Assessing the effectiveness of prevention of mother-to-child HIV transmission

Abstract

Aim. To analyze the outcomes of a set of interventions to prevent vertical transmission of the human immunodeficiency virus (HIV) in the Republic of Mari El.

Methods. A retrospective analysis of temporary registration forms “Notifications of the termination of pregnancy in an HIV-infected woman” and “Notifications of a newborn born by an HIV-infected mother”, case histories and outpatient medical records of HIV-infected women who gave birth in 2000–2018 was carried out. The study included all children born in the Republic of Mari El to HIV-positive women registered with the Republican Center for the Prevention and Control of AIDS and Infectious Diseases, as well as children whose HIV status is detected after birth as a result of epidemiological investigations. The assessment of the risks of transmission as an outcome of the three-step preventive interventions has been carried out. A comparative analysis of the results of perinatal prevention of HIV transmission in the Republic of Mari El and other regions of the Russian Federation was performed.

Results. A total of 299 HIV-infected pregnant women and 368 children born to these women during the study period were registered in the region; 63 (21.7%) of these women had more than one child. Over the entire study period, 18 (4.8%) children with confirmed HIV infection were registered. The most common factor associated with infant HIV infection is late maternal HIV diagnosis: (1) several years after childbirth in the absence of antiretroviral (ARV) prophylaxis and the infants were breastfeeding (11 cases, 64.7%); (2) during or shortly after childbirth, when the patient did not receive entire three-step antiretroviral prophylaxis during pregnancy and childbirth (6 cases, 29.4%); (3) in the third trimester of pregnancy (1 case, 5.5%). An important limitation for the successful prevention of vertical transmission of HIV was the lack of routine HIV testing, which is required by women and their partners before and at various stages during pregnancy. A single case of self-infection indicates the need to introduce preventive measures from early adolescence among children.

Conclusion. Due to the late maternal HIV diagnosis, during or after delivery, HIV transmission events occurred either with limited or no limited antiretroviral prophylaxis.

Keywords

HIV-infection / antiretroviral therapy / pregnancy / prevention of perinatal transmission

References

[1] World Health Organization. Key facts HIV/AIDS. https://www.who.int/news-room/fact-sheets/detail/hiv-aids (access date: 10.08.2020).

[2] UNAIDS. Global HIV & AIDS statistics — 2020 fact sheet. https://www.unaids.org/en/resources/fact-sheet (access date: 30.10.2020).

[3] World Health Organization. HIV country profile. http://cfs.hivci.org/country-factsheet.html (access date: 10.08.2020).

[4] Federal Service for Surveillance on Consu­mer Rights Protection and Human Wellbeing. State report “On the state of sanitary and epidemiological well-being of the population in the Russian Federation in 2018”. https://rospotrebnadzor.ru/documents/details.php? ELEMENT_ID=10145 (access date: 19.07.2020. (In Russ.)

[5] Федеральная служба по надзору в сфере защиты прав потребителей и благополучия человека. Государственный доклад «О состоянии санитарно-эпидемиологического благополучия населения в Российской Федерации в 2018 году». https://rospotrebnadzor.ru/ documents/details.php?ELEMENT_ID=10145 (дата обращения: 19.07.2020).

[6] World Health Organization. Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations. July 2016. https://www.who.int/hiv/pub/guidelines/keypopulations-2016/en/ (access date: 20.08.2020).

[7] Car L.T., van-Velthoven M.H., Brusamento S., Elmoniry H., Car J., Majeed A., Atun R. Integrating prevention of mother-to-child HIV transmission (PMTCT) programs with other health services for preventing HIV infection and improving HIV outcomes in developing countries. Cochrane Database of Syst. Rev. 2011; (6): CD008741. DOI: 10.1002/14651858.CD008741.pub2.

[8] Melnikov A.S., Rukoyatkina E.A., Latysheva I.B., Fun­den R.A., Balasanyan V.G. Pregnancy among HIV-infec­ted patients and antiretroviral treatment — prospects birth of healthy children. Akusherstvo i ginekologiya Sankt-Peterburga. 2017; (1): 22–25. (In Russ.)

[9] Мельников А.С., Рукояткина Е.А., Латышева И.Б., Фунден Р.А., Баласанян В.Г. Беременность у ВИЧ-инфицированных и антиретровирусная терапия — перспективы рождения здоровых детей. Акушерство и гинекология Санкт-Петербурга. 2017; (1): 22–25.

