Medical Research Council Centre of Epidemiology for Child Health, University College London Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, England.
Bull World Health Organ. 2013 Jul 1;91(7):491-500. doi: 10.2471/BLT.12.114405. Epub 2013 Apr 24.
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).
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.
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).
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.
调查自乌克兰将产前联合抗逆转录病毒疗法（cART）纳入国家预防母婴传播（PMTCT）艾滋病毒政策以来，cART 的推广情况。
分析了 2008-2010 年参加乌克兰欧洲合作研究的 3535 名 HIV 阳性孕妇的数据。调查了接受齐多夫定单药治疗（AZTm）而非 cART 的因素，以及 HIV 母婴传播（MTCT）的发生率。
cART 的覆盖率显著增加，从 2008 年的 22%增加到 2010 年的 61%。在调整了可能的混杂因素后，与开始产前 AZTm 治疗而非 cART 治疗相关的因素包括同居（已婚；调整后的患病率比，aPR：1.09；95%置信区间，CI：1.02-1.16）、至少两次以前的活产（无；aPR：1.22；95%CI：1.11-1.35）以及在孕早期或孕中期诊断为 HIV 感染（孕前；aPR：1.11；95%CI：1.03-1.20）。总的 MTCT 率为 4.1%（95%CI：3.4-4.9）；42%（49/116）的传播来自于 8%（n=238）未接受产前 ART 的妇女。与 AZTm 相比，cART 使 MTCT 的风险降低了 70%（调整后的比值比：0.30；95%CI：0.16-0.56）。
2008 年至 2010 年间，乌克兰产前 cART 的获得情况显著改善，但世界卫生组织的“选项 B”政策的实施进展缓慢。为了在乌克兰消除母婴传播，迫切需要改善 HIV 护理中妇女的保留率，并进一步推广“选项 B”。
