Syphilis in pregnant women living with HIV/AIDS in Brazil and the relationship between coinfection and mother-to-child transmission of HIV

Syphilis in pregnant women living with HIV/AIDS in Brazil and the relationship between coinfection and mother-to-child transmission of HIV | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Syphilis in pregnant women living with HIV/AIDS in Brazil and the relationship between coinfection and mother-to-child transmission of HIV Mayra Gonçalves Aragón, Leonor Henriette de Lannoy, Pâmela Cristina Gaspar, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6740613/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 06 Dec, 2025 Read the published version in BMC Public Health → Version 1 posted 13 You are reading this latest preprint version Abstract Background HIV and syphilis are sexually transmitted infections of concern during pregnancy that affect women and children globally. However, limited data is available regarding the prevalence of syphilis infection among pregnant women living with HIV/AIDS and its influence on mother‒to-child transmission (MTCT) of HIV. The present research aims to analyze HIV and syphilis coinfection during pregnancy through a national analysis of surveillance data from Brazil. Methods This retrospective cohort study used secondary data from the Ministry of Health's information systems. The data included reported cases of pregnant women living with HIV and syphilis, with childbirth between 2016 and 2020, and children with HIV/AIDS with a year of birth from 2016–2020. Cross-referencing was performed between notification databases of pregnant women with HIV/AIDS and syphilis and pregnant women with HIV/AIDS and children with HIV/AIDS to identify potential mother‒child pairs. Pregnant women without a paired child with HIV were considered to have no outcome of MTCT for HIV. Logistic regression analysis was performed to estimate the effect of HIV and syphilis coinfection during pregnancy and HIV-MTCT, with a final significance level of 5%. Results Among 40,634 pregnant women living with HIV, 2,788 were coinfected with syphilis, yielding a coinfection rate of 6.9%. The MTCT of HIV was significantly greater among HIV-positive pregnant women coinfected with syphilis (2%) than among those without coinfection (1.2%), with an odds ratio of 1.7 (95% CI 1.29–2.25, p ≤ 0.05). Coinfection with HIV and syphilis was more prevalent among young women (aged 10–24), non-white individuals and people with lower educational attainment, and those who did not receive prenatal care and had late laboratory evidence of HIV during pregnancy, indicating a more vulnerable population among the coinfected pregnant women. Conclusions Compared with HIV-positive pregnant women without syphilis, HIV coinfection with syphilis during pregnancy was associated with a higher MTCT rate of HIV. Intersectoral public policies addressing social determinants are essential to achieve the goals of eliminating MTCT. HIV Syphilis Pregnancy Mother-to-child transmission Background HIV and syphilis are sexually transmitted infections (STIs) of impact during pregnancy, affecting thousands of women and children worldwide [ 1 , 2 ]. Despite their importance, consolidated data on the prevalence of syphilis among pregnant women living with HIV/AIDS (PWLHA) and the impact of this coinfection throughout pregnancy and the postpartum period remain limited. According to the World Health Organization (WHO), there were 1.2 million PWLHA worldwide in 2023 [ 3 ]. For syphilis, an estimated 1 million pregnant women had active syphilis worldwide in 2016 [ 4 ]. In Brazil, the detection rate of syphilis in pregnant women was 13.3 per 1,000 live births in 2016, rising to 17.2 in 2017 and reaching 34.0 in 2023 [ 5 , 6 ]. During the same period, the detection rate of HIV in pregnant women remained relatively stable, ranging from 2.5 to 2.7 per 1,000 live births [ 7 ]. Syphilis is the most common coinfection in PWLHA, especially among socially vulnerable populations [ 8 – 13 ]. The adverse outcomes of HIV and syphilis for both pregnant individuals and fetuses are well documented, and the synergy between these two conditions may increase the risk of preterm birth, miscarriage, and low birth weight [ 14 ]. Importantly, there are effective treatments for controlling these conditions during pregnancy, as well as preventive measures to avoid mother‒to-child transmission (MTCT) of both conditions [ 15 , 16 ]. The presence of STIs increases the risk of sexual transmission of HIV [ 17 – 19 ], but how STIs are related to MTCT of HIV is less understood. Some studies have shown that HIV coinfection with other STIs during pregnancy increases the risk of HIV MTCT, although no specific correlation between MTCT of syphilis and HIV has been identified [ 20 – 22 ]. On the other hand, other studies have revealed some associations between syphilis infection and increased MTCT of HIV [ 24 , 25 ]. In Brazil, for example, studies in Porto Alegre (capital) and Rio Grande do Sul (state) reported syphilis coinfection rates of 10.3% and 13.5%, respectively, in PWLHA [ 25 , 26 ], with both studies linking coinfection rates to higher HIV-MTCT rates. Several factors may explain the increased risk of HIV-MTCT in pregnant women coinfected with HIV and other STIs. In cases of genital lesions caused by STIs, which increase local leukocyte recruitment, PWLHA had higher levels of HIV release in the genital area, increasing the risk of transmission during childbirth [ 27 ]. In cervicitis, the infection may increase, causing chorioamnionitis and chronic placental inflammation. Chorioamnionitis reduces the natural protection of the placenta, increasing the risk of the intrauterine transmission of microorganisms. Chronic inflammation at the maternal‒fetal interface triggers immune activation and alters cytokine production, leading to increased HIV viral loads in pregnant women, a key factor predisposing them to HIV-MTCT [ 21 , 22 ]. Despite these explanatory factors, the role of syphilis in the MTCT of HIV remains uncertain. However, when syphilis causes ulcers, it recruits leukocytes to the area and increases the HIV concentration while compromising the skin barrier, yet its influence on MTCT after the regression of primary lesions is unclear [ 22 , 27 ]. Therefore, given the limited research on the frequency of HIV and syphilis coinfection during pregnancy and its relationship with MTCT, performing this national study is substantial once the data generated will assist in clinical decisions for monitoring PWLHA with or without syphilis and guide health policy planning to reduce MTCT of HIV toward its elimination. Methods Study Design A retrospective cohort study was conducted using secondary data available from the Brazilian Ministry of Health's information systems. All reported cases of pregnant women with HIV and pregnant women with syphilis with delivery dates between 2016 and 2020 were studied to identify cases of coinfection and children with HIV/AIDS born between 2016 and 2020 to identify HIV-MTCT cases. Study population Notified HIV in Pregnant women, syphilis in pregnant women, and cases of MTCT for HIV in Brazil were analyzed. The epidemiological data of the studied infections were obtained from the National Brazilian Notifiable Diseases Information System (SINAN). The inclusion criteria were as follows: reported cases of HIV in pregnant women with delivery dates between 2016 and 2020, reported cases of children diagnosed with HIV/AIDS born between 2016 and 2020, and cases of HIV and syphilis coinfection during pregnancy with delivery dates between 2016 and 2020. Data collection and variables To construct the database for the cohort, a cross-referencing of the notification databases for pregnant women with HIV and syphilis during pregnancy was performed. The database of pregnant women living with HIV was subsequently cross-referenced with the database of children with HIV/AIDS to identify potential mother‒child pairs. Sociodemographic, behavioral and clinical variables present in the notification forms, such as procedures and treatments performed, dates of diagnoses, outcomes of pregnancy and MTCT, were studied. After that, linkage of the databases was performed via Reclink® III software to identify cases of coinfection and mother‒child pairs. The first step in this process consists of defining the parameters of the hit and error probabilities that will be used to remove duplications and execute the relationships between dataframes. These parameters are defined on the basis of a 5% sample of each of the bases involved in the matrix generation, which creates matching pairs between databases and parameter modules to determine statistical criteria to evaluate whether matching records correspond to the same individual of Reclink® III [ 28 , 29 ]. Data comparison was carried out via the following database attributes: patient name, mother’s name, and date of birth. A diagnosis of syphilis or HIV/AIDS within a 90-day window was considered a simultaneous diagnosis. To match the mother‒child pairs, the pregnant woman's name, the child's mother's name, and the delivery date, including the birth date, were used. Possible duplicates in mother‒child pairs were removed, and only one child was presented for each matched mother. To eliminate potential duplicates in mother‒child pairings, the following factors were evaluated in order of priority: date of birth, delivery date, municipality of residency, diagnosis date and notification date. Pregnant women who did not have a matched child were considered to have an outcome of a child exposed to HIV without HIV-MTCT. In cases of missing delivery dates for pregnant women, an estimated calculation was made using the diagnosis date and gestational age, or in the absence of this, the notification date was considered. Additionally, cases of pregnant women notified of HIV between 2016 and 2020 were included, with corrections made to the delivery dates, resulting in a small increase in the total number of pregnant women. Statistical analysis Variables related to sociodemographic characteristics, including the frequency distribution of qualitative variables, were descriptively analyzed in Excel®. For statistical analysis, the data were entered into a spreadsheet of the Statistical Package for the Social Sciences (SPSS Inc.