[10] Kozyrina N.V., Ladnaya N.N., Narsia R.S. Ways to elimination of mother-to-child transmission of HIV. Journal of microbiology, epidemiology and immunobiology. 2018; (6): 18–25. (In Russ.) DOI: 10.36233/0372-9311-2018-6-18-25.

[11] Козырина Н.В., Ладная Н.Н., Нарсия Р.С. Пути элиминации вертикальной передачи ВИЧ-инфекции. Ж. микробиол., эпидемиол. и иммунобиол. 2018; (6): 18–17. DOI: 10.36233/0372-9311-2018-6-18-25.

[12] World Health Organization. Global Guidance on Criteria and Processes for Validation: Elimination of Mother-to Child Transmission (EMTCT) of HIV and Syphilis. https://www.who.int/publications/i/item/global-guidance-on-criteria-and-processes-for-validation-elimination-of-mother-to-child-transmission-of-hiv-and-syphilis (access date: 11.08.2020).

[13] Latysheva I.B., Voronin E.E. Monitoring i otsenka meropriyatiy po profilaktike peredachi VICh-infektsii ot materi rebenku na territorii Rossiyskoy Federatsii v 2008–2018 godakh: informatsionnyy byulleten’. (Information bulletin “Monitoring and eva­luation of measures to prevent mother-to-child transmission of HIV infection in the Russian Federation in 2008–2018”.) Saint Petersburg. 2019; 36 p. (In Russ.)

[14] Латышева И.Б., Воронин Е.Е. Информационный бюллетень «Мониторинг и оценка мероприятий по профилактике передачи ВИЧ-инфекции от матери ребёнку на территории Российской Федерации в 2008–2018 годах». СПб. 2019; 36 с.

[15] Order of the Ministry of health and social development of the Russian Federation No. 166 of 17.03.2006. “On the approval of the instructions for filling out the annual form of the federal state statistical observation No. 61 “Information on the contingents of HIV-infected patients”. http://www.consultant.ru/document/cons_doc_LAW_59648/ (access date: 02.08.2020). (In Russ.)

[16] Приказ Минздравсоцразвития РФ от 17.03.2006 №166 «Об утверждении инструкции по заполнению годовой формы федерального государственного статистического наблюдения №61 “Сведения о контингентах больных ВИЧ-инфекцией”». http://www.consultant.ru/document/cons_doc_LAW_59648/ (дата обращения: 10.08.2020).

[17] Jurin O.G. Clinical classification and diagnosis of HIV infection. In: Lekcii po VICh-­infekcii. (Lectures on HIV infection.) Ed. by V.V. Pokrovsky. M.: GEOTAR-Media. 2018; 119–133. (In Russ.)

[18] Юрин О.Г. Клиническая классификация и установление диагноза ВИЧ-инфекции. В кн.: Лекции по ВИЧ-инфекции. Под ред. В.В. Покровского. М.: ­ГЭОТАР-Медиа. 2018; 119–133.

[19] Vororini E.E., Afonina L.Yu., Laty`sheva I.B. et al. Clinical guidelines. HIV infection: prevention of perinatal transmission of human immunodeficiency virus. Nacional`naya associaciya specialistov po profilaktike, diagnostike i lecheniyu VICh-infekcii. 2017. http://rushiv.ru/category/kids-and-hiv/pregnant/ (access date: 30.12.2020). (In Russ.)

[20] Ворорини Е.Е., Афонина Л.Ю., Латышева И.Б., Розенберг В.Я., Фомин Ю.А. Клинические рекомендации. ВИЧ-инфекция: профилактика перинатальной передачи вируса иммунодефицита человека. Национальная ассоциация специалистов по профилактике, диагностике и лечению ВИЧ-инфекции. 2017. http://rushiv.ru/category/kids-and-hiv/pregnant/ (дата обращения: 30.12.2020).

[21] World Health Organization. Model list of essential medicines. 21st ed. 2019. https://www.who.int/publications/i/item/WHOMVPEMPIAU2019.06 (access date: 12.12.2020).

[22] Mateo-Urdiales A., Johnson S., Smith R., Nachega J.B., Eshun-Wilson I. Rapid initiation of antiretroviral therapy for people living with HIV. Cochrane Database Syst. Rev. 2019; 6 (6): CD012962. DOI: 10.1002/14651858.CD012962.pub2.

[23] Teeraananchai S., Kerr S.J., Amin J., Ruxrungtham K., Law M.G. Life expectancy of HIV-positive people after starting combination antiretroviral therapy: a meta-analysis. HIV Med. 2017; 18 (4): 256–266. DOI: 10.1111/hiv.12421.

