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. 2023 Oct 30;32(3):e2023439.
doi: 10.1590/S2237-96222023000300003.EN. eCollection 2023.

Subnational certification of elimination of mother-to-child transmission of HIV and/or syphilis: a Brazilian experience report

[Article in English, Portuguese, Spanish]
Angélica Espinosa Miranda  1 , Pâmela Cristina Gaspar  1 , Leonor Henriette de Lannoy  1 , Aranaí Sampaio Diniz Guarabyra  1 , Rayone Moreira Costa Veloso Souto  1 , Esdras Daniel Dos Santos Pereira  1 , Gerson Fernando Pereira  1 , Guilherme Borges Dias  1 , Carmen Silvia Bruniera Domingues  1 , Aparecida Morais Lima  1 , Ariane Tiago Bernardo de Matos  1 , Maria da Guia de Oliveira  1 , Mayra Gonçalves Aragón  1 , Nádia Maria da Silva Machado  1 , Luíz Fernando Aires Junior  1 , Isabella Mayara Diana de Souza  1 , Ethel Leonor Maciel  2 , Draurio Barreira  1
Affiliations

Subnational certification of elimination of mother-to-child transmission of HIV and/or syphilis: a Brazilian experience report

[Article in English, Portuguese, Spanish]
Angélica Espinosa Miranda et al. Epidemiol Serv Saude. .

Abstract
in English, Spanish, Portuguese

Objective: to describe the subnational implementation process of the certification for elimination of mother-to-child transmission of HIV and/or syphilis, its main barriers, challenges and opportunities.

Methods: in 2022, indicators from the last full year for impact targets and the last two full years for process targets, available in national information systems, were evaluated; descriptive reports were analyzed and actions were acknowledged within four thematic axes, according to PAHO/WHO recommendations.

Results: 43 municipalities ≥ 100,000 inhabitants were certified, covering 24.6 million inhabitants; one municipality achieved dual elimination (HIV-syphilis), 28 municipalities achieved elimination of HIV and 10 received silver tiers; regarding syphilis, one elimination was observed, along with 4 gold tiers, 13 silver tiers and 4 bronze tiers; a higher number of certifications was identified in the Southeast and South regions.

Conclusion: barriers and challenges of the process were overcome through tripartite collaboration; the experience provided better integration of surveillance with care and improved actions aimed at preventing mother-to-child transmission.

Main results: First experience of the sub-national process of certification of elimination of mother-to-child transmission (MTCT) of HIV and/or syphilis at a global level. In 2022, 43 municipalities ≥ 100,000 inhabitants were certified, covering 24.6 million inhabitants.

Implications for services: The experience of sub-national certification of the EMTCT was important in mobilizing the municipalities that engaged in its initiatives, worked to improve the quality of care and surveillance and emerging as the main proponents in the process.

Perspectives: Through this ongoing and dynamic initiative, there is an anticipation of over 100 municipalities and states joining in 2023. Sub-national certification aims to enhance comprehensive care for pregnant women, in order to achieve national certification of EMTCT.

Objetivo:: describir el proceso de implementación subnacional de la certificación de eliminación de la transmisión vertical (TV) de sífilis y/o VIH, barreras, oportunidades y desafíos.

Métodos:: en 2022, se evaluaron indicadores del último año completo para la meta de impacto y de los dos últimos años para las de proceso en los sistemas de información; se analizaron informes descriptivos y se reconocieron acciones de cuatro ejes, según las recomendaciones de la OPS/OMS.

Resultados:: se certificaron 43 municipios ≥ 100.000 mil habitantes, cubriendo 24,6 millones de habitantes; un municipio logró la doble eliminación (VIH-sífilis), 28 la eliminación del VIH y 10 sellos plata; para sífilis, hubo una eliminación, 4 sellos oro, 13 plata y 4 bronce; las regiones Sudeste y Sur obtuvieron más certificaciones.

Conclusión:: barreras y desafíos fueron superados mediante la colaboración tripartita; la experiencia permitió la integración de la vigilancia con la atención y la cualificación de acciones para la prevención de la TV.

Objetivo:: descrever o processo de implantação subnacional da certificação da eliminação da transmissão vertical de HIV e/ou sífilis, suas principais barreiras, desafios e oportunidades.

Métodos:: em 2022, foram avaliados indicadores do último ano completo para meta de impacto, e dos dois últimos anos completos para metas de processo, disponíveis nos sistemas nacionais de informações; foram analisados relatórios descritivos e reconhecidas ações em quatro eixos temáticos, conforme recomendações da OPAS/OMS.

Resultados:: 43 municípios ≥ 100 mil habitantes foram certificados, abrangendo 24,6 milhões de habitantes; um município alcançou dupla eliminação (HIV-sífilis), 28 alcançaram eliminação para HIV e 10, selos prata; para sífilis, houve uma eliminação, 4 selos ouro, 13 prata e 4 bronze; identificou-se maior número de certificações nas regiões Sudeste e Sul.

Conclusão:: barreiras e desafios do processo foram superados pela colaboração tripartite; a experiência proporcionou melhor integração da vigilância com a assistência e qualificação das ações para prevenção da transmissão vertical.

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Conflict of interest statement

CONFLICTS OF INTEREST: The authors declare they have no conflicts of interest.

Figures

Figure 1
Figure 1. - Operational flow of the municipal certifications process of mother-to-child transmission of HIVa and/or syphilis based on the responsibilities of the Ministry of Health, committees and validation team
Figure 2
Figure 2. - Distribution of Brazilian municipalities with 100,000 inhabitants or more, according to population size (A) regions (B) and population per region (C)
Figure 3
Figure 3. - Distribution of Brazilian municipalities, according to certification for the elimination or towards the elimination of mother-to-child transmission of HIV (A), syphilis (B) and eligibility for HIV and/or syphilis certification, by performance of process and outcome indicators (C)
See this image and copyright information in PMC

References

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