®). To compare the distributions, chi-square independence tests were implemented for all variables in relation to whether the pregnant woman had only HIV or both HIV and syphilis. Associations with the variables were tested via chi-square tests, when appropriate. Odds ratios and 95% confidence intervals were obtained in the analysis. Furthermore, to estimate the binary effect of a variable while controlling for the effects of others on the probability of HIV-MTCT in pregnant women with HIV and syphilis coinfection, we performed logistic regression analysis. To assess the adequacy and performance of the logistic regression model, the Hosmer–Lemeshow test was used [ 30 ]. The final significance level considered was 5%. In logistic regression, observations of missing information (i.e., "ignored" values) were removed from each variable to avoid compromising the results. To obtain the final regression model, the "stepwise forward" method based on maximum likelihood (likelihood ratio - LR) was used. This method selects the variables to be incrementally included in the model. It starts with an empty model and adds variables one by one on the basis of their statistical significance. The variables are retained in the model if their predictive capacity is improved, as measured by the likelihood ratio [ 31 ]. The criterion for including a variable was a p value lower than 0.05, indicating that the variable contributes significantly to the model. Ethical considerations The authorization for the use of the national databases was obtained from the Department of HIV/AIDS, Tuberculosis, Viral Hepatitis, and Sexually Transmitted Infections, Brazilian Ministry of Health. The protocol was submitted to the Research Ethics Committee of the Health Sciences Center at the Federal University of Espírito Santo, Brazil, in accordance with Resolution Number 466/2012 of the National Health Council and approved under number 5,400,655/2022. Privacy and confidentiality were ensured at all stages of the project through coding. The databases were analyzed without identifying the subjects. Results There were 40,634 pregnant women living with HIV during the study period. Of those, 2,788 were coinfected with syphilis, yielding a coinfection rate of 6.9% (95% CI: 6.6–7.1%). The MTCT of HIV was significantly greater among HIV-positive pregnant women coinfected with syphilis than among those without coinfection (2.0% vs. 1.2%, p ≤ 0.05), with an odds ratio of 1.7 (95% CI: 1.29–2.25), as displayed in Table 1 . Table 1 Correlation of MTCT of HIV between PWLHA without syphilis and PWLHA with syphilis, Brazil 2016–2020. Presence or absence of MTCT of HIV PWLHA without syphilis N (%) PWLHA and syphilis coinfection N (%) Total N (%) Without MTCT: child exposed to HIV 37388 (98.8) 2731 (98) 40119 (98.7) p = 0.0001 With MTCT: child with HIV/AIDS. 458 (1.2) 57 (2) 515 (1.3) OR = 1.704 (CI 1.29–2.25) Total 37846 (100) 2788 (100) 40634 (100) MTCT mother-to-child transmission. PWLHA pregnant women living with HIV/AIDS. The sociodemographic characteristics of PWLHA without syphilis and PWLHA coinfected with syphilis are shown in Table 2 . Age categories were distinct between the two groups: PWLHA without syphilis were mostly composed of women between 25 and 34 years old (43.2%), and PWLHA with syphilis were represented by women between 10 and 24 years old (45.9%). In terms of race, both groups were predominantly composed of white individuals, PWLHA without syphilis (62.2%), and PWLHA with syphilis (70.6%). Regarding education, 47.8% of PWLHA without syphilis had 8 years or more of schooling, whereas the proportions of PWLHA with syphilis were very similar between those with less than 8 years (39.6%) and those with 8 years or more (39.3%). Both groups, PWLHA without syphilis (90.1%) and PWLHA with syphilis (91.9%), lived mainly in urban areas of the country. Table 2 Sociodemographic characteristics of PWLHA without and with syphilis coinfection, Brazil 2016–2020. Sociodemographic characteristics PWLHA without syphilis N (%) PWLHA and syphilis coinfection N (%) Total N (%) Age 10 to 24 years 15291 (40.4) 1279 (45.9) 16570 (40.8) 25 to 34 years 16315 (43.1) 1156 (41.4) 17471 (43.0) ≥ 35 years 5631 (14.9) 331 (11.9) 5962 (14.7) Ignored 609 (1.6) 22 (0.8) 631 (1.5) Total 37846 (100) 2788 (100) 40634 (100) p = 0.000 Race white/not white White 12705 (33.6) 716 (25.6) 13421 (33.0) Not white 23527 (62.1) 1969 (70.6) 25496 (62.8) Ignored 1614 (4.3) 103 (3.7) 1717 (4.2) Total 37846 (100) 2788 (100) 40634 (100) p = 0.000 Race (all categories) White 12705 (33.6) 716 (25.7) 13421 (3.0) Black 5053 (13.3) 526 (18.9) 5579 (13.6) Asian 223 (0.6) 11 (0.4) 234 (0.6) Brown 18093 (47.8) 1427 (51.2) 19520 (48.0) Indigenous 158 (0.4) 5 (0.2) 163 (0.4) Ignored 1614 (4.3) 103 (3.7) 1717 (4.2) Total 37846 (100) 2788 (100) 40634 (100) p = 0.000 Education < 8 years 11078 (29.3) 1104 (39.6) 12182 (30) ≥ 8 years 19257 (50.9) 1095 (39.3) 20352 (50.1) Ignored 7511 (19.8) 589 (21.1) 8100 (19.9) Total 37846 (100) 2788 (100) 40634 (100) p = 0.000 Residence zone Urban 34077 (90) 2562 (91.9) 36639 (90.2) Rural 2465 (6.5) 135 (4.8) 2600 (6.4) Ignored 1304 (3.4) 91 (3.3) 1395 (3.4) Total 37846 (100) 2788 (100) 40634 (100) p = 0.002 PWLHA pregnant women living with HIV/AIDS. Concerning the clinical characteristics of PWLHA, it is stratified by the presence or absence of syphilis coinfection, as shown in Table 3 . Both groups received antenatal care, with PWLHA without syphilis accounting for 90.3% of women receiving prenatal care and PWLHA with syphilis accounting for 83.8%. With respect to gestational trimester, 35.6% of pregnant women were notified as PWLHA in the first trimester of gestation. PWLHA without syphilis using antiretroviral (ARV) medication during prenatal care accounted for 68.7%, and PWLHA with syphilis accounted for 56.6%. However, the proportion of ignored information in this variable was relatively high: 18.9% for PWLHA and 27.0% for PWLHA with syphilis. Moreover, in the two groups, cesarean delivery was the most common type of birth, but the percentage of cases with an unknown type of delivery was greater than 30% in both groups. The proportion of children born alive was equal in both groups (60.5%). Furthermore, PWLHA with syphilis were more likely to have stillbirth and miscarriage (5.1%) than PWLHA without syphilis (4.6%). Among the children born alive from PWLHA without or with syphilis, 56.7% and 55.4% used preventive ARV in the first 24 hours, respectively. For all three of these latest attributes, the percentage of missing information was greater than 30%. Table 3 Clinical, diagnosis, healthcare aspects and pregnancy evolution of PWLHA without and with syphilis, Brazil 2016–2020. Clinical and healthcare characteristics HIV without syphilis HIV and syphilis Total N (%) N (%) N (%) Prenatal care Yes 34160 (90.3) 2335 (83.8) 36495 (89.8) No 2215 (5.8) 352 (12.6) 2567 (6.3) Ignored 1471 (3.9) 101 (3.6) 1572 (3.9) Total 37846 (100) 2788 (100) 40634 (100) p = 0.000 Gestational trimester 1st trimester 13657 (36.1) 819 (29.4) 14476 (35.6) 2nd trimester 8484 (22.4) 641 (23.0) 9125 (22.5) 3rd trimester 11787 (31.1) 1056 (37.9) 12843 (31.6) Ignored 3918 (10.4) 272 (9.7) 4190 (10.3) Total 37846 (100) 2788 (100) 40634 (100) p = 0.000 Laboratory evidence of HIV Before prenatal care 21472 (56.7) 1222 (43.8) 22694 (55.8) During prenatal 13656 (36.1) 1241 (44.4) 14897 (36.7) During childbirth 2184 (5.8) 257 (9.2) 2441 (6.0) After childbirth 354 (0.9) 53 (1.9) 407 (1.0) Ignored 180 (0.5) 15 (0.5) 195 (0.5) Total 37846 (100) 2788 (100) 40634 (100) p = 0.000 Use of ARV during prenatal care Yes 25971 (68.7) 1579 (56.6) 27550 (67.8) No 4705 (12.4) 456 (16.4) 5161 (12.7) Ignored 7170 (18.9) 753 (27.0) 7923 (19.5) Total 37846 (100) 2788 (100) 40634 (100) p = 0.000 Type of birth Vaginal 6999 (18.5) 627 (22.5) 7626 (18.8) Cesarean 16539 (43.7) 1126 (40.4) 17665 (43.5) Does not apply 1649 (4.4) 127 (4.5) 1776 (4.4) Ignored 12659 (33.4) 908 (32.6) 13567 (33.3) Total 37846 (100) 2788 (100) 40634 (100) p = 0.000 ARV use during childbirth Yes 21378 (56.5) 1422 (51.0) 22800 (56.1) No 3890 (10.3) 405 (14.5) 4295 (10.6) Ignored 12578 (33.2) 961 (34.5) 13539 (33.3) Total 37846 (100) 2788 (100) 40634 (100) p = 0.000 Use of ARV by the child In the first 24 hours 21469 (56.7) 1544 (55.4) 23013 (56.6) 24 hours after birth 304 (0.8) 20 (0.7) 324 (0.8) Does not apply 1524 (4.0) 140 (5.0) 1664 (4.1) Unrealized 649 (1.7) 58 (2.1) 707 (1.7) Ignored 13900 (36.8) 1026 (36.8) 14926 (36.7) Total 37846 (100) 2788 (100) 40634 (100) p = 0.053 Evolution of pregnancy Born alive 22901 (60.5) 1686 (60.5) 24587 (60.6) Stillbirth and miscarriage 1746 (4.6) 142 (5.1) 1888 (4.6) Ignored 13199 (34.9) 960 (34.4) 14159 (34.8) Total 37846 (100) 2788 (100) 40634 (100) p = 0.488 PWLHA pregnant women living with HIV/AIDS. ARV antiretroviral. For the logistic regression (Table 4 ), the model was tested with all variables, except "Evolution of pregnancy", since it exhibited multicollinearity with other variables. Only complete observations of all the variables were considered for the model, representing 14,406 (36.8%) of all the cases. Coinfection with syphilis (p = 0.55), a later start of prenatal care (p = 0.002 for the second trimester and p < 0.001 for the third trimester), laboratory evidence of HIV during prenatal care (p = 0.020), during (p < 0.001) and after childbirth (p = 0.006) and not using ARV during pregnancy (p = 0.002) remained statistically relevant to the outcome of MTCT for HIV. Table 4 Multivariable logistic regression with unadjusted and adjusted models for odds of MTCT of HIV. Characteristic Unadjusted OR (CI 95%) p value Adjusted OR (CI 95%) p value Infection HIV Reference Reference HIV and syphilis 1.43 (0.87–2.33) 0.15 1.41 (0.99–2.02) 0.55 Age 10 to 24 years Reference 25 to 34 years 0.83 (0.61–1.14) 0.25 ≥ 35 years 0.54 (0.31–0.92) 0.02 Race White Reference Black 0.69 (0.41–1.17) 0.18 Asian 0.82 (0.11–6.10) 0.85 Brown 0.68 (0.49–0.97) 0.03 Indigenous 1.06 (0.14–8.05) 0.95 Education < 8 years Reference ≥ 8 years 0.79 (0.59–1.08) 0.14 Residence zone Urban Reference Rural 0.98 (0.56–1.72) 0.94 Gestational trimester 1st trimester Reference Reference 2nd trimester 1.76 (1.09–2.85) 0.02 1.46 (1.09–1.96) 0.01 3rd trimester 2.18 (1.42–3.34) 0.00 1.83 (1.40–2.39) 0.00 Laboratory evidence of HIV Before prenatal care Reference Reference During prenatal 1.28 (0.90–1.78) 0.17 1.321 (1.05–1.671) 0.02 During childbirth 2.38 (1.39–4.06) 0.00 2.880 (1.92–4.322) 0.00 After childbirth 4.37 (1.69–11.31) 0.00 3.143 (1.40-7.074) 0.01 Prenatal care Yes Reference No 0.00 (0.00) 0.99 Use of ARV during prenatal care Yes Reference Reference No 2.11 (1.37–3.22) 0.00 1.53 (1.16-2.00) 0.00 Type