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Thorne C.,University College London | Semenenko I.,Perinatal Prevention of AIDS Initiative | Malyuta R.,Perinatal Prevention of AIDS Initiative
Addiction | Year: 2012

Aims To compare clinical status, mother-to-child transmission (MTCT) rates, use of prevention of (PMTCT) interventions and pregnancy outcomes between HIV-infected injecting drug users (IDUs) and non-IDUs. Design and setting Prospective cohort study conducted in seven human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) Centres in Ukraine, 2000-10. Participants Pregnant HIV-infected women, identified before/during pregnancy or intrapartum, and their live-born infants (n=6200); 1028 women followed post-partum. Measurements Maternal and delivery characteristics, PMTCT prophylaxis, MTCT rates, preterm delivery (PTD) and low birth weight (LBW). Findings Of 6200 women, 1111 (18%) reported current/previous IDU. The proportion of IDUs diagnosed with HIV before conception increased from 31% in 2000/01 to 60% in 2008/09 (P<0.01). Among women with undiagnosed HIV at conception, 20% of IDUs were diagnosed intrapartum versus 4% of non-IDUs (P<0.01). At enrolment, 14% of IDUs had severe/advanced HIV symptoms versus 6% of non-IDUs (P<0.001). IDUs had higher rates of PTD and LBW infants than non-IDUs, respectively, 16% versus 7% and 22% versus 10% (P<0.001). IDUs were more likely to receive no neonatal or intrapartum PMTCT prophylaxis compared with non-IDUs (OR 2.81, p<0.001). MTCT rates were 10.8% in IDUs versus 5.9% in non-IDUs; IDUs had increased MTCT risk (adjusted odds ratio 1.32, P=0.049). Fewer IDUs with treatment indications received HAART compared with non-IDUs (58% versus 68%, P=0.03). Conclusions Pregnant human immunodeficiency virus-infected injecting drug users in Ukraine have worse clinical status, poorer access to prevention of mother-to-child transmission prophylaxis and highly active antiretroviral therapy, more adverse pregnancy outcomes and higher risk of mother-to-child transmission than non-injecting drug user women. © 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.

Hoskins S.,Medical Research Council Clinical Trials Unit | Weller I.,University College London | Jahn A.,Ministry of Health | Jahn A.,International Training and Education Center on | And 5 more authors.
AIDS | Year: 2010

Monitoring the progress of HIV programmes is vital, as services are scaled up to include increasing numbers in need of care. Globally, the presence of multiple donors at all levels of HIV care has produced vast monitoring systems. Within HIV-treatment programmes in low and middle-income countries, directly assessing long-term outcomes such as survival is problematic, so indicators are used to monitor the progress of the treated population. However, the internal, external, construct validity and predictive value of current indicators have never been evaluated. Although the burden on facility staff compiling routine monitoring reports is vast, there is uncertainty as to which indicators best monitor patient progress. This burden will grow as increasing numbers of life-cohorts are created for monitoring purposes leading to data inaccuracies and compromising the internal validity of reported indicators. Furthermore, a number of fundamental indicators, including survival and retention, may not capture the construct they intend to measure, compromising the ability of programme managers to obtain reliable estimates regarding the welfare of their population in care. It is not known which indicators can predict the longer-term outcome of the patient population, and as such, can enable managers to respond to predictors of failure early. An evaluation of current indicators is urgently needed to ensure that reported facility-level data accurately reflect the welfare of the treated population and comparisons of programme performance are meaningful. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Ahn J.V.,University College London | Bailey H.,University College London | Malyuta R.,Perinatal Prevention of AIDS Initiative | Volokha A.,Shupyk National Medical Academy of Postgraduate Education | Thorne C.,University College London
AIDS and Behavior | Year: 2016

Ukraine has one of the largest populations of persons living with HIV in Europe. Data on 2019 HIV-positive married or cohabiting women enrolled in a postnatal cohort from 2007 to 2012 were analysed to investigate prevalence and factors associated with self-reported non-disclosure of HIV status. Median age at enrolment was 27.5 years, with two-thirds diagnosed during their most recent pregnancy. Almost all had received antenatal antiretroviral therapy and 24 % were taking it currently. One-tenth (n = 198) had not disclosed their HIV status to their partner and 1 in 20 (n = 93) had disclosed to no-one. Factors associated with non-disclosure were: unmarried status (AOR 2.99 (95 % CI 1.51–5.92), younger age at leaving full-time education (AOR 0.41 (95 % CI 0.19–0.88) for ≥19 years vs ≤16 years) and lack of knowledge of partner’s HIV status (AOR 2.01 (95 % CI 1.09–3.66). Further work is needed to support disclosure in some groups and to explore relationships between disclosure and psychological factors in this setting, including depression, lack of support and perception of stigma. © 2015, Springer Science+Business Media New York.

