Factores relacionados con la adherencia a los exámenes de diagnóstico del VIH gestacional en afiliadas del régimen subsidiado de salud en Barranquilla
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Fecha
2025
Autores
Beltrán Zabaleta, Claudia Patricia
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Ediciones Universidad Simón Bolívar
Facultad de Ciencias de la Salud
Facultad de Ciencias de la Salud
Resumen
Antecedentes: La adherencia a los exámenes de diagnóstico de VIH durante el
embarazo es fundamental para prevenir la transmisión materno-infantil del virus,
una prioridad destacada por la Organización Mundial de la Salud (OMS), que
recomienda intervenciones integrales que incluyan educación, reducción del
estigma y mejora del acceso a los servicios. Sin embargo, en Latinoamérica —y
particularmente en Colombia— persisten importantes desafíos que afectan la
realización de estas pruebas, los cuales están relacionados con barreras
estructurales, culturales, socioeconómicas y de conocimiento. Diversos estudios
(Castro y López, González et al., Ipia-Ordóñez et al., García-Balaguera, Martínez y
Gómez, Hernández y Sánchez, Torres y Rodríguez) han identificado factores
como el bajo nivel educativo, ingresos reducidos, desempleo, estigmatización,
cuidado del hogar, y la lejanía geográfica como condicionantes claves en la baja
asistencia a controles prenatales y la no realización del diagnóstico de VIH. Estas
barreras afectan especialmente a mujeres jóvenes, con menor escolaridad o
residentes en zonas rurales, evidenciando desigualdades en el acceso y la calidad
del cuidado prenatal. Aunque la cobertura del control prenatal en Colombia es alta,
como señala García-Balaguera (2017), persisten dificultades en la autorización de
pruebas, el acceso a especialistas y la percepción de calidad, lo que incide
negativamente en la salud materno-perinatal. Ante este panorama, el presente
estudio busca identificar los factores que influyen en la adherencia a los exámenes
de diagnóstico de VIH gestacional en gestantes afiliadas al régimen subsidiado en
Barranquilla, reconociendo la urgente necesidad de diseñar estrategias basadas
en evidencia que respondan a las características sociodemográficas de esta
población y contribuyan a cerrar brechas de acceso, mejorar la atención prenatal y
cumplir con los estándares internacionales de salud materna. Objetivos:
Determinar los factores relacionados con la adherencia a los exámenes de
diagnóstico de VIH gestacional en gestantes afiliadas al Régimen Subsidiado de
Salud en Barranquilla. Lo anterior, se logró a través de la identificación y
descripción de las características sociodemográficas, las barreras personales, de
conocimiento, sociales y culturales, de atención en salud y de accesibilidad
percibidas por las gestantes objeto de estudio, así como el establecimiento de
relaciones entre las barreras según las características sociodemográficas.