of birth Vaginal Reference Caesarion 0.94 (0.66–1.33) 0.74 ARV use during childbirth Yes Reference No 0.79 (0.47–1.35) 0.39 Uso of ARV by the child In the first 24 hours Reference 24 hours after birth 1.49 (0.52–4.25) 0.45 Unrealized 1.21 (0.35–4.20) 0.76 OR odds ratio. CI confidence interval. ARV pregnant women living with HIV/AIDS. MTCT mother-to-child transmission. Discussion This study highlights the high syphilis coinfection rate in PWLHA (6.9%) and the significantly increased risk of HIV-MTCT among PWLHA coinfected with syphilis compared with those without coinfection. The observed coinfection rate during pregnancy was higher than those reported in other international studies, which showed rates of 0.3%; 1.5%; 3.5%; and 5% [ 13 , 14 , 23 , 32 ], but lower than the 9.3% reported in a multicenter study across Brazil, South Africa, Argentina, and the United States [ 33 ], and lower than the 8% rate observed in a cohort from Malawi [ 24 ]. The rate found in this present study is in agreement with another population-based study in Brazil that used data from an observational cohort study on dolutegravir that registered a 7.7% coinfection rate [ 34 ]. In this specific study, a case of syphilis was defined as having documentation of a diagnosis or treatment of syphilis or a positive result on either a treponemal or nontreponemal syphilis test, which may increase the number of syphilis cases. Other local studies have shown variations in coinfection rates of syphilis in PWLHA, with rates between 3.8% and 13.7%, indicating that there are regional differences in the prevalence of these infections in pregnant women in Brazil [ 25 , 26 , 35 , 36 ], which is expected considering the macro regional differences, sociodemographic aspects and inequalities, and sexual behavior across the country [ 37 , 38 ]. HIV-MTCT was greater among HIV-positive pregnant women coinfected with syphilis. The MTCT rate was 2% in PWLHA with syphilis, whereas it was 1.2% in those without coinfection. This finding aligns with other studies identifying syphilis as a risk factor for HIV vertical transmission [ 23 – 26 , 32 , 35 ]. In these studies, syphilis coinfection was generally more common among women with additional risk factors, such as inadequate ARV use and incomplete prenatal care. However, similar to the present research, syphilis remained an independent risk factor for HIV vertical transmission in multivariate analyses [ 11 , 23 – 26 , 32 ]. These findings highlight the need for key strategic actions to prevent HIV transmission, emphasizing the importance of timely diagnosis and treatment of syphilis during pregnancy, as well as partner treatment, to prevent MTCT of both syphilis and HIV. The pregnant women with HIV and syphilis in this study were more frequently younger (10–24 years old), nonwhite, and had lower education levels, indicating greater social vulnerability. They also had poorer healthcare access, with higher rates of missed prenatal care and late HIV diagnosis — which are findings consistent with other Brazilian studies [ 21 , 25 , 26 , 35 ], and these characteristics can favor the MTCT of HIV. Additionally, syphilis during pregnancy is more prevalent in vulnerable populations, reinforcing its status as a socially determined disease. The associations between maternal and congenital syphilis, lower socioeconomic conditions, and limited healthcare access have been documented in both national [ 39 – 45 ] and international studies [ 46 , 47 ]. Therefore, the characteristics of the HIV-syphilis coinfection patients in this study further highlight their social vulnerability. The limitations of this study are related to the use of secondary data, which include some information with a high percentage of missing data, above 20%, which may hinder the interpretation of these results. These data, although with some limitations, have national representation. A special awareness should be aimed at the fact that Brazil has the highest HIV-syphilis coinfection rate compared with similar international studies, likely reflecting the country's high syphilis prevalence. Notably, studies using secondary data from clinical trials in Brazil (9.3%), Malawi (8%), and India (5%) tested women at delivery, capturing those without prenatal care [ 23 , 24 , 33 ]. In contrast, studies in Ukraine (3.5%), Tanzania (0.3%), and Botswana (1.5%) tested women throughout pregnancy and reported lower rates [ 13 , 14 , 32 ]. Social determinants remain the greatest challenge for STI-MTCT prevention in Brazil. While vertical HIV transmission has decreased, cases still occur in areas with limited healthcare access [ 48 ], and increasing numbers of infections among young women may progress slowly [ 49 ]. Socioeconomic factors also limit access to HIV and syphilis testing during prenatal care [ 41 , 50 – 52 ]. Areas with fewer diagnostic and treatment options for syphilis have higher rates of gestational and congenital syphilis [ 53 , 54 ]. Despite more prenatal visits, the incidence of congenital syphilis has increased [ 55 ]. Vulnerable populations, often pregnant at younger ages and with limited access to prevention methods, remain disproportionately affected by vertical STI transmission [ 43 , 56 – 58 ]. Despite a nearly 2% reduction in MTCT of HIV in Brazil, which is approaching the WHO's target for elimination, syphilis has significantly increased over the past decade, with rising rates of acquired, maternal, and congenital syphilis [ 6 , 7 ]. While HIV care benefits from ARV medications and prevention strategies such as postexposure prophylaxis (PEP) and preexposure prophylaxis (PrEP), people with syphilis are mainly diagnosed and managed by primary healthcare services, where challenges include hesitancy to use penicillin, patient resistance to injectable treatments, and difficulties in antibiotic dispensing [ 59 ]. Addressing prenatal inequities is essential for eliminating MTCT of both HIV and syphilis [ 40 , 50 , 60 ]. Conclusions The prevalence of syphilis among pregnant women living with HIV/AIDS was high (6.9%), and the MTCT of HIV was significantly greater among HIV-positive pregnant women coinfected with syphilis (2%) than among those without coinfection (1.2%). Pregnant women with HIV and syphilis were more likely to be younger (aged 10–24 years), have a higher prevalence of nonwhite individuals, and have lower education levels. Gaining a deeper understanding of the factors influencing vertical HIV transmission, even with antiretroviral therapy, could aid sustain the HIV-MTCT rate below 2%, endorsing its elimination as a public health priority. Abbreviations AIDS Acquired immune deficiency syndrome ARV antiretroviral HIV Human immunodeficiency virus MTCT mother-to-child transmission PEP postexposure prophylaxis PrEP preexposure prophylaxis PWLHA pregnant women living with HIV/AIDS STIs sexually transmitted infections WHO World Health Organization Declarations Ethics approval and consent to participate The authorization for the use of the national databases was obtained from the Department of HIV/AIDS, Tuberculosis, Viral Hepatitis, and Sexually Transmitted Infections, Brazilian Ministry of Health. The protocol was submitted to the Research Ethics Committee of the Health Sciences Center at the Federal University of Espírito Santo, Brazil, in accordance with Resolution Number 466/2012 of the National Health Council, approved under number 5,400,655/2022, and the need for consent to participate was waived by the ethics committee in question. The study adhered to the Declaration of Helsinki. Consent for publication Not applicable. Availability of data and materials The data that support the findings of this study are available in the Brazilian Ministry of Health databases, but restrictions apply to the availability of these data, which were used under license for the current study and are not publicly available. However, the data are available from the authors upon reasonable request and with the permission of the Brazilian Ministry of Health. Competing interests The authors declare that they have no competing interests. Funding Not applicable. Authors' contributions M.G.A. led the data analysis, wrote the manuscript, and generated the tables. L.H.L, A.P.B.S. and R.A.C. contributed to the data analysis. All the authors read and approved the final manuscript. Acknowledgments Not applicable. References Joint United Nations Programme on HIV/AIDS (UNAIDS). Transforming Vision into Reality: The 2024 Global Alliance Progress Report on Ending AIDS in Children by 2030. UNAIDS, 2024. Available: https://www.unaids.org/sites/default/files/media_asset/transforming-vision-into-reality_en.pdf World Health Organization [homepage na internet]. Global Sexually Transmitted Infections Programme: Mother-to-child transmission of syphilis [accessed April 28, 2025]. Available: https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/stis/prevention/mother-to-child-transmission-of-syphilis World Health Organization [homepage na internet]. