Bulletin of the World Health Organization

Impact of expanded access to combination antiretroviral therapy in pregnancy: results from a cohort study in Ukraine

Heather Bailey, Claire L Townsend, Igor Semenenko, Ruslan Malyuta, Mario Cortina-Borja, Claire Thorne & for the Ukraine European Collaborative Study Group in EuroCoord

Objective

To investigate the scale-up of antenatal combination antiretroviral therapy (cART) in Ukraine since this became part of the national policy for the prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV).

Methods

Data on 3535 HIV-positive pregnant women who were enrolled into the Ukraine European Collaborative Study in 2008–2010 were analysed. Factors associated with receipt of zidovudine monotherapy (AZTm) – rather than cART – and rates of mother-to-child transmission (MTCT) of HIV were investigated.

Findings

cART coverage increased significantly, from 22% of deliveries in 2008 to 61% of those in 2010. After adjusting for possible confounders, initiation of antenatal AZTm – rather than cART – was associated with cohabiting (versus being married; adjusted prevalence ratio, aPR: 1.09; 95% confidence interval, CI: 1.02–1.16), at least two previous live births (versus none; aPR: 1.22; 95% CI: 1.11–1.35) and a diagnosis of HIV infection during the first or second trimester (versus before pregnancy; aPR: 1.11; 95% CI: 1.03–1.20). The overall MTCT rate was 4.1% (95% CI: 3.4–4.9); 42% (49/116) of the transmissions were from the 8% (n = 238) of women without antenatal ART. Compared with AZTm, cART was associated with a 70% greater reduction in the risk of MTCT (adjusted odds ratio: 0.30; 95% CI: 0.16–0.56).

Conclusion

Between 2008 and 2010, access to antenatal cART improved substantially in Ukraine, but implementation of the World Health Organization’s Option-B policy was slow. For MTCT to be eliminated in Ukraine, improvements in the retention of women in HIV care and further roll-out of Option B are urgently needed.

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