Materiales y Métodos: esta investigación fue descriptiva, con un enfoque
empírico analítico y de corte transaccional, ya que los datos se recolectaron entre
el último trimestre del 2023 y el primer trimestre del 2024, a partir de una muestra
de 209 gestantes del régimen subsidiado, mayores de edad, inscritas al programa
materno perinatal y que no se realizaron alguna de las pruebas de VIH durante el
transcurso del programa. Asimismo, para determinar las asociaciones entre las
variables se utilizó Chi-cuadrado con corrección de monte Carlo y la prueba exacta
de Fisher. Resultados: La mayoría de las participantes reside en la localidad
Suroriente (184; 88,0 %), tiene entre 19 y 23 años (84; 40,2 %), alcanzó el nivel de
secundaria completa (129; 61,7 %), se dedica principalmente a labores del hogar
(149; 71,3 %), vive en unión libre (131; 62,7 %), convive con su pareja (144;
68,9 %), tiene un hijo (124; 59,3 %) y se encontraba entre las 27 y 39 semanas de
embarazo (117; 56,0 %) en el momento de su participación. Las principales
barreras para la realización de la prueba del VIH entre las gestantes se relacionan,
en primer lugar, con factores del sistema de salud, ya que casi la mitad indicó que
su médico o enfermera no les propuso la prueba (48,8 %) y un 34,4 % afirmó que
nunca se la ofrecieron, lo que sugiere una escasa promoción desde el ámbito
clínico; en segundo lugar, surgen obstáculos de acceso y logística, donde el
39,7 % no tiene fácil acceso a un lugar para realizarla y el 29,2 % no dispone de
tiempo; también destacan las barreras sociales y culturales, con un 37,8 % que
perciben desaprobación de su pareja o familia y un 31,1 % que desconfían de la
confidencialidad de sus datos; en cuanto a barreras personales, el 30,6 % no ve
prioritaria la prueba durante el embarazo y el 28,7 % no se perciben en riesgo;
finalmente, las barreras de conocimiento se evidencian en un 32,1 % que confían
en que sus parejas no tienen VIH y un 28,2 % que creen estar protegidas por el
uso de condón, mientras que el nivel de conocimiento general sobre la prueba se
sitúa en un rango medio en el 65,6 % de las participantes. El análisis de
asociaciones estadísticas revela que las barreras para la realización de la prueba
del VIH entre gestantes están significativamente relacionadas con diversas
variables sociodemográficas y obstétricas. En las barreras personales, no creerse
en riesgo está asociado tanto con la localidad (χ²=10,287; p=0,031) como con el
rango de edad (χ²=11,731; p=0,032), y el temor a morir por un diagnóstico se
vincula con la cantidad de hijos (χ²=11,716; p=0,032). En cuanto a las barreras de
conocimiento, no considerarse en riesgo nuevamente se asocia con la localidad,
las semanas de embarazo y el nivel educativo (p<0,05 en todos los casos),
mientras que otras percepciones erróneas como confiar en el uso del condón o
pensar que no se puede tener VIH están también ligadas significativamente al
nivel educativo y a las semanas de gestación. Las barreras sociales y culturales
muestran asociaciones con la composición del hogar, la localidad y la ocupación,
reflejando cómo las dinámicas familiares, comunitarias y laborales influyen en la
toma de decisiones (todos con p<0,05). Las barreras de acceso y logística están
relacionadas con la localidad y el rango de edad, lo que indica desigualdades
territoriales y generacionales en el acceso y percepción de los servicios (p<0,05).
Por último, las barreras relacionadas con el sistema de salud presentan fuertes
asociaciones con la localidad, la cantidad de hijos, semanas de embarazo y el
estado civil (hasta p=0,002), revelando deficiencias institucionales que afectan la
equidad y cobertura en la atención prenatal.
Background: Adherence to HIV diagnostic testing during pregnancy is essential to preventing mother-to-child transmission of the virus. This priority has been emphasized by the World Health Organization (WHO), which advocates for comprehensive interventions including education, stigma reduction, and improved access to healthcare services. However, significant challenges persist in Latin America—and particularly in Colombia—that hinder the uptake of these tests. These challenges are related to structural, cultural, socioeconomic, and knowledge-related barriers. Various studies (Castro & López; González et al.; IpiaOrdóñez et al.; García-Balaguera; Martínez & Gómez; Hernández & Sánchez; Torres & Rodríguez) have identified key factors such as low educational attainment, limited income, unemployment, stigmatization, household caregiving responsibilities, and geographical remoteness as determinants negatively influencing attendance at prenatal check-ups and completion of HIV testing. These barriers disproportionately affect young women with lower educational levels or those residing in rural areas, highlighting disparities in access to and quality of prenatal care. Despite high prenatal care coverage in Colombia, as noted by García-Balaguera (2017), persistent issues such as test authorization, limited access to specialists, and perceived service quality continue to negatively impact maternal and