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6740613","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":465538151,"identity":"d8b5b28a-a440-4ff9-bf30-718f1f320018","order_by":0,"name":"Mayra Gonçalves 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Brazil","correspondingAuthor":false,"prefix":"","firstName":"Draurio","middleName":"","lastName":"Barreira","suffix":""},{"id":465538157,"identity":"a7ec6dab-0fa2-4199-b8a8-bc59fce406b2","order_by":6,"name":"Angélica Espinosa Miranda","email":"","orcid":"","institution":"Post Graduation Program of Infectious Diseases, Federal University of Espírito Santo","correspondingAuthor":false,"prefix":"","firstName":"Angélica","middleName":"Espinosa","lastName":"Miranda","suffix":""}],"badges":[],"createdAt":"2025-05-24 19:08:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6740613/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6740613/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12889-025-25338-9","type":"published","date":"2025-12-06T15:58:23+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":97724677,"identity":"c1aa8c77-0711-4ee9-babc-43cc10a65e41","added_by":"auto","created_at":"2025-12-08 16:13:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1253538,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6740613/v1/17df8b52-4cd8-4bc2-a5b6-652514f958d5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Syphilis in pregnant women living with HIV/AIDS in Brazil and the relationship between coinfection and mother-to-child transmission of HIV","fulltext":[{"header":"Background","content":"\u003cp\u003eHIV and syphilis are sexually transmitted infections (STIs) of impact during pregnancy, affecting thousands of women and children worldwide [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Despite their importance, consolidated data on the prevalence of syphilis among pregnant women living with HIV/AIDS (PWLHA) and the impact of this coinfection throughout pregnancy and the postpartum period remain limited. According to the World Health Organization (WHO), there were 1.2\u0026nbsp;million PWLHA worldwide in 2023 [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. For syphilis, an estimated 1\u0026nbsp;million pregnant women had active syphilis worldwide in 2016 [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In Brazil, the detection rate of syphilis in pregnant women was 13.3 per 1,000 live births in 2016, rising to 17.2 in 2017 and reaching 34.0 in 2023 [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. During the same period, the detection rate of HIV in pregnant women remained relatively stable, ranging from 2.5 to 2.7 per 1,000 live births [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSyphilis is the most common coinfection in PWLHA, especially among socially vulnerable populations [\u003cspan additionalcitationids=\"CR9 CR10 CR11 CR12\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The adverse outcomes of HIV and syphilis for both pregnant individuals and fetuses are well documented, and the synergy between these two conditions may increase the risk of preterm birth, miscarriage, and low birth weight [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Importantly, there are effective treatments for controlling these conditions during pregnancy, as well as preventive measures to avoid mother‒to-child transmission (MTCT) of both conditions [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe presence of STIs increases the risk of sexual transmission of HIV [\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], but how STIs are related to MTCT of HIV is less understood. Some studies have shown that HIV coinfection with other STIs during pregnancy increases the risk of HIV MTCT, although no specific correlation between MTCT of syphilis and HIV has been identified [\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. On the other hand, other studies have revealed some associations between syphilis infection and increased MTCT of HIV [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In Brazil, for example, studies in Porto Alegre (capital) and Rio Grande do Sul (state) reported syphilis coinfection rates of 10.3% and 13.5%, respectively, in PWLHA [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], with both studies linking coinfection rates to higher HIV-MTCT rates.\u003c/p\u003e \u003cp\u003eSeveral factors may explain the increased risk of HIV-MTCT in pregnant women coinfected with HIV and other STIs. In cases of genital lesions caused by STIs, which increase local leukocyte recruitment, PWLHA had higher levels of HIV release in the genital area, increasing the risk of transmission during childbirth [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. In cervicitis, the infection may increase, causing chorioamnionitis and chronic placental inflammation. Chorioamnionitis reduces the natural protection of the placenta, increasing the risk of the intrauterine transmission of microorganisms. Chronic inflammation at the maternal‒fetal interface triggers immune activation and alters cytokine production, leading to increased HIV viral loads in pregnant women, a key factor predisposing them to HIV-MTCT [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite these explanatory factors, the role of syphilis in the MTCT of HIV remains uncertain. However, when syphilis causes ulcers, it recruits leukocytes to the area and increases the HIV concentration while compromising the skin barrier, yet its influence on MTCT after the regression of primary lesions is unclear [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Therefore, given the limited research on the frequency of HIV and syphilis coinfection during pregnancy and its relationship with MTCT, performing this national study is substantial once the data generated will assist in clinical decisions for monitoring PWLHA with or without syphilis and guide health policy planning to reduce MTCT of HIV toward its elimination.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eA retrospective cohort study was conducted using secondary data available from the Brazilian Ministry of Health's information systems. All reported cases of pregnant women with HIV and pregnant women with syphilis with delivery dates between 2016 and 2020 were studied to identify cases of coinfection and children with HIV/AIDS born between 2016 and 2020 to identify HIV-MTCT cases.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy population\u003c/h3\u003e\n\u003cp\u003eNotified HIV in Pregnant women, syphilis in pregnant women, and cases of MTCT for HIV in Brazil were analyzed. The epidemiological data of the studied infections were obtained from the National Brazilian Notifiable Diseases Information System (SINAN).\u003c/p\u003e \u003cp\u003eThe inclusion criteria were as follows: reported cases of HIV in pregnant women with delivery dates between 2016 and 2020, reported cases of children diagnosed with HIV/AIDS born between 2016 and 2020, and cases of HIV and syphilis coinfection during pregnancy with delivery dates between 2016 and 2020.\u003c/p\u003e\n\u003ch3\u003eData collection and variables\u003c/h3\u003e\n\u003cp\u003eTo construct the database for the cohort, a cross-referencing of the notification databases for pregnant women with HIV and syphilis during pregnancy was performed. The database of pregnant women living with HIV was subsequently cross-referenced with the database of children with HIV/AIDS to identify potential mother‒child pairs. Sociodemographic, behavioral and clinical variables present in the notification forms, such as procedures and treatments performed, dates of diagnoses, outcomes of pregnancy and MTCT, were studied.\u003c/p\u003e \u003cp\u003eAfter that, linkage of the databases was performed via Reclink\u0026reg; III software to identify cases of coinfection and mother‒child pairs. The first step in this process consists of defining the parameters of the hit and error probabilities that will be used to remove duplications and execute the relationships between dataframes. These parameters are defined on the basis of a 5% sample of each of the bases involved in the matrix generation, which creates matching pairs between databases and parameter modules to determine statistical criteria to evaluate whether matching records correspond to the same individual of Reclink\u0026reg; III [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eData comparison was carried out via the following database attributes: patient name, mother\u0026rsquo;s name, and date of birth. A diagnosis of syphilis or HIV/AIDS within a 90-day window was considered a simultaneous diagnosis. To match the mother‒child pairs, the pregnant woman's name, the child's mother's name, and the delivery date, including the birth date, were used. Possible duplicates in mother‒child pairs were removed, and only one child was presented for each matched mother.\u003c/p\u003e \u003cp\u003eTo eliminate potential duplicates in mother‒child pairings, the following factors were evaluated in order of priority: date of birth, delivery date, municipality of residency, diagnosis date and notification date.\u003c/p\u003e \u003cp\u003ePregnant women who did not have a matched child were considered to have an outcome of a child exposed to HIV without HIV-MTCT.\u003c/p\u003e \u003cp\u003eIn cases of missing delivery dates for pregnant women, an estimated calculation was made using the diagnosis date and gestational age, or in the absence of this, the notification date was considered. Additionally, cases of pregnant women notified of HIV between 2016 and 2020 were included, with corrections made to the delivery dates, resulting in a small increase in the total number of pregnant women.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eVariables related to sociodemographic characteristics, including the frequency distribution of qualitative variables, were descriptively analyzed in Excel\u0026reg;. For statistical analysis, the data were entered into a spreadsheet of the Statistical Package for the Social Sciences (SPSS Inc.\u0026reg;). To compare the distributions, chi-square independence tests were implemented for all variables in relation to whether the pregnant woman had only HIV or both HIV and syphilis. Associations with the variables were tested via chi-square tests, when appropriate. Odds ratios and 95% confidence intervals were obtained in the analysis. Furthermore, to estimate the binary effect of a variable while controlling for the effects of others on the probability of HIV-MTCT in pregnant women with HIV and syphilis coinfection, we performed logistic regression analysis. To assess the adequacy and performance of the logistic regression model, the Hosmer\u0026ndash;Lemeshow test was used [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. The final significance level considered was 5%.\u003c/p\u003e \u003cp\u003eIn logistic regression, observations of missing information (i.e., \"ignored\" values) were removed from each variable to avoid compromising the results. To obtain the final regression model, the \"stepwise forward\" method based on maximum likelihood (likelihood ratio - LR) was used. This method selects the variables to be incrementally included in the model. It starts with an empty model and adds variables one by one on the basis of their statistical significance. The variables are retained in the model if their predictive capacity is improved, as measured by the likelihood ratio [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. The criterion for including a variable was a p value lower than 0.05, indicating that the variable contributes significantly to the model.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical considerations\u003c/h3\u003e\n\u003cp\u003eThe authorization for the use of the national databases was obtained from the Department of HIV/AIDS, Tuberculosis, Viral Hepatitis, and Sexually Transmitted Infections, Brazilian Ministry of Health. The protocol was submitted to the Research Ethics Committee of the Health Sciences Center at the Federal University of Esp\u0026iacute;rito Santo, Brazil, in accordance with Resolution Number 466/2012 of the National Health Council and approved under number 5,400,655/2022. Privacy and confidentiality were ensured at all stages of the project through coding. The databases were analyzed without identifying the subjects.