Ликвидация передачи от матери ребенку ВИЧ-инфекции и сифилиса в Украине: прогресс и вызовы

The objective of this study is to analyze the indicators of impact and process of EMTCT of HIV and syphilis in Ukraine thus helping to prepare for validation of this process according to the WHO targets and сriteria.Materials and Methods. In this retrospective study were presented the epidemiological and clinical data about 237 women who had syphilis before or during pregnancy and babies born to them (238) from 1999 to 2007 yy. Besides in article were used statistical forms of the Public Health Center and Center for Medical Statistics of the Ministry of Health of Ukraine for the incidence of syphilis and HIV in women of reproductive age, pregnant women and children born to them, including those who were diagnosed with congenital syphilis and HIV infection from 2007 to 2016 yyResults. The analysis of the data from Public Health Center shows that one of the target indicators for the impact of HIV/AIDS has been achieved in Ukraine: the number of new cases of mother-to-child transmission of HIV per 100,000 live births was 20.8 in 2015. But in the same time the indicator of mother-to-child transmission of HIV in Ukraine is still higher than the WHO minimum criterion (≤2%) and was 3.7% according to a cohort of children born to HIV-infected women in 2015, which still does not meet the criteria WHO to validate this process.Despite the main target indicator of CS elimination has been achieved, some process indicators of syphilis as coverage of syphilis testing and treatment of pregnant women have not reached yet.Conclusions. Given the policy of dual elimination of MTCT of HIV and syphilis in Ukraine, an expansion of the PMTCT program on universal access to HIV and syphilis diagnostics and treatment services in pregnant women at high-risk groups is reguired.Цель этого иссследования – проанализировать индикаторы воздействия и процессов ликвидации передачи матери ребенку (ПМР) ВИЧ инфекции и сифилиса в системе профилактики врожденного сифилиса и программе профилактики ПМР ВИЧ в Украине на основе данных ретроспективного исследования, способствуя, таким образом, подготовке к двойной валидации этих процессов в соответствии с целями и критериями ВО

HCV co-infection and markers of liver injury and fibrosis among HIV-positive childbearing women in Ukraine: results from a cohort study

BACKGROUND: Ukraine's injecting drug use-driven HIV epidemic is among the most severe in Europe with high burden of HCV co-infection. HIV/HCV co-infected individuals are at elevated risk of HCV-related morbidity, but little is known about burden of liver disease and associated factors in the HIV-positive population in Ukraine, particularly among women. METHODS: Characteristics of 2050 HIV-positive women enrolled into the Ukrainian Study of HIV-infected Childbearing Women were described by HCV serostatus. Aspartate transaminase (AST) to platelet ratio (APRI) and FIB-4 scores were calculated and exact logistic regression models fitted to investigate factors associated with significant fibrosis (APRI >1.5) among 762 women with an APRI score available. RESULTS: Of 2050 HIV-positive women (median age 27.7 years, IQR 24.6-31.3), 33% were HCV co-infected (79% of those with a history of injecting drug use vs 23% without) and 17% HBsAg positive. A quarter were on antiretroviral therapy at postnatal cohort enrolment. 1% of the HIV/HCV co-infected group had ever received treatment for HCV. Overall, 24% had an alanine aminotransferase level >41 U/L and 34% an elevated AST (53% and 61% among HIV/HCV co-infected). Prevalence of significant fibrosis was 4.5%; 2.5% among 445 HIV mono-infected and 12.3% among 171 HIV/HCV co-infected women. 1.2% had a FIB-4 score >3.25 indicating advanced fibrosis. HCV RNA testing in a sub-group of 56 HIV/HCV co-infected women indicated a likely spontaneous clearance rate of 18% and predominance of HCV genotype 1, with one-third having genotype 3 infection. Factors associated with significant fibrosis were HCV co-infection (AOR 2.53 95%CI 1.03-6.23), history of injecting drug use (AOR 3.51 95%CI 1.39-8.89), WHO stage 3-4 HIV disease (AOR 3.47 95%CI 1.51-7.99 vs stage 1-2 HIV disease) and not being on combination antiretroviral therapy (AOR 3.08 95%CI 1.23-7.74), adjusted additionally for HBV co-infection, smoking and age. CONCLUSIONS: Most HIV/HCV co-infected women had elevated liver enzymes and 12% had significant fibrosis according to APRI. Risk factors for liver fibrosis in this young HIV-positive population include poorly controlled HIV and high burden of HCV. Results highlight the importance of addressing modifiable risk factors and rolling out HCV treatment to improve the health outcomes of this group

Young people in HIV care in Ukraine: a national survey on characteristics and service provision [version 2; peer review: 2 approved]

