Prevention of mothertochild transmission of HIV infection: Ukraine experience to date Ruslan Malyuta

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Prevention of mother-to-child transmission of HIV
infection Ukraine experience to dateRuslan
Malyuta, Marie-Louise Newell, Mikael Ostergren,
Claire Thorne, Nadezhda Zhilka(2006) European
Journal of Public Health, 16 (2), 123-127.

• Sandy Van Horn

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PMTCT in the Ukraine

• CONTEXT
• European WHO goal ? the number of HIV-infected
  infants to less than 1 per 100,000 live births by
  2010
• Ukrainian PMTCT program implemented in 2001

• RATIONALE
• HIV prevalence rates in pregnant women
  0.5-greater than 1
• Ukraine is a low resource setting
• Efficacy of PMTCT program needs to be tested
• Of Note 10 of women receive no antenatal care
  and abortion is still a major fertility control
  method (828/1000 live births in 2002)

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STUDY DESIGN

• A cohort of 860 women who tested HIV during
  antenatal test or during delivery was established
• 13 maternity hospitals, 3 cities with the highest
  HIV prevalence
• To look at how well the various components of the
  PMTCT program were being implemented

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METHODS

• Data categories
• Timing of diagnosis
• Demographic characteristics
• Type of prophylactic ARV
• Mode of delivery
• Perinatal outcome factors
• Gestational age
• Birth weight
• Breastfeeding vs formula feeding

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RESULTS

• 98 Caucasian
• Median Age of 25.1
• 43 married/ 37 cohabitating
• Transmission Risk
• Unspecified-46
• IDU IDU ptr-20
• IDU ptr-19
• IDU only-9

• Testing
• Pre-pregnancy-18
• Antenatal-67
• During labor-15
• 702/860 recd ARV, 71 single dose NVP for mother
  and child
• 64 vaginal births/33 CS
• 99.5 formula feed

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CONCLUSIONS

• Due to the fact that 67 of the women were tested
  antenatally means that they are receiving
  antenatal care
• Prophylactic ARVs are being given to reduce MTCT
• Shift from IDU to general heterosexual
  population, maybe

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• STRENGTHS
• Size of study
• PMTCT efficacy in low resource setting
• Europe (/ARV)

• LIMITATIONS
• Additional information solicitation (recd
  counseling?, recd ARV pre/post-pregnancy?)
• Education/SES

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ALTERNATIVE APPROACHES

• Gathering more information
• Qualitative study about why the women came back
  for their test results and why they use antenatal
  care so we could see if these factors could be
  implemented/replicated in other low resource
  settings (Africa)
• Reaching out specifically to IDU pregnant women
  for antenatal care

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SIGNIFICANCE

• Implementing effective PMTCT programs in low
  resource settings is incredibly important as the
  pandemic is now overwhelming being located within
  women.