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThere were 40,634 pregnant women living with HIV during the study period. Of those, 2,788 were coinfected with syphilis, yielding a coinfection rate of 6.9% (95% CI: 6.6\u0026ndash;7.1%). The MTCT of HIV was significantly greater among HIV-positive pregnant women coinfected with syphilis than among those without coinfection (2.0% vs. 1.2%, p\u0026thinsp;\u0026le;\u0026thinsp;0.05), with an odds ratio of 1.7 (95% CI: 1.29\u0026ndash;2.25), as displayed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation of MTCT of HIV between PWLHA without syphilis and PWLHA with syphilis, Brazil 2016\u0026ndash;2020.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresence or absence of MTCT of HIV\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePWLHA without syphilis\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePWLHA and syphilis coinfection\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWithout MTCT: child exposed to HIV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37388 (98.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2731 (98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40119 (98.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWith MTCT: child with HIV/AIDS.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e458 (1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e515 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR\u0026thinsp;=\u0026thinsp;1.704\u003c/p\u003e \u003cp\u003e(CI 1.29\u0026ndash;2.25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37846 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2788 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40634 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eMTCT\u003c/em\u003e mother-to-child transmission. \u003cem\u003ePWLHA\u003c/em\u003e pregnant women living with HIV/AIDS.\u003c/p\u003e \u003cp\u003eThe sociodemographic characteristics of PWLHA without syphilis and PWLHA coinfected with syphilis are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Age categories were distinct between the two groups: PWLHA without syphilis were mostly composed of women between 25 and 34 years old (43.2%), and PWLHA with syphilis were represented by women between 10 and 24 years old (45.9%). In terms of race, both groups were predominantly composed of white individuals, PWLHA without syphilis (62.2%), and PWLHA with syphilis (70.6%). Regarding education, 47.8% of PWLHA without syphilis had 8 years or more of schooling, whereas the proportions of PWLHA with syphilis were very similar between those with less than 8 years (39.6%) and those with 8 years or more (39.3%). Both groups, PWLHA without syphilis (90.1%) and PWLHA with syphilis (91.9%), lived mainly in urban areas of the country.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic characteristics of PWLHA without and with syphilis coinfection, Brazil 2016\u0026ndash;2020.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSociodemographic characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePWLHA without syphilis\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePWLHA and syphilis coinfection\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10 to 24 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15291 (40.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1279 (45.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16570 (40.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25 to 34 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16315 (43.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1156 (41.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17471 (43.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;35 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5631 (14.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e331 (11.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5962 (14.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIgnored\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e609 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e631 (1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37846 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2788 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40634 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRace white/not white\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12705 (33.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e716 (25.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13421 (33.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot white\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23527 (62.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1969 (70.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25496 (62.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIgnored\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1614 (4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e103 (3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1717 (4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37846 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2788 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40634 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRace (all categories)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12705 (33.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e716 (25.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13421 (3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5053 (13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e526 (18.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5579 (13.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e223 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e234 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18093 (47.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1427 (51.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19520 (48.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndigenous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e158 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (0.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e163 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIgnored\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1614 (4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e103 (3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1717 (4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37846 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2788 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40634 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;8 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11078 (29.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1104 (39.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12182 (30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;8 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19257 (50.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1095 (39.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20352 (50.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIgnored\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7511 (19.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e589 (21.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8100 (19.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37846 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2788 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40634 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResidence zone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34077 (90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2562 (91.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36639 (90.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2465 (6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e135 (4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2600 (6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIgnored\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1304 (3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91 (3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1395 (3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37846 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2788 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40634 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003ePWLHA\u003c/em\u003e pregnant women living with HIV/AIDS.\u003c/p\u003e \u003cp\u003eConcerning the clinical characteristics of PWLHA, it is stratified by the presence or absence of syphilis coinfection, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Both groups received antenatal care, with PWLHA without syphilis accounting for 90.3% of women receiving prenatal care and PWLHA with syphilis accounting for 83.8%. With respect to gestational trimester, 35.6% of pregnant women were notified as PWLHA in the first trimester of gestation. PWLHA without syphilis using antiretroviral (ARV) medication during prenatal care accounted for 68.7%, and PWLHA with syphilis accounted for 56.6%. However, the proportion of ignored information in this variable was relatively high: 18.9% for PWLHA and 27.0% for PWLHA with syphilis. Moreover, in the two groups, cesarean delivery was the most common type of birth, but the percentage of cases with an unknown type of delivery was greater than 30% in both groups. The proportion of children born alive was equal in both groups (60.5%). Furthermore, PWLHA with syphilis were more likely to have stillbirth and miscarriage (5.1%) than PWLHA without syphilis (4.6%). Among the children born alive from PWLHA without or with syphilis, 56.7% and 55.4% used preventive ARV in the first 24 hours, respectively. For all three of these latest attributes, the percentage of missing information was greater than 30%.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical, diagnosis, healthcare aspects and pregnancy evolution of PWLHA without and with syphilis, Brazil 2016\u0026ndash;2020.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical and healthcare characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHIV without syphilis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHIV and syphilis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrenatal care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34160 (90.