The WHO/UNAIDS Strategic response to prevention of HIV infection in infants involves four "pillars"-primary prevention of infection in women, prevention of unintended pregnancies in HIV-infected women, prevention of transmission from HIV-infected women to their infants and provision of treatment, care and support to HIV-infected women and their families .In resource-rich settings, where antenatal highly active antiretroviral therapy (HAART) is extensively used, MTCT rates have declined from around 16–25% in non-breastfeeding women to less than 1–2% .
Our aim was to evaluate the uptake and effectiveness of PMTCT interventions over an eight year period in Ukraine, within a multicentre cohort study of HIV-infected pregnant women and their infants, the European Collaborative Study (ECS).
The ECS is an ongoing birth cohort study, in which HIV-1 infected pregnant women are enrolled and their infants prospectively followed according to a standard protocol.
The ECS was established in 1985 in Western Europe to estimate the rate of and risk factors for MTCT .
Ukraine was the epicentre of the HIV epidemic in Eastern Europe, which has the most rapidly accelerating HIV epidemic world-wide today; national HIV prevalence is currently estimated at 1.6%.
Our objective was to evaluate the uptake and effectiveness of interventions for prevention of mother-to-child transmission (PMTCT) over an eight year period within operational settings in Ukraine, within the context of an ongoing birth cohort study.
The European Collaborative Study (ECS) is an ongoing birth cohort study in which HIV-infected pregnant women identified before or during pregnancy or at delivery were enrolled and their infants prospectively followed.Three centres in Ukraine started enrolling in 2000, with a further three joining in September 2006.Of the 3356 women enrolled, 21% (689) reported current or past injecting drug use (IDU).Most women were diagnosed antenatally and of those, the proportion diagnosed in the first/second trimester increased from 47% in 2000/01 (83/178) to 73% (776/1060) in 2006/07 (p There have been substantial improvements in use of PMTCT interventions in Ukraine, including earlier diagnosis of HIV-infected pregnant women and increasing coverage with antiretroviral prophylaxis and the initial MTCT rate has more than halved.Future research should focus on hard-to-reach populations such as IDU and on missed opportunities for further reducing the MTCT rate.Ukraine has the most severe HIV epidemic in the whole of Europe and the Commonwealth of Independent States with an estimated 440,000 people living with HIV/AIDS and an adult HIV prevalence rate of 1.6% .