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

Abstract

Background: The HIV epidemic in Russia has increasingly involved reproductive-aged women, which may increase perinatal HIV transmission.

Methods: Standard 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.

Results: Among 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.

Conclusions: Reduced 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.

Figure 1

HIV seroprevalence among women giving birth and birth rate among HIV-infected women. Proportion of HIV-infected women giving birth among all HIV-infected women and proportion of HIV-infected women among all women giving birth, St. Petersburg, Russia, 2004-2009, standard HIV surveillance.

Figure 2

History of injection drug use and prevalence of hepatitis C among HIV-infected women giving birth. History of injection drug use, history of injection drug use during pregnancy, and prevalence of hepatitis C among HIV-infected women giving birth, St. Petersburg, Russia, 2004-2008, enhanced perinatal HIV surveillance.

Figure 3

CD4-cell count and viral load testing among HIV-infected women giving birth. CD4-cell counts and percentage covered by immunologic monitoring, viral load and percentage covered by virologic monitoring, HIV-infected women giving birth, St. Petersburg, Russia, 2004-2008, enhanced perinatal HIV surveillance.

Figure 4

Timing and completeness of antiretroviral prophylaxis and perinatal HIV transmission. Percentage of HIV-infected women who started prenatal ARV ≤28 weeks gestation and received a full course dual/triple ARV prophylaxis, rate of perinatal HIV transmission, St. Petersburg, Russia, 2004-2008, enhanced perinatal HIV surveillance.