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2335 (83.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36495 (89.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2215 (5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e352 (12.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2567 (6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIgnored\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1471 (3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101 (3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1572 (3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37846 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2788 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40634 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGestational trimester\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1st trimester\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13657 (36.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e819 (29.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14476 (35.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2nd trimester\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8484 (22.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e641 (23.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9125 (22.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3rd trimester\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11787 (31.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1056 (37.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12843 (31.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIgnored\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3918 (10.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e272 (9.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4190 (10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37846 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2788 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40634 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaboratory evidence of HIV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBefore prenatal care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21472 (56.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1222 (43.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22694 (55.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuring prenatal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13656 (36.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1241 (44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14897 (36.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuring childbirth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2184 (5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e257 (9.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2441 (6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfter childbirth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e354 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53 (1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e407 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIgnored\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e180 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e195 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37846 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2788 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40634 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUse of ARV during prenatal care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25971 (68.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1579 (56.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27550 (67.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4705 (12.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e456 (16.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5161 (12.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIgnored\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7170 (18.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e753 (27.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7923 (19.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37846 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2788 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40634 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaginal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6999 (18.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e627 (22.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7626 (18.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCesarean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16539 (43.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1126 (40.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17665 (43.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDoes not apply\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1649 (4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e127 (4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1776 (4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIgnored\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12659 (33.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e908 (32.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13567 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37846 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2788 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40634 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eARV use during childbirth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21378 (56.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1422 (51.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22800 (56.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3890 (10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e405 (14.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4295 (10.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIgnored\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12578 (33.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e961 (34.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13539 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37846 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2788 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40634 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUse of ARV by the child\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn the first 24 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21469 (56.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1544 (55.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23013 (56.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24 hours after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e304 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e324 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDoes not apply\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1524 (4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e140 (5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1664 (4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnrealized\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e649 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e707 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIgnored\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13900 (36.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1026 (36.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14926 (36.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37846 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2788 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40634 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.053\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEvolution of pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBorn alive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22901 (60.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1686 (60.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24587 (60.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStillbirth and miscarriage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1746 (4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e142 (5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1888 (4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIgnored\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13199 (34.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e960 (34.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14159 (34.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37846 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2788 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40634 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.488\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003ePWLHA\u003c/em\u003e pregnant women living with HIV/AIDS. \u003cem\u003eARV\u003c/em\u003e antiretroviral.\u003c/p\u003e \u003cp\u003eFor the logistic regression (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e), the model was tested with all variables, except \"Evolution of pregnancy\", since it exhibited multicollinearity with other variables. Only complete observations of all the variables were considered for the model, representing 14,406 (36.8%) of all the cases. Coinfection with syphilis (p\u0026thinsp;=\u0026thinsp;0.55), a later start of prenatal care (p\u0026thinsp;=\u0026thinsp;0.002 for the second trimester and p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for the third trimester), laboratory evidence of HIV during prenatal care (p\u0026thinsp;=\u0026thinsp;0.020), during (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and after childbirth (p\u0026thinsp;=\u0026thinsp;0.006) and not using ARV during pregnancy (p\u0026thinsp;=\u0026thinsp;0.002) remained statistically relevant to the outcome of MTCT for HIV.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariable logistic regression with unadjusted and adjusted models for odds of MTCT of HIV.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnadjusted\u003c/p\u003e \u003cp\u003eOR (CI 95%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAdjusted\u003c/p\u003e \u003cp\u003eOR (CI 95%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHIV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHIV and syphilis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.43 (0.87\u0026ndash;2.