Impact of expanded access to combination antiretroviral therapy in pregnancy: results from a cohort study in Ukraine

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. Findings 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). Conclusion 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.