HTLV-1/2 antenatal screening in Distrito Federal, Brazil: evaluation of programme implementation and public health impact

Background The Pan American Health Organization (PAHO) aims to eliminate HTLV-1 vertical transmission, and Brazil is rolling out an antenatal screening programme. Lessons can be learned from pioneer regions, such as Distrito Federal. Methods This was a retrospective data analysis to assess operational aspects of the HTLV-1/2 antenatal testing strategy; a cross-sectional study with a questionnaire applied to women living with HTLV-1/2; and a study of children and adolescents born to women living with HTLV-1/2 to assess transmission rates. Results Programme implementation reduced vertical transmission from 10.5% to 0%. Most women (82.1%) diagnosed with HTLV-1/2 completed the testing strategy by the second trimester of pregnancy. Only 3.7% were diagnosed after delivery (up to 61 days later). The median turnaround times for the screening and confirmatory tests were 7 and 12 days, respectively. Most women diagnosed with HTLV formula fed their babies (86.5%) and received free formula (78.4%). However, only half received formula before being discharged from maternity (51.3%). Only 16.2% of the children born after maternal diagnosis had been tested for HTLV-1/2 prior to the study, indicating poor coverage of infant testing. Conclusions The programme implemented in Distrito Federal is effective in reducing HTLV-1 vertical transmission. Most women’s diagnoses are timely, allowing the implementation of measures to prevent transmission. The acceptance of exclusive formula feeding is high. The coverage of infant testing for HTLV-1 is limited. The data indicate that the implementation of a programme to eliminate HTLV-1 vertical transmission as a public health concern is feasible in Brazil.