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.41 (0.99\u0026ndash;2.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10 to 24 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25 to 34 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.83 (0.61\u0026ndash;1.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge; 35 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.54 (0.31\u0026ndash;0.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRace\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.69 (0.41\u0026ndash;1.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.82 (0.11\u0026ndash;6.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.68 (0.49\u0026ndash;0.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndigenous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.06 (0.14\u0026ndash;8.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt; 8 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge; 8 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.79 (0.59\u0026ndash;1.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResidence zone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.98 (0.56\u0026ndash;1.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGestational trimester\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1st trimester\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2nd trimester\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.76 (1.09\u0026ndash;2.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.46 (1.09\u0026ndash;1.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3rd trimester\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.18 (1.42\u0026ndash;3.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.83 (1.40\u0026ndash;2.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaboratory evidence of HIV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBefore prenatal care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuring prenatal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.28 (0.90\u0026ndash;1.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.321 (1.05\u0026ndash;1.671)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuring childbirth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.38 (1.39\u0026ndash;4.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.880 (1.92\u0026ndash;4.322)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfter childbirth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.37 (1.69\u0026ndash;11.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.143 (1.40-7.074)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrenatal care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.00 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUse of ARV during prenatal care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.11 (1.37\u0026ndash;3.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.53 (1.16-2.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaginal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCaesarion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.94 (0.66\u0026ndash;1.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eARV use during childbirth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.79 (0.47\u0026ndash;1.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUso of ARV by the child\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn the first 24 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24 hours after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.49 (0.52\u0026ndash;4.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnrealized\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.21 (0.35\u0026ndash;4.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eOR\u003c/em\u003e odds ratio. \u003cem\u003eCI\u003c/em\u003e confidence interval. \u003cem\u003eARV\u003c/em\u003e pregnant women living with HIV/AIDS. \u003cem\u003eMTCT\u003c/em\u003e mother-to-child transmission.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study highlights the high syphilis coinfection rate in PWLHA (6.9%) and the significantly increased risk of HIV-MTCT among PWLHA coinfected with syphilis compared with those without coinfection. The observed coinfection rate during pregnancy was higher than those reported in other international studies, which showed rates of 0.3%; 1.5%; 3.5%; and 5% [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], but lower than the 9.3% reported in a multicenter study across Brazil, South Africa, Argentina, and the United States [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], and lower than the 8% rate observed in a cohort from Malawi [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The rate found in this present study is in agreement with another population-based study in Brazil that used data from an observational cohort study on dolutegravir that registered a 7.7% coinfection rate [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. In this specific study, a case of syphilis was defined as having documentation of a diagnosis or treatment of syphilis or a positive result on either a treponemal or nontreponemal syphilis test, which may increase the number of syphilis cases. Other local studies have shown variations in coinfection rates of syphilis in PWLHA, with rates between 3.8% and 13.7%, indicating that there are regional differences in the prevalence of these infections in pregnant women in Brazil [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], which is expected considering the macro regional differences, sociodemographic aspects and inequalities, and sexual behavior across the country [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHIV-MTCT was greater among HIV-positive pregnant women coinfected with syphilis. The MTCT rate was 2% in PWLHA with syphilis, whereas it was 1.2% in those without coinfection. This finding aligns with other studies identifying syphilis as a risk factor for HIV vertical transmission [\u003cspan additionalcitationids=\"CR24 CR25\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. In these studies, syphilis coinfection was generally more common among women with additional risk factors, such as inadequate ARV use and incomplete prenatal care. However, similar to the present research, syphilis remained an independent risk factor for HIV vertical transmission in multivariate analyses [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan additionalcitationids=\"CR24 CR25\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. These findings highlight the need for key strategic actions to prevent HIV transmission, emphasizing the importance of timely diagnosis and treatment of syphilis during pregnancy, as well as partner treatment, to prevent MTCT of both syphilis and HIV.\u003c/p\u003e \u003cp\u003eThe pregnant women with HIV and syphilis in this study were more frequently younger (10\u0026ndash;24 years old), nonwhite, and had lower education levels, indicating greater social vulnerability. They also had poorer healthcare access, with higher rates of missed prenatal care and late HIV diagnosis \u0026mdash; which are findings consistent with other Brazilian studies [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], and these characteristics can favor the MTCT of HIV. Additionally, syphilis during pregnancy is more prevalent in vulnerable populations, reinforcing its status as a socially determined disease. The associations between maternal and congenital syphilis, lower socioeconomic conditions, and limited healthcare access have been documented in both national [\u003cspan additionalcitationids=\"CR40 CR41 CR42 CR43 CR44\" citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e] and international studies [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. Therefore, the characteristics of the HIV-syphilis coinfection patients in this study further highlight their social vulnerability.\u003c/p\u003e \u003cp\u003eThe limitations of this study are related to the use of secondary data, which include some information with a high percentage of missing data, above 20%, which may hinder the interpretation of these results. These data, although with some limitations, have national representation. A special awareness should be aimed at the fact that Brazil has the highest HIV-syphilis coinfection rate compared with similar international studies, likely reflecting the country's high syphilis prevalence. Notably, studies using secondary data from clinical trials in Brazil (9.3%), Malawi (8%), and India (5%) tested women at delivery, capturing those without prenatal care [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. In contrast, studies in Ukraine (3.5%), Tanzania (0.3%), and Botswana (1.5%) tested women throughout pregnancy and reported lower rates [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSocial determinants remain the greatest challenge for STI-MTCT prevention in Brazil. While vertical HIV transmission has decreased, cases still occur in areas with limited healthcare access [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e], and increasing numbers of infections among young women may progress slowly [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. Socioeconomic factors also limit access to HIV and syphilis testing during prenatal care [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan additionalcitationids=\"CR51\" citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. Areas with fewer diagnostic and treatment options for syphilis have higher rates of gestational and congenital syphilis [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. Despite more prenatal visits, the incidence of congenital syphilis has increased [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. Vulnerable populations, often pregnant at younger ages and with limited access to prevention methods, remain disproportionately affected by vertical STI transmission [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan additionalcitationids=\"CR57\" citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite a nearly 2% reduction in MTCT of HIV in Brazil, which is approaching the WHO's target for elimination, syphilis has significantly increased over the past decade, with rising rates of acquired, maternal, and congenital syphilis [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. While HIV care benefits from ARV medications and prevention strategies such as postexposure prophylaxis (PEP) and preexposure prophylaxis (PrEP), people with syphilis are mainly diagnosed and managed by primary healthcare services, where challenges include hesitancy to use penicillin, patient resistance to injectable treatments, and difficulties in antibiotic dispensing [\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]. Addressing prenatal inequities is essential for eliminating MTCT of both HIV and syphilis [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe prevalence of syphilis among pregnant women living with HIV/AIDS was high (6.9%), and the MTCT of HIV was significantly greater among HIV-positive pregnant women coinfected with syphilis (2%) than among those without coinfection (1.2%). Pregnant women with HIV and syphilis were more likely to be younger (aged 10\u0026ndash;24 years), have a higher prevalence of nonwhite individuals, and have lower education levels. Gaining a deeper understanding of the factors influencing vertical HIV transmission, even with antiretroviral therapy, could aid sustain the HIV-MTCT rate below 2%, endorsing its elimination as a public health priority.