In recent years, Ukraine has witnessed a growing number of HIV-positive people, including a significant number of women mostly of reproductive age. This is due, primarily, to the increase of heterosexual transmission. As a result, there has been a significant increase of the number of children born to HIV-infected mothers. In the absence of prevention and treatment, the virus is transmitted from mothers to 30% of newborns.
Therefore, prevention of vertical transmission from mother to child is essential.
HIV transmission from mother to child occurs:
1. During pregnancy: via transplacental rising (through amniotic membranes and amniotic fluid) paths, as well as through invasive diagnostic interventions.
2. During delivery when the fetus passes through the natural maternal passages.
3. After childbirth, in case of breastfeeding.
The strategy of prevention of HIV transmission from mother to child
The strategy of prevention of HIV transmission from mother to child in Ukraine is based on the 4-component approach established by the World Health Organization:
1. prevention of HIV infection among women
2. prevention of unwanted pregnancy
3. prevention of HIV transmission from mother to child:
• antenatal protection of the fetus;
• pre-test and post-test counseling;
• testing pregnant women for HIV;
• antiretroviral prophylaxis and treatment of pregnant women, parturient women, mothers of newborns and newborns;
• safe delivery, testing of newborns for HIV;
• safe feeding.
4. care and social support for mothers after childbirth, newborns and their families.
Risk Factors
Risk factors that increase the rate of HIV transmission from mother to child:
• Advanced stage of HIV infection;
• Lack of antiretroviral therapy during pregnancy;
• The presence of sexually transmitted infections;
• Low rate of gaining weight during pregnancy;
• Burdened obstetric history;
• Threat of abortion;
• Development of placental insufficiency and fetal growth retardation, oligohydramnios;
• Long-term waterless period;
• Delivery through the natural maternal passages, invasive interventions during labor;
• Breastfeeding;
• Low social status of women, malnutrition, poor living conditions;
• Bad habits during pregnancy (drug intake, smoking, alcohol use);
• Lack of antiretroviral treatment for women in childbirth, mothers and newborns.
These official statistics and research results show that Ukraine is still faced with problems hindering the prevention of HIV transmission from mother to child, and attest to the fact that it is unreasonable to impose restrictions on the continuation of lifelong antiretroviral treatment for women who have given birth. For example, in Ukraine there has been an increase to the number of pregnant women who knew about their HIV-positive status prior to pregnancy, there are problems associated with the fact that HIV-positive women tardily address for antinatal medical aid.
According to a special study*, 33.0% of mothers of HIV-positive children first approached a gynecologist only at the time of birth, 25% of mothers of children with HIV before birth had high HIV viral load in the blood plasma corresponding to disseminated HIV infection (30 001-100 000 copies / ml) and AIDS stage (>100,000 copies / ml). It was also found that over half (56.0%) women who gave birth to HIV-positive children manifested low adherence to antiretroviral treatment. Social support during ARVP was provided to only one in four women (25.0%) who needed it.
In Ukraine, the resistant strains of HIV are spreading, which is the main cause of the inefficiency of specific treatment. According to the WHO recommendations, to minimize the risk of HIV resistance to ARV drugs it is necessary to provide universal and continuous access to ART, ensure high adherence of patients to ART, avoid lowering doses of medications because of moderate side effects, etc. Suspension of antiretroviral treatment after birth can result in HIV resistance to the drugs that the HIV-positive woman was taking during her pregnancy.
On the way to fulfilling the international targets for 2015, i.e. to reduce the HIV transmission from mother to child to 0%, it is necessary to address a number of pressing issues at both the national and regional levels, which will truly grant universal access to PMTCT activities for all HIV-positive pregnant women, especially women belonging to particularly vulnerable and disadvantaged groups. Given the above negative trends of the incidence of MTCT indicator and risks of the vertical transmission of HIV that currently exist in the country, restraining HIV epidemic and elimination of HIV transmission from mother to child may be achieved by implementing the PMTCT strategy in the “B +” version, i.e. lifelong ART for HIV-positive women who have given birth.
Today, Ukraine urgently needs the approval of a new Unified Clinical Protocol for the Prevention of HIV Transmission from Mother to Child drafted in 2013-2014 by the working group of the Ministry of Healthcare of Ukraine and including innovative technologies for the prevention of HIV infection of children born to HIV-positive mothers, as well as updated approaches to testing pregnant women and their sexual partners for HIV, etc. It is also important to improve the diagnosing of HIV infection in children with undetermined HIV status using the method of “dry drop”, the study of potential resources and ensuring implementation of the decentralization of the early diagnosing of HIV in children.
*Institutional study “Socio-Demographic and Medical Determinants of Risk of HIV Transmission from Mother to Child in Ukraine” Annotated Report – 2013, SI Ukrainian Centre of Control Over Social Diseases of the Ministry of Healthcare of Ukraine, UNICEF, the Institute of Sociology of the NAS of Ukraine.
Registration of children born to HIV-positive women in 2014
Registration of children aged 0-18 years in healthcare institutions in 2014
Order of the MOH of Ukraine of 14.11.2007 № 716 “On Approval of the Clinical Protocol for Obstetric Care ‘Prevention of Mother-to-Child Transmission’.”
Order of the MOH of Ukraine of August 3, 2012 № 612 “On Approval of Primary Records and Reporting on Monitoring Measures to Prevent HIV Transmission from Mother to Child, Instructions for Filling Them up” registered in the Ministry of Justice of Ukraine on September 3, 2012 under number 1483 / 21795
• INSTRUCTIONS for completing form of primary records № 501-1/o ‘Notice № 1 № ___ on HIV-infected pregnant woman’. Form – .doc document for download
• INSTRUCTIONS for completing form of primary records № 501-2/o ‘Notice № 2 № ___ on the end of pregnancy of an HIV-infected pregnant woman’. Form – .doc document for download
• INSTRUCTIONS for completing form of primary records № 501-3 (I)/o ‘Notice № 3 (I) № ___ on registration of a child born by an HIV-positive woman’. Form – .doc document for download
• INSTRUCTIONS for completing form of primary records № 501-3 (II)/o ‘Notice № 3 (II) № ___ on the results of early diagnosing of HIV and prophylaxis with Co-trimoxazole in a child born by an HIV-positive woman’. Form – .doc document for download
• INSTRUCTIONS for completing form of primary records № 501-3 (III)/o ‘Notice № 3 (III) № ___ on clarification of the HIV status of a child born to an HIV-positive woman’ form - .doc document for download. Form – .doc document for download
• INSTRUCTIONS for completing form of primary records № 501-4/o ‘Notice № 4 № ___ on HIV-positive child born by an HIV-positive woman’. Form – .doc document for download
• INSTRUCTIONS for completing report form № 501-5/o ‘Notice № 5 № ___ ‘Informed consent to take part in the program of prophylaxis of mother-to-child transmission of HIV for 20__’. Form – .doc document for download
• INSTRUCTIONS for completing report form № 63 (annual) ‘Prevention of HIV transmission from mother to child for 20___’. Form – .doc document for download
• Consent to the processing of personal data - .doc document for download