Gaps between screening and counseling in the prevention of mother-to-child transmission of HIV and syphilis in a Paraguayan referral hospital

Abstract

Mother-to-child transmission of HIV and syphilis remains a significant challenge in Latin America. This cross-sectional study evaluated the prevalence of these infections and the coverage of preventive services at the Regional Hospital of Ciudad del Este, Paraguay. Data from 238 pregnant and postpartum women were analyzed during 2022-2023, collected through structured interviews and review of clinical records. HIV prevalence was 4.6% and syphilis 5.0%, rates higher than previously reported in the region. Screening coverage was high (>90% for both infections), but only 37% of patients received adequate counseling. Educational level and early initiation of prenatal care were significantly associated with a higher likelihood of receiving counseling (OR=2.14, 95%CI:1.42-3.22 and OR=1.89, 95%CI:1.31-2.73, respectively). Age under 20 years was identified as a risk factor for syphilis (OR=2.84, 95%CI:1.46-5.52). The main barriers to effective implementation of preventive services included limitations in healthcare infrastructure, shortage of trained personnel, and sociocultural factors. The findings suggest the need to strengthen prevention programs, with emphasis on improving counseling quality and reducing access barriers, particularly for vulnerable populations. Specific interventions that consider the local context and sociodemographic characteristics of the served population are required.