Academic journal article Bulletin of the World Health Organization

Impact of Expanded Access to Combination Antiretroviral Therapy in Pregnancy: Results from a Cohort Study in Ukraine/ Impact De L'acces Elargi Au Traitement Par Association D'antiretroviraux Pendant la Grossesse: Resultats D'une Etude De Cohorte En Ukraine

Academic journal article Bulletin of the World Health Organization

Impact of Expanded Access to Combination Antiretroviral Therapy in Pregnancy: Results from a Cohort Study in Ukraine/ Impact De L'acces Elargi Au Traitement Par Association D'antiretroviraux Pendant la Grossesse: Resultats D'une Etude De Cohorte En Ukraine

Article excerpt

Introduction

Among the countries of Europe, Ukraine has the highest prevalence of adult infection with human immunodeficiency virus (HIV) (1.6%) and the highest rate of mortality attributable to acquired immunodeficiency syndrome (AIDS) (8.2 deaths per 100 000 population in 2011). (1-3) The country's epidemic of HIV infection has been driven by the practice of injecting illicit drugs. (1) The quality of HIV care provided in Ukraine has been badly affected by the severe economic crisis that followed the country's independence in 1991 and by the limitations of its verticalized health-care system. (4) Although the national scale-up of antiretroviral therapy (ART) began in 2004, need has outstripped supply and the devolution of budgets has led to regional disparities in access to such therapy. (4,5) In 2011, 30% of individuals who were eligible for ART and in HIV care in Ukraine were not receiving ART, and 13% of those on ART were having their therapy financed by the Global Fund to Fight AIDS, Tuberculosis and Malaria. (1) In the same year, the ART regimens in common use in Ukraine cost at least 100 United States dollars per patient. (6)

The elimination of new HIV infections in infants by 2015 is a current global target, (7) and the prevention of mother-to-child transmission (PMTCT) of HIV has become a public-health priority in many countries, including Ukraine. (1) In 2010, the World Health Organization (WHO) published guidelines for the use of ART in pregnant women. (8) These guidelines recommended initiation of lifelong combination ART (cART) for all pregnant women with CD4+ T-lymphocyte (CD4+ cell) counts of [less than or equal to] 350 per [micro]l and/or HIV disease in WHO stage 3 or 4. They also recommended two options for those pregnant women who require ART for PMTCT only: Option A, consisting of zidovudine monotherapy (AZTm) plus single-dose nevirapine (sdNVP), and Option B, consisting of antenatal cART. (8) In 2012, WHO published a programmatic update on "Option B+"--the initiation of lifelong cART for all HIV-positive pregnant women. (9) The potential benefits of this approach include improved maternal health and the harmonization of treatment programmes. (10)

Following the scale-up of PMTCT services in Ukraine, the rate of MTCT fell from 15% in 2001 to 6-7% in 2007, although the annual numbers of new infections in women of childbearing age--many of which had been acquired heterosexually--increased over the same period. (1,3,11-13) By 2011, the prevalence of HIV infection among pregnant women was higher in Ukraine (0.47%) than in any other country in Europe (1) and exceeded 3% in some regions of the country (personal communication, Natalya Nizova, 2012). In 2007, 92% of the HIV-positive pregnant women in Ukraine received ART, and PMTCT prophylaxis was based on AZTm and sdNVP. (13,14) In November 2007, the country's Ministry of Health recommended the national implementation of WHO's Option-B strategy. The present study was based on data collected in Ukraine between 2008 and 2010 as part of a larger, prospective, observational study of HIV-positive pregnant women and their infants. The aims of the present study were to investigate coverage with antenatal cART, the factors associated with receipt of AZTm--rather than cART--and MTCT rates.

Methods

The European Collaborative Study is an ongoing, observational, birth cohort study in which HIV-positive pregnant women--diagnosed before or during pregnancy or around the time of delivery--are enrolled and their infants are prospectively followed, either for 18-24 months if HIV-negative or on an ongoing basis if HIV-positive. (13) Data collection takes place at delivery and then as often as infant follow-up allows. The study began enrolment in Ukraine in 2000 and seven Ukrainian centres for HIV care currently participate. Informed consent is obtained for collection of linked anonymous data on maternal, infant and delivery characteristics and clinical parameters. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.