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAIDS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAcquired immune deficiency syndrome\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eARV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eantiretroviral\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHIV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHuman immunodeficiency virus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMTCT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003emother-to-child transmission\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePEP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003epostexposure prophylaxis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePrEP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003epreexposure prophylaxis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePWLHA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003epregnant women living with HIV/AIDS\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSTIs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003esexually transmitted infections\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld Health Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authorization for the use of the national databases was obtained from the Department of HIV/AIDS, Tuberculosis, Viral Hepatitis, and Sexually Transmitted Infections, Brazilian Ministry of Health. The protocol was submitted to the Research Ethics Committee of the Health Sciences Center at the Federal University of Espírito Santo, Brazil, in accordance with Resolution Number 466/2012 of the National Health Council, approved under number 5,400,655/2022, and the need for consent to participate was waived by the ethics committee in question. The study adhered to the Declaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available in the Brazilian Ministry of Health databases, but restrictions apply to the availability of these data, which were used under license for the current study and are not publicly available. However, the data are available from the authors upon reasonable request and with the permission of the Brazilian Ministry of Health.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eM.G.A. led the data analysis, wrote the manuscript, and generated the tables. L.H.L, A.P.B.S. and R.A.C. contributed to the data analysis. All the authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eJoint United Nations Programme on HIV/AIDS (UNAIDS). Transforming Vision into Reality: The 2024 Global Alliance Progress Report on Ending AIDS in Children by 2030. UNAIDS, 2024. Available: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.unaids.org/sites/default/files/media_asset/transforming-vision-into-reality_en.pdf\u003c/span\u003e\u003cspan address=\"https://www.unaids.org/sites/default/files/media_asset/transforming-vision-into-reality_en.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization [homepage na internet]. 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Portuguese, Spanish. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1590/s1679-4974202100005.esp1\u003c/span\u003e\u003cspan address=\"10.1590/s1679-4974202100005.esp1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Erratum in: Epidemiol Serv Saude. 2021;30(spe1):e2021266. http://doi.org/10.1590/S1679-4974202100003.esp1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWooley NO, Macinko J. Association between sociodemographic characteristics and sexual behaviors among a nationally representative sample of adolescent students in Brazil. 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Rev bras Epidemiol. 2021;24(suppl 2):E210018. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1590/1980-549720210018.supl.2\u003c/span\u003e\u003cspan address=\"10.1590/1980-549720210018.supl.2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTorres PMA, Reis ARP, dos Santos AST, Negrinho NBS, Menegueti MG, Gir E. Factors associated with inadequate treatment of syphilis during pregnancy: an integrative review. Rev Bras Enferm. 2022;75(6):e20210965. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1590/0034-7167-2021-0965\u003c/span\u003e\u003cspan address=\"10.1590/0034-7167-2021-0965\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePereira GFM, Sabid\u0026oacute; M, Caruso A, Oliveira SB, Mesquita F, Benzaken AS. HIV Prevalence among Pregnant Women in Brazil: A National Survey. Revista Brasileira de Ginecol e Obstetr\u0026iacute;cia. 2016;38(8):391\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1055/s-0036-1592102\u003c/span\u003e\u003cspan address=\"10.1055/s-0036-1592102\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"HIV, Syphilis, Pregnancy, Mother-to-child transmission","lastPublishedDoi":"10.21203/rs.3.rs-6740613/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6740613/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eHIV and syphilis are sexually transmitted infections of concern during pregnancy that affect women and children globally. However, limited data is available regarding the prevalence of syphilis infection among pregnant women living with HIV/AIDS and its influence on mother‒to-child transmission (MTCT) of HIV. The present research aims to analyze HIV and syphilis coinfection during pregnancy through a national analysis of surveillance data from Brazil.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis retrospective cohort study used secondary data from the Ministry of Health's information systems. The data included reported cases of pregnant women living with HIV and syphilis, with childbirth between 2016 and 2020, and children with HIV/AIDS with a year of birth from 2016\u0026ndash;2020. Cross-referencing was performed between notification databases of pregnant women with HIV/AIDS and syphilis and pregnant women with HIV/AIDS and children with HIV/AIDS to identify potential mother‒child pairs. Pregnant women without a paired child with HIV were considered to have no outcome of MTCT for HIV. Logistic regression analysis was performed to estimate the effect of HIV and syphilis coinfection during pregnancy and HIV-MTCT, with a final significance level of 5%.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong 40,634 pregnant women living with HIV, 2,788 were coinfected with syphilis, yielding a coinfection rate of 6.9%. The MTCT of HIV was significantly greater among HIV-positive pregnant women coinfected with syphilis (2%) than among those without coinfection (1.2%), with an odds ratio of 1.7 (95% CI 1.29\u0026ndash;2.25, p\u0026thinsp;\u0026le;\u0026thinsp;0.05). Coinfection with HIV and syphilis was more prevalent among young women (aged 10\u0026ndash;24), non-white individuals and people with lower educational attainment, and those who did not receive prenatal care and had late laboratory evidence of HIV during pregnancy, indicating a more vulnerable population among the coinfected pregnant women.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eCompared with HIV-positive pregnant women without syphilis, HIV coinfection with syphilis during pregnancy was associated with a higher MTCT rate of HIV. Intersectoral public policies addressing social determinants are essential to achieve the goals of eliminating MTCT.\u003c/p\u003e","manuscriptTitle":"Syphilis in pregnant women living with HIV/AIDS in Brazil and the relationship between coinfection and mother-to-child transmission of HIV","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-05 18:39:17","doi":"10.21203/rs.3.rs-6740613/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-23T05:53:11+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"8932654854183201071026456672375414176","date":"2025-09-21T15:17:38+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-21T04:35:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"171206416728949404185564549545387322938","date":"2025-09-20T15:03:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"149922845876707665160280577813671094062","date":"2025-09-20T04:06:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"217498248929464118485932828032244134111","date":"2025-09-20T02:38:34+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-27T15:06:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"88713258979952947932645548511949003580","date":"2025-06-16T00:40:12+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-03T01:29:14+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-03T01:27:27+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-02T11:13:59+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-31T15:02:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-05-31T14:58:56+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"091e82e9-9739-47ca-b6dd-1dc66bc2c99a","owner":[],"postedDate":"June 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-08T16:10:27+00:00","versionOfRecord":{"articleIdentity":"rs-6740613","link":"https://doi.org/10.1186/s12889-025-25338-9","journal":{"identity":"bmc-public-health","isVorOnly":false,"title":"BMC Public Health"},"publishedOn":"2025-12-06 15:58:23","publishedOnDateReadable":"December 6th, 2025"},"versionCreatedAt":"2025-06-05 18:39:17","video":"","vorDoi":"10.1186/s12889-025-25338-9","vorDoiUrl":"https://doi.org/10.1186/s12889-025-25338-9","workflowStages":[]},"version":"v1","identity":"rs-6740613","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6740613","identity":"rs-6740613","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}