title: Impact of expanded access to combination antiretroviral therapy in pregnancy: results from a cohort study in Ukraine.
abstract: 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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Medical Research Council Centre of Epidemiology for Child Health, University College London Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, England.
authors.forename: Heather
authors.initials: H
authors.lastname: Bailey
authors.forename: Claire L
authors.initials: CL
authors.lastname: Townsend
authors.forename: Igor
authors.initials: I
authors.lastname: Semenenko
authors.forename: Ruslan
authors.initials: R
authors.lastname: Malyuta
authors.forename: Mario
authors.initials: M
authors.lastname: Cortina-Borja
authors.forename: Claire
authors.initials: C
authors.lastname: Thorne
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D016001:Confidence Intervals; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000635:transmission; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D016017:Odds Ratio; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy; D014455:Ukraine; D055815:Young Adult; D015215:Zidovudine / Q000627:therapeutic use*
chemical_list: D019380:Anti-HIV Agents; D044966:Anti-Retroviral Agents; D015215:Zidovudine