Background: Ukraine’s perinatally HIV-infected (PHIV) young people are ageing into adolescence/young adulthood and, alongside those with horizontally-acquired HIV infections, require transitional and other support services. We aimed to map this population and policies/service provision at specialist HIV centres, to inform future service development. Methods: A national survey was conducted of 28 HIV/AIDS centres on number, characteristics (age group, HIV acquisition mode) and care setting (paediatric/adult) of 10-24 year olds in HIV care in each of 24 regions in January 2016. Information was collected on policies/service provision at each centre. Results: Of 13,286 young people aged 10-24 years registered for HIV care nationally in Ukraine in January 2016, 1,675 were aged 10-18 years. Three-quarters of ≤19 year olds were PHIV, while 72% of 20-24-year-olds had sexually-acquired infection. Five regions accounted for two-thirds of 10-18 year olds in paediatric and 85% of 19-24 year olds in adult services. In 2015, 97 young people transitioned from paediatric to adult services nationally, typically at 18 years although with flexibility in timing at 17/28 centres. At 27/28 centres, horizontally HIV-infected young people aged <18 years began their HIV care in paediatric services sometimes (5) or always (22). Transition support most commonly consisted of a joint appointment with paediatrician and adult doctor, and support from a psychologist/social worker (both at 24/28 centres). Only 5/28 centres offered routine HIV care during the evening or weekend, and availability of integrated sexual/reproductive health and harm reduction services was uneven. Of 16/28 centres selectively following-up patients who did not attend for care, 15 targeted patients in paediatric services. Conclusions: Heterogeneity in the population and in service availability at the main regional/municipal HIV/AIDS centres has implications for potential structural barriers to HIV care, and development of services for this group

ЛиквидациЯ передачИ оТ матерИ ребенкУ ВИЧ-ИнфекцИИ И сифилисА В Украине: прогреСС И вЫзовЫ

Цель этого иссследования – проанализировать индикаторы воздействия и процессов ликвидации передачи матери ребенку (ПМР) ВИЧ инфекции и сифилиса в системе профилактики врожденного сифилиса и программе профилактики ПМР ВИЧ в Украине на основе данных ретроспективного исследования, способствуя, таким образом, подготовке к двойной валидации этих процессов в соответствии с целями и критериями ВО

Anxiety symptoms and felt stigma among young people living with perinatally or behaviourally-acquired HIV in Ukraine: A cross-sectional survey.

BackgroundUkraine has the second largest European HIV epidemic. This study aimed to describe stigma, demographic and social factors and their association with anxiety among perinatally and behaviourally-HIV-infected (PHIV; BHIV) young people in Kiev and Odessa.Methods104 PHIV and 100 BHIV young people aged 13-25 years completed a confidential tablet-based survey. Survey tools included the Hospital Anxiety and Depression Scale (HADS) (anxiety sub-scale scores of 8-10 indicating mild and ≥11 moderate/severe symptoms in last 7 days), Rosenberg Self-Esteem Scale (RSES) and HIV Stigma Scale (HSS) (short version, composite of disclosure, negative self-image and public attitudes sub-scales). Unadjusted Poisson regression models were fitted to explore factors associated with moderate/severe anxiety symptoms.ResultsPHIV and BHIV young people were of median age 15.5 [IQR 13.9-17.1] and 23.0 [21.0-24.3] years, having registered for HIV care a median 12.3 [10.3-14.4] and 0.9 [0.2-2.4] years previously; 97% (97/100) and 66% (65/99) respectively were on ART. Overall 43% (95%CI 36-50%) reported any and 13% (95%CI 9-19%) moderate/severe anxiety symptoms, with no difference by HIV acquisition mode (p = 0.405) or gender (p = 0.700). 42% (75/180) reported history of an emotional health problem for which they had not been referred/attended for care. Moderate/severe anxiety symptoms were associated with HIV-related stigma (prevalence ratio (PR) 1.24 95%CI 1.14-1.34 per HSS unit increase), lower self-esteem (PR 0.83 95%CI 0.78-0.90 per RSES point increase), CD4 ≤350 cells/mm3 (PR 2.29 95%CI 1.06-4.97), having no-one at home who knew the respondent's HIV status (PR 9.15 95%CI 3.40-24.66 vs all know) and, among BHIV, less stable living situation (PR 6.83 95%CI 1.99-23.48 for ≥2 vs no home moves in last 3 years) and history of drug use (PR 4.65 95%CI 1.83-11.85).ConclusionsResults indicated unmet need for psychosocial support. Further work is needed to explore strategies for mental health support, particularly around disclosure, self-esteem and stigma