Five-year trends in epidemiology and prevention of mother-to-child HIV transmission, St. Petersburg, Russia: results from perinatal HIV surveillance

Dmitry M Kissin,Nikolay A Belyakov,Charles Vitek,Aza G Rakhmanova,Denise J Jamieson,William C Miller,Susan Hillis,Natalia Akatova,Galina V Volkova,Alexey A Yakovlev,Joanna Robinson,Michele G Mandel,Evgeny E Voronin

doi:10.1186/1471-2334-11-292

Abstract

BackgroundThe HIV epidemic in Russia has increasingly involved reproductive-aged women, which may increase perinatal HIV transmission.MethodsStandard HIV case-reporting and enhanced perinatal HIV surveillance systems were used for prospective assessment of HIV-infected women giving birth in St. Petersburg, Russia, during 2004-2008. Trends in social, perinatal, and clinical factors influencing mother-to-child HIV transmission stratified by history of injection drug use, and rates of perinatal HIV transmission were assessed using two-sided χ2 or Cochran-Armitage tests.ResultsAmong HIV-infected women who gave birth, the proportion of women who self-reported ever using injection drugs (IDUs) decreased from 62% in 2004 to 41% in 2008 (P < 0.0001). Programmatic improvements led to increased uptake of the following clinical services from 2004 to 2008 (all P < 0.01): initiation of antiretroviral prophylaxis at ≤28 weeks gestation (IDUs 44%-54%, non-IDUs 45%-72%), monitoring of immunologic (IDUs 48%-64%, non-IDUs 58%-80%) and virologic status (IDUs 8%-58%, non-IDUs 10%-75%), dual/triple antiretroviral prophylaxis (IDUs 9%-44%, non-IDUs 14%-59%). After initial increase from 5.3% (95% confidence interval [CI] 3.5%-7.8%) in 2004 to 8.5% (CI 6.1%-11.7%) in 2005 (P < 0.05), perinatal HIV transmission decreased to 5.3% (CI 3.4%-8.3%) in 2006, and 3.2% (CI 1.7%-5.8%) in 2007 (P for trend <0.05). However, the proportion of women without prenatal care and without HIV testing before labor and delivery remained unchanged.ConclusionsReduced proportion of IDUs and improved clinical services among HIV-infected women giving birth were accompanied by decreased perinatal HIV transmission, which can be further reduced by increasing outreach and HIV testing of women before and during pregnancy.

Highlights

The HIV epidemic in Russia has increasingly involved reproductive-aged women, which may increase perinatal HIV transmission
Prevention of mother-to-child HIV transmission is among the highest priorities in Russia, current transmission rates are still higher than observed in high-income countries, where elimination of perinatal HIV infection is a feasible goal [7,8]
Many barriers to effective perinatal prevention relate to either behavioral characteristics of HIVinfected women themselves or to the quantity and quality of clinical services provided to these women and their infants during pregnancy, labor and delivery, and the postpartum period [10]

Summary

Introduction

The HIV epidemic in Russia has increasingly involved reproductive-aged women, which may increase perinatal HIV transmission. Many barriers to effective perinatal prevention relate to either behavioral characteristics of HIVinfected women themselves (e.g., lack of family planning or prenatal care) or to the quantity and quality of clinical services provided to these women and their infants during pregnancy, labor and delivery, and the postpartum period (e.g., late or inadequate antiretroviral prophylaxis, lack of HIV disease progression monitoring) [10]. It is unclear whether trends in these behavioral and clinical barriers differ among those HIV-infected women who used injection drugs, compared with those who did not

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Results

Conclusion