright. All rights reserved.

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