Assessment of compliance with recommendations for HIV perinatal transmission prevention, timely diagnosis and early treatment of children living with HIV in Brazil.

Introduction: Strategies for perinatally transmitted HIV (PTHIV) prevention are inconsistently adopted. Moreover, delays in diagnosis and treatment initiation for children living with HIV may aggravate outcomes.

Methods: We used a survey study administered to Brazilian maternities to evaluate compliance with individual PTHIV prevention interventions as well as the overall compliance using a combined endpoint. We also investigated associations with the average number of births per month and municipal social vulnerability index (SVI) using regression models. Next, using data from Brazilian HIV monitoring systems, we obtained information on age at first HIV viral load (VL) testing and age at first antiretroviral dispensation to evaluate delayed diagnosis (first VL testing ≥6 months) and delayed antiretroviral initiation (first dispensation ≥12 months) among children living with HIV, investigating associations with race/ethnicity, sex and SVI.

Results: Of 801 maternities, only 21% were compliant with the combined endpoint. Facilities located in cities with higher SVI and those with a lower number of births per month had lower odds of being compliant. Among 1152 children living with HIV, the median age at first HIV VL testing was 3 months (range 0-18) and 24% had a delayed diagnosis. Children living with HIV in cities with higher SVI had higher odds of delayed diagnosis. The median age at antiretroviral initiation was 6 months (range 1-120), and those with a delayed diagnosis had higher odds of delayed treatment initiation (aOR 4.9, 95% CI 3.5-9.9).

Conclusion: Our study reveals significant challenges in access to PTHIV prevention, timely diagnosis and timely treatment initiation for children living with HIV, potentially related to social determinants.