Aebi-Popp K.,University of Bern | Bailey H.,University College London | Malyuta R.,Perinatal Prevention of AIDS Initiative | Volokha A.,Shupyk National Medical Academy of Postgraduate Education | Thorne C.,University College London
BMC Pregnancy and Childbirth | Year: 2016

Background: Over 3500 HIV-positive women give birth annually in Ukraine, a setting with high prevalence of sexually transmitted infections. Herpes simplex virus Type 2 (HSV-2) co-infection may increase HIV mother-to-child transmission (MTCT) risk. We explored factors associated with HSV-2 seropositivity among HIV-positive women in Ukraine, and its impact on HIV MTCT. Methods: Data on 1513 HIV-positive women enrolled in the Ukraine European Collaborative Study from 2007 to 2012 were analysed. Poisson and logistic regression models respectively were fit to investigate factors associated with HSV-2 seropositivity and HIV MTCT. Results: Median maternal age was 27 years (IQR 24-31), 53 % (796/1513) had been diagnosed with HIV during their most recent pregnancy and 20 % had a history of injecting drugs. Median antenatal CD4 count was 430 cells/mm3 (IQR 290-580). Ninety-six percent had received antiretroviral therapy antenatally. HSV-2 seroprevalence was 68 % (1026/1513). In adjusted analyses, factors associated with HSV-2 antibodies were history of pregnancy termination (APR 1.30 (95 % CI 1.18-1.43) for ≥2 vs. 0), having an HIV-positive partner (APR 1.15 (95 % CI 1.05-1.26) vs partner's HIV status unknown) and HCV seropositivity (APR 1.23 (95 % CI 1.13-1.35)). The overall HIV MTCT rate was 2.80 % (95 % CI 1.98-3.84); no increased HIV MTCT risk was detected among HSV-2 seropositive women after adjusting for known risk factors (AOR 1.43 (95 % CI 0.54-3.77). Conclusion: No increased risk of HIV MTCT was detected among the 68 % of HIV-positive women with antibodies to HSV-2, in this population with an overall HIV MTCT rate of 2.8 %. Markers of ongoing sexual risk among HIV-positive HSV-2 seronegative women indicate the importance of interventions to prevent primary HSV-2 infection during pregnancy in this high-risk group. © 2016 Aebi-Popp et al.

Bagkeris E.,University College London | Malyuta R.,Perinatal Prevention of AIDS Initiative | Volokha A.,Shupyk National Medical Academy of Postgraduate Education | Cortina-Borja M.,University College London | And 3 more authors.
The Lancet HIV | Year: 2015

Background Women living with HIV are potentially at increased risk of adverse pregnancy outcomes, due to a range of factors, including immunosuppression, use of combination antiretroviral therapy (ART), and injecting drug use. Rates of mother-to-child transmission of HIV in Ukraine have declined to around 2-4%, but little is known about other pregnancy outcomes in this setting. We used data from an observational prospective cohort study to assess pregnancy outcomes among HIV-positive women in Ukraine. Methods The European Collaborative Study (ECS) in EuroCoord is a continuing cohort study, established in Ukraine in 2000. Eligible women are those with a diagnosis of HIV infection before or during pregnancy (including intrapartum) who deliver liveborn babies at seven sites. Maternal sociodemographic, HIV-related, and delivery (mother and infant) data were collected with study-specifi c questionnaires. We used Poisson regression models to identify factors associated with preterm delivery (before 37 weeks' gestation) and small weight for gestational age (less than the tenth percentile of weight for gestational age), based on complete cases. Findings Between January, 2000, and July, 2012, data were collected on 8884 HIV-positive mother and liveborn infant pairs. Median maternal age was 26·5 years (IQR 23·1-30·3). 832 (11%) women had WHO stage 3 or 4 HIV and 1474 (17%) had a history of injecting drug use. 7348 (83%) had received antenatal ART. Among 7435 for whom ART type was available, 4396 (50%) had received zidovudine monotherapy and 2949 (33%) combination ART. Preterm delivery was seen in 780 (9%, 95% CI 8-9) of 8860 births overall and in 77 (9%, 7-11) of 889 babies with small size for gestational age. Factors associated with preterm delivery were history of injecting drug use (adjusted risk ratio 1·64, 95% CI 1·38-1·95), no ART (2·94, 2·43-3·57 vs zidovudine monotherapy), antenatal combination ART (1·40, 1·14-1·73 vs zidovudine monotherapy), WHO stage 4 HIV (2·42, 1·71-3·41 vs WHO stage 1), and being in the most socially deprived group (1·38, 1·11-1·71). Small size for gestational age was associated with history of injecting drug use (adjusted RR 1·39, 95% CI 1·16-1·65), most socially deprived (1·32, 1·09-1·61), no ART (1·60, 1·32-1·94 vs zidovudine monotherapy), and antenatal combination ART (1·33, 1·12-1·60 vs zidovudine monotherapy). Interpretation Some risk factors for adverse pregnancy outcomes were directly associated with HIV and treatment and others were shared with the general antenatal population. Monitoring of pregnancy outcomes in Ukraine will be important as use of antenatal combination ART increases. Funding European Union Seventh Framework Programme, Wellcome Trust.

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