perinatal health outcomes. Against this backdrop, the present study aims to identify the factors influencing adherence to gestational HIV diagnostic testing among pregnant women enrolled in the subsidized health regime in Barranquilla. The study underscores the urgent need to develop evidence-based strategies tailored to the sociodemographic characteristics of this population in order to bridge access gaps, improve prenatal care, and meet international maternal health standards. Objectives: To determine the factors related to adherence to gestational HIV diagnostic testing among pregnant women affiliated with the Subsidized Health Regime in Barranquilla. This objective was achieved through the identification and description of sociodemographic characteristics, as well as the personal, knowledge-related, social, cultural, healthcare-related, and perceived accessibility barriers reported by the pregnant women included in the study. Additionally, relationships were established between these barriers and the participants’ sociodemographic characteristics. Materials and Methods: This was a descriptive study employing an empirical-analytical approach with a crosssectional design, as data were collected between the last quarter of 2023 and the first quarter of 2024. The sample consisted of 209 pregnant women of legal age, enrolled in the maternal-perinatal program under the subsidized regime, who had not undergone one or more HIV tests during the program. Furthermore, to determine the associations between variables, the Chi-square test with Monte Carlo correction and Fisher’s exact test were used.Results: Most participants resided in the Southeast locality (184; 88.0%), were between 19 and 23 years old (84; 40.2%), had completed secondary education (129; 61.7%), were primarily homemakers (149; 71.3%), lived in a common-law union (131; 62.7%), cohabited with their partners (144; 68.9%), had one child (124; 59.3%), and were between 27 and 39 weeks pregnant at the time of participation (117; 56.0%). The main barriers to HIV testing were primarily related to the healthcare system. Nearly half of the participants reported that their physician or nurse did not propose the test (48.8%), and 34.4% stated it was never offered, suggesting insufficient promotion within clinical settings. The second major category involved access and logistical barriers: 39.7% indicated limited access to testing sites, and 29.2% cited lack of time. Social and cultural barriers were also notable: 37.8% perceived disapproval from their partners or families, and 31.1% distrusted the confidentiality of their personal data. Personal barriers included the perception that testing was not a priority during pregnancy (30.6%) and a lack of perceived risk (28.7%). Knowledge-related barriers were evident in the 32.1% who trusted that their partners did not have HIV and 28.2% who believed condom use offered full protection. Furthermore, 65.6% demonstrated a moderate level of knowledge about HIV testing. Statistical association analyses revealed significant relationships between testing barriers and various sociodemographic and obstetric variables. Regarding personal barriers, not perceiving oneself at risk was associated with locality (χ²=10.287; p=0.031) and age range (χ²=11.731; p=0.032), while fear of dying from a diagnosis associated with number of children (χ²=11.716; p=0.032). Knowledge-related barriers, such as not considering oneself at risk, were also linked to locality, gestational age, and educational level (all with p<0.05). Misconceptions—such as believing condom use fully prevents HIV or thinking they cannot contract the virus—were significantly associated with education level and gestational weeks. Social and cultural barriers showed associations with household composition, locality, and occupation, highlighting how family, community, and employment dynamics influence decision-making (all with p<0.05). Access and logistical barriers were related to locality and age range, indicating territorial and generational inequalities in access and perception of services (p<0.05). Finally, healthcare system-related barriers showed strong associations with locality, number of children, gestational weeks, and marital status (up to p=0.002), revealing institutional deficiencies that compromise equity and coverage in prenatal care
