Progress in prevention of mother-to-child transmission of HIV infection in Ukraine: results from a birth cohort study

Background: 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.Methods: 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.Results: 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 < 0.001); intrapartum diagnosis was associated with IDU (Adjusted odds ratio 4.38; 95% CI 3.19-6.02). The percentage of women not receiving any antiretroviral prophylaxis declined from 18% (36/205) in 2001 to 7% in 2007 (61/843) p < 0.001). Use of sdNVP alone substantially declined after 2003, with a concomitant increase in zidovudine prophylaxis. Median antenatal zidovudine prophylaxis duration increased from 24 to 72 days between 2000 and 2007. Elective caesarean section (CS) rates were relatively stable over time and 34% overall. Mother-to-child transmission (MTCT) rates decreased from 15.2% in 2001 (95% CI 10.2-21.4) to 7.0% in 2006 (95% CI 2.6-14.6). In adjusted analysis, MTCT risk was reduced by 43% with elective CS versus vaginal delivery and by 75% with zidovudine versus no prophylaxis.Conclusion: 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

Anti-Corruption Law in Local Government: Legal Issues related to Ordinance-Design and Municipal-Level Anti-Corruption Agencies in Macedonia

Macedonian municipalities should pass anti-corruption ordinances in order to reduce corruption. The paper reviews the legal issues involved in drafting such ordinances and provides legal advisors to local councils with the legal and economic analysis needed to tackle some of the more difficult and detailed questions. The most important issue revolves around the creation of a model ordinance which Macedonian municipalities (or the Association of Units of Local Self-Government of the Republic of Macedonia) could adopt in order to set-up and run municipal-level anti-corruption agencies. The location of such agencies as well as their competencies (to monitor conflicts of interests, oversee asset declarations, and conduct corruption risk-audits among others ) are analysed. The paper also provides legal interpretations of Macedonian legislation and their likely impact on municipal council ordinance design in the area of anti-corruption - providing the legal basis for positive administrative silence, the splitting of municipal procurement contracts, and (most controversially) qui tam rewards at the municipal level. A brief regulatory impact analysis of the ordinance shows a gain of Euro 162,900 in social welfare if such a programme were rolled-out in Macedonia.