Abstract
| Original language | English |
|---|---|
| Pages (from-to) | e00170918-e00170932 |
| Number of pages | 14 |
| Journal | Cadernos de Saude Publica |
| Volume | Vol. 35 |
| Issue number | n.º 6 |
| DOIs | |
| Publication status | Published - 30 May 2019 |
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Keywords
- Health services accessibility
- Prenatal care
- HIV
- Syphilis
- Vertical infectious disease transmission
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Inequalities in access to HIV and syphilis tests in prenatal care in Brazil. / Claudia Helena Soares de Morais, Freitas, ; Franklin Delano Soares, Forte,; Maria Helena Rodrigues, Galvão,; Coêlho, Ardigleusa Alves; Angelo Giuseppe, Roncall,; Dias, S.
In: Cadernos de Saude Publica, Vol. Vol. 35, No. n.º 6, 30.05.2019, p. e00170918-e00170932.Research output: Contribution to journal › Article
TY - JOUR
T1 - Inequalities in access to HIV and syphilis tests in prenatal care in Brazil
AU - Claudia Helena Soares de Morais, Freitas,
AU - Franklin Delano Soares, Forte,
AU - Maria Helena Rodrigues, Galvão,
AU - Coêlho, Ardigleusa Alves
AU - Angelo Giuseppe, Roncall,
AU - Dias, S
PY - 2019/5/30
Y1 - 2019/5/30
N2 - This study aims to evaluate the social determinants of access to HIV and VDRL tests during pregnancy in Brazil. The dependent variables were based on prenatal care access: prenatal care appointments, no HIV and syphilis tests. The independent variables at the first level were formal education level, age, race, work and participation in the Family Income program conditional cash transfer program. The city-level variables were the human development index (HDI), Gini index, and indicators related to health services. An exploratory analysis was performed assessing the effect of each level through prevalence ratios (PR) calculation. A multilevel mixed-effect Poisson regression model was constructed for all outcomes to verify the effect of individual level and with both the individual and contextual levels. Regarding prenatal appointments, the main implicated factors were related to individual socioeconomic position (education level and participation in the Family Income Program conditional cash transfer program), however only HDI maintained significance for the city-level context. The city-level variance dropped from 0.049 to 0.042, indicating an important between-city effect. Regarding the outcomes performing tests in prenatal care, the worst conditions such as contextual (HDI > 0.694, p < 0.001; Gini index ≥ 0.521, p < 0.001) and individual (> 8 years of schooling, p < 0.001) showed a risk effect in the final model. Variables related to health services did not show significant effects. They were associated with individual socioeconomic position and a city-level contextual effect. These findings indicate the importance of strengthening HIV and syphilis infection control programs during pregnancy.
AB - This study aims to evaluate the social determinants of access to HIV and VDRL tests during pregnancy in Brazil. The dependent variables were based on prenatal care access: prenatal care appointments, no HIV and syphilis tests. The independent variables at the first level were formal education level, age, race, work and participation in the Family Income program conditional cash transfer program. The city-level variables were the human development index (HDI), Gini index, and indicators related to health services. An exploratory analysis was performed assessing the effect of each level through prevalence ratios (PR) calculation. A multilevel mixed-effect Poisson regression model was constructed for all outcomes to verify the effect of individual level and with both the individual and contextual levels. Regarding prenatal appointments, the main implicated factors were related to individual socioeconomic position (education level and participation in the Family Income Program conditional cash transfer program), however only HDI maintained significance for the city-level context. The city-level variance dropped from 0.049 to 0.042, indicating an important between-city effect. Regarding the outcomes performing tests in prenatal care, the worst conditions such as contextual (HDI > 0.694, p < 0.001; Gini index ≥ 0.521, p < 0.001) and individual (> 8 years of schooling, p < 0.001) showed a risk effect in the final model. Variables related to health services did not show significant effects. They were associated with individual socioeconomic position and a city-level contextual effect. These findings indicate the importance of strengthening HIV and syphilis infection control programs during pregnancy.
KW - Health services accessibility
KW - Prenatal care
KW - HIV
KW - Syphilis
KW - Vertical infectious disease transmission
UR - http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2019000705003
U2 - 10.1590/0102-311x00170918
DO - 10.1590/0102-311x00170918
M3 - Article
VL - Vol. 35
SP - e00170918-e00170932
JO - Cadernos de Saude Publica
JF - Cadernos de Saude Publica
SN - 0102-311X
IS - n.º 6
ER -