Background: Adherence to HIV diagnostic testing during pregnancy is essential to preventing mother-to-child transmission of the virus. This priority has been emphasized by the World Health Organization (WHO), which advocates for comprehensive interventions including education, stigma reduction, and improved access to healthcare services. However, significant challenges persist in Latin America—and particularly in Colombia—that hinder the uptake of these tests. These challenges are related to structural, cultural, socioeconomic, and knowledge-related barriers. Various studies (Castro & López; González et al.; IpiaOrdóñez et al.; García-Balaguera; Martínez & Gómez; Hernández & Sánchez; Torres & Rodríguez) have identified key factors such as low educational attainment, limited income, unemployment, stigmatization, household caregiving responsibilities, and geographical remoteness as determinants negatively influencing attendance at prenatal check-ups and completion of HIV testing. These barriers disproportionately affect young women with lower educational levels or those residing in rural areas, highlighting disparities in access to and quality of prenatal care. Despite high prenatal care coverage in Colombia, as noted by García-Balaguera (2017), persistent issues such as test authorization, limited access to specialists, and perceived service quality continue to negatively impact maternal and perinatal health outcomes. Against this backdrop, the present study aims to identify the factors influencing adherence to gestational HIV diagnostic testing among pregnant women enrolled in the subsidized health regime in Barranquilla. The study underscores the urgent need to develop evidence-based strategies tailored to the sociodemographic characteristics of this population in order to bridge access gaps, improve prenatal care, and meet international maternal health standards. Objectives: To determine the factors related to adherence to gestational HIV diagnostic testing among pregnant women affiliated with the Subsidized Health Regime in Barranquilla. This objective was achieved through the identification and description of sociodemographic characteristics, as well as the personal, knowledge-related, social, cultural, healthcare-related, and perceived accessibility barriers reported by the pregnant women included in the study. Additionally, relationships were established between these barriers and the participants’ sociodemographic characteristics. Materials and Methods: This was a descriptive study employing an empirical-analytical approach with a crosssectional design, as data were collected between the last quarter of 2023 and the first quarter of 2024. The sample consisted of 209 pregnant women of legal age, enrolled in the maternal-perinatal program under the subsidized regime, who had not undergone one or more HIV tests during the program. Furthermore, to determine the associations between variables, the Chi-square test with Monte Carlo correction and Fisher’s exact test were used.Results: Most participants resided in the Southeast locality (184; 88.0%), were between 19 and 23 years old (84; 40.2%), had completed secondary education (129; 61.7%), were primarily homemakers (149; 71.3%), lived in a common-law union (131; 62.7%), cohabited with their partners (144; 68.9%), had one child (124; 59.3%), and were between 27 and 39 weeks pregnant at the time of participation (117; 56.0%). The main barriers to HIV testing were primarily related to the healthcare system. Nearly half of the participants reported that their physician or nurse did not propose the test (48.8%), and 34.4% stated it was never offered, suggesting insufficient promotion within clinical settings. The second major category involved access and logistical barriers: 39.7% indicated limited access to testing sites, and 29.2% cited lack of time. Social and cultural barriers were also notable: 37.8% perceived disapproval from their partners or families, and 31.1% distrusted the confidentiality of their personal data. Personal barriers included the perception that testing was not a priority during pregnancy (30.6%) and a lack of perceived risk (28.7%). Knowledge-related barriers were evident in the 32.1% who trusted that their partners did not have HIV and 28.2% who believed condom use offered full protection. Furthermore, 65.6% demonstrated a moderate level of knowledge about HIV testing. Statistical association analyses revealed significant relationships between testing barriers and various sociodemographic and obstetric variables. Regarding personal barriers, not perceiving oneself at risk was associated with locality (χ²=10.287; p=0.031) and age range (χ²=11.731; p=0.032), while fear of dying from a diagnosis associated with number of children (χ²=11.716; p=0.032). Knowledge-related barriers, such as not considering oneself at risk, were also linked to locality, gestational age, and educational level (all with p<0.05). Misconceptions—such as believing condom use fully prevents HIV or thinking they cannot contract the virus—were significantly associated with education level and gestational weeks. Social and cultural barriers showed associations with household composition, locality, and occupation, highlighting how family, community, and employment dynamics influence decision-making (all with p<0.05). Access and logistical barriers were related to locality and age range, indicating territorial and generational inequalities in access and perception of services (p<0.05). Finally, healthcare system-related barriers showed strong associations with locality, number of children, gestational weeks, and marital status (up to p=0.002), revealing institutional deficiencies that compromise equity and coverage in prenatal care
Descripción
Palabras clave
VIH, Embarazo, Atención perinatal, Síndrome de Inmunodeficiencia Adquirida, Mujeres
