Abrem-se as cortinas: o revelar das estratégias de saúde para o enfrentamento da transmissão vertical do HIV em Manaus

Abstract

Manaus has presented in the last 3 years a total of 530 notifications of HIV pregnant women and in the same period registered 32 cases of AIDS in children under 5 years old. The scenario requires programmatic measures of quality public health, especially in primary care, which are directed towards shared care for these women with HIV during pregnancy, childbirth and the puerperium. Therefore, this study analyzed the strategies implemented in the municipal health care network in response to vertical transmission of HIV in the Southern Health District in Manaus. For that, it mapped the services available in the municipal health care network for HIV pregnant women; Identify convergences and divergences between the instituted path and the real path taken by HIV pregnant women in search of health care; and outlined the socio-epidemiological profile of HIV pregnant women monitored by the SAE under municipal management in the Southern District. The methodological course comprised the following locus and subjects: the HIV Specialized Care Service of the Antônio Reis Polyclinic - SAE and the Basic Health Units - UBSs of the Southern Health District, within the scope of the Municipal Health Secretariat-SEMSA, and their respective professionals who followed HIV pregnant women in 2019. The HIV pregnant women identified through the SAE records in 2019 totaled 08 (eight) women, from there it was identified their medical records and only 07 (seven) of them had referral from UBSs that shared the care. In all, 08 (eight) health professionals were interviewed, according to the inclusion and exclusion criteria, being 04 (four) professionals from the SAE and 04 (four) professionals from UBSs. The field research started in January 2020 and ended in March this year. In addition to the interviews, documentary analyzes of the evolution of the records of HIV pregnant women regarding the period of pregnancy in the aforementioned equipment and indicators from the local SINAN Database, from the period 2017, 2018 and 2019, were carried out. This layout revealed that prenatal care it has started late and consequently the monitoring of the HIV condition as well. Pregnant women have faced difficulties in effective access to exams, especially genotyping. The monitoring of these women occurs predominantly by the figure of the doctor and nursing, just as the records are presented without much detail, the notification forms in most cases do not have quality in the recorded information, which reveals the fragility of the multidisciplinary team. The link to motherhood, as well as the active search, are weak and not outlined strategies. Points such as responsibility for the indication of the mode of delivery, guidance on not breastfeeding and the availability of the milk formula, are not well defined, although there are guidelines in these protocols and legislation. Family support is crucial for adherence and monitoring of this HIV pregnant woman. The services exist within the scope of SEMSA, but with limited human resources. In short, it is imperative to qualify the multiprofessional team, as the bottlenecks identified with regard to the effective materialization of coping strategies for vertical transmission require the use of light and light hard technologies. Fostering moments of exchange of experiences and collective professional construction is a possibility in view of the problems identified.