Rapid HIV testing, pregnancy, antiretroviral prophylaxis and infant abandonment in St Petersburg

Hillis, Susan D.; Rakhmanova, Aza; Vinogradova, Elena; Voronin, Evgeny; Yakovlev, A. A.; Khaldeeva, N A; Akatova, Natalia; Samarskaya, Mida F.; Волкова, Г. В.; Kissin, D.M.; Jamieson, Denise J.; Glynn, M. Kathleen; Robinson, Joanna; Miller, William C.

doi:10.1258/095646207779949781

Cited by 17 publications

(15 citation statements)

References 3 publications

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“…If scaled up to a total of five metropolitan areas with highest HIV seroprevalence (i.e., Samara, Irkutsk, Yekaterinburg, Orenburg) [6], enhanced perinatal surveillance may provide valuable national data on the risk factors for perinatal HIV transmission for considerably less than one percent of the amount spent on HIV prevention in Russia [20]. In St. Petersburg, enhanced perinatal surveillance was critical in identifying areas needing improvement, such as limited use of effective family planning [21], low infant follow-up [10], and delayed and less effective antiretroviral prophylaxis [9]. Immediate, focused attention by the local public health leadership made it possible to address each of these issues in a timely fashion through program and policy improvements.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2011

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2011

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“…One in 10 IDUs were diagnosed intrapartum, with sdNVP the only potential option for PMTCT prophylaxis compared with 3% of other women, reflecting the fact that one in six received no ANC. In a study in St Petersburg, Russian Federation, two-thirds of women presenting in labour with unknown HIV status were IDUs, mostly without ANC [27]; here the equivalent figure was 43%. IDU has been identified previously as a risk factor for non-receipt of PMTCT prophylaxis in western Europe [25,26], but not consistently [38].…”

Section: Discussionmentioning

confidence: 99%

Prevention of mother‐to‐child transmission of human immunodeficiency virus among pregnant women using injecting drugs in Ukraine, 2000–10

Thorne

Semenenko²,

Malyuta³

2011

Addiction

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AimsTo 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 settingProspective cohort study conducted in seven human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) Centres in Ukraine, 2000–10.ParticipantsPregnant HIV-infected women, identified before/during pregnancy or intrapartum, and their live-born infants (n = 6200); 1028 women followed post-partum.MeasurementsMaternal and delivery characteristics, PMTCT prophylaxis, MTCT rates, preterm delivery (PTD) and low birth weight (LBW).FindingsOf 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).ConclusionsPregnant 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.

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“…Young people living part time or full time on the street, known as 'street youth', constitute a group particularly at risk. Multiple factors lead youth to the streets, including abuse or neglect at home or in an orphanage, abandonment, and parental substance abuse or death [2][3][4][5][6]. Although many Experts estimate there are 1-3 million street youth in Russia [7].…”

Section: Introductionmentioning

confidence: 99%

HIV seroprevalence in street youth, St Petersburg, Russia

Kissin

Zapata

Yorick

et al. 2007

Aids

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Rapid HIV testing, pregnancy, antiretroviral prophylaxis and infant abandonment in St Petersburg

Cited by 17 publications

References 3 publications

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

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

Prevention of mother‐to‐child transmission of human immunodeficiency virus among pregnant women using injecting drugs in Ukraine, 2000–10

HIV seroprevalence in street youth, St Petersburg, Russia

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