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Issue In the state of São Paulo (SSP), the rate of mother-to-child transmission of HIV (MTCT) was estimated at 2.7%, in 2006. However, for reaching elimination, its level should be &amp;lt; 2%. From 2000 to 2018, the SSP concentrated 21.3% (26,427/125,144) of the total cases of pregnant women living with HIV (PWLH) in Brazil. Description of the Problem The occurrence of MTCT cases shows failures of healthcare system. The aim of this study was to assess the response of the Sao Paulo State STI/AIDS Program to prevent MTCT, from 2010 to 2018. A descriptive analysis of clinical monitoring indicators of the PWLH was performed. The National Surveillance Data System was used to estimate the underreporting of cases. Data from antiretroviral drug delivery, viral load (VL) and genotyping results were used to calculate the indicators and were obtained through database of the National Antiretroviral Drug System, Laboratory Control System and Genotyping System. Results In the period, despite identifying 15,463 PWLH in the systems, only 11,316 were notified (26.8% underreporting). Comparing 2010 and 2018, there was an improvement in accessing combined antiretroviral therapy (cART) from 81.2% (1,366/1,683) to 86.6% (1,543/1,782); in performing of VL before delivery from 70.8% (1.192/1.683) to 72.8% (1.298/1.782); in VL suppression &amp;lt;50 copies/mL from 39.9% (671/1,683) to 53.4% (951/1,782); and in the pretreatment genotyping from 0.2% (2/992) to 22.4% (154/688). In 2016, the loss of follow up of cART in 6 and 18 months after delivery was 20% and 24%, respectively. Additionally, the number of children born with HIV decreased 79.7%, from 64 to 13 cases. Lessons The decrease in the number of cases suggests improvement in preventing MTCT in the SSP. However, many challenges remain, such as breaking down individual, social and programmatic barriers to expand access to cART, pretreatment genotyping, VL suppression before delivery, retention in care and adherence to cART over time. Key messages The National Systems of surveillance, antiretroviral drugs, laboratory and genotyping network are important for performing clinical monitoring, reducing treatment gaps and underreporting. The integration of the Sexually Transmitted Infections and HIV/AIDS Program with the Primary Care and the Maternal and Child Health Program is essential to achieve the goals of eliminating MTCT.

Monitoring of HIV pregnant women for evaluating mother-to-child transmission in Sao Paulo, 2010-2018