title: Prevention of mother-to-child transmission of human immunodeficiency virus among pregnant women using injecting drugs in Ukraine, 2000-10.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Prospective cohort study conducted in seven human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) Centres in Ukraine, 2000-10.
  
  
  METHODS
  Pregnant HIV-infected women, identified before/during pregnancy or intrapartum, and their live-born infants (n = 6200); 1028 women followed post-partum.
  
  
  METHODS
  Maternal and delivery characteristics, PMTCT prophylaxis, MTCT rates, preterm delivery (PTD) and low birth weight (LBW).
  
  
  RESULTS
  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.
authors.affiliation: MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, University College London, London, UK. c.thorne@ich.ucl.ac.uk
authors.forename: Claire
authors.initials: C
authors.lastname: Thorne
authors.forename: Igor
authors.initials: I
authors.lastname: Semenenko
authors.forename: Ruslan
authors.initials: R
authors.lastname: Malyuta
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission*; D006304:Health Status; D054625:Healthcare Disparities; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control* / Q000706:statistics & numerical data; D008297:Male; D056990:Post-Exposure Prophylaxis / Q000379:methods / Q000706:statistics & numerical data; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D014455:Ukraine / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D044966:Anti-Retroviral Agents