[24] Ambalova S.S., Galazova A.A. Analiz rezul'tativnosti perinatal'noj profilaktiki VICh-infekcii v Respublike Severnaja Osetija-­Alanii. Aktual'nye voprosy VICh-infekcii. Zhenshiny i VICh. (Analysis of the effectiveness of perinatal HIV prevention in the Republic of North Ossetia-Alania. Topical issues of HIV infection. Women and HIV.) SPb.:Chelovek i ego zdorov'e. 2017; 231–233. (In Russ.)

[25] Амбалова С.С., Галазова А.А. Анализ результативности перинатальной профилактики ВИЧ-инфекции в Республике Северная Осетия-Алании. Актуальные вопросы ВИЧ-инфекции. Женщины и ВИЧ. СПб.: Человек и его здоровье. 2017; 231–233.

[26] Statistics in the Ulyanovsk region. State Institution “Regional Center for Prevention and Control of AIDS”. http://www.aids73.ru/vich/statistic_in_ulyanovsk/ (access date: 09.08.2020). (In Russ.)

[27] Статистика в Ульяновской области. ГУЗ «Областной центр профилактики и борьбы со СПИД». http://www.aids73.ru/vich/statistic_in_ulyanovsk/ (дата обращения: 09.08.2020).

[28] Abdullova N.F., Kalinnikova N.V. Analysis of perinatal HIV transmission in the Ulyanovsk region in 2018: successes and problems, solutions. In: Materialy 54-y mezh­regional'noy nauchno-prakticheskoy meditsinskoy konferentsii «Natsional'nye proekty — prioritet razvitiya zdravookhraneniya regionov». (Materials of the 54th Interregional Scientific and Practical Medical Conference “National Projects — a Priority for Regional Healthcare Deve­lopment”.) Ulyanovsk, May 16–17, 2019. https://elibrary.ru/item.asp?id=39206376 (access date: 18.08.2020). (In Russ.)

[29] Абдуллова Н.Ф., Калинникова Н.В. Анализ перинатальной передачи ВИЧ-инфекции в Ульяновской области в 2018 г.: успехи и проблемы, пути решения. Материалы 54-й межрегиональной научно-практической медицинской конференции «Национальные проекты — приоритет развития здравоохранения регио­нов»; 16–17 мая 2019 г. Ульяновск. https://elibrary.ru/item.asp?id=39206376 (дата обращения: 18.08.2020).

[30] Yastrebova E.B., Samarina A.V., Fertyh E.K., Gutova L.V. Pediatric problems of HIV infection and solutions in Saint Petersburg. VICh-infektsiya i immunosupressii. 2019; 11 (1): 31–37. (In Russ.) DOI: 10.22328/2077-9828-2019-11-1-31-37.

[31] Ястребова Е.Б., Самарина А.В., Фертих Е.К., Гутова Л.В. Педиатрические проблемы ВИЧ-инфекции и пути их решения в Санкт-Петербурге. ВИЧ-инфекция и иммуносупрессии. 2019; 11 (1): 31–37. DOI: 10.22328/2077-9828-2019-11-1-31-37.

[32] Matuzkova A.N., Suladze A.G., Ryndich A.A., Tverdokhlebova T.I. Actual issues in HIV infection and prevention of perinatal HIV transmission in the South of Russia. Zhurnal infektologii. 2018; 10 (3): 91–107. (In Russ.) DOI: 10.22625/2072-6732-2018-10-3-91-107.

[33] Матузкова А.Н., Суладзе А.Г., Рындич А.А., Твердохлебова Т.И. Актуальные вопросы ВИЧ-инфекции и профилактики перинатальной трансмиссии ВИЧ на юге России. Ж. инфектол. 2018; 10 (3): 91–107. DOI: 10.22625/2072-6732-2018-10-3-91-107.

[34] Samarina A.V., Belyakov N.A. Implementation of approaches to reducing perinatal HIV transmission. VICh-­infektsiya i immunosupressii. 2014; 6 (2): 7–24. (In Russ.) DOI: 10.22328/2077-9828-2014-6-2-7-24.

[35] Самарина А.В., Беляков Н.А. Реализация подходов по снижению перинатальной передачи ВИЧ. ВИЧ-инфекция и иммуносупрессии. 2014; 6 (2): 7–24. DOI: 10.22328/2077-9828-2014-6-2-7-24.

[36] Informacionnyj bjulleten' No. 74 “VICh-infekcija v Privolzhskom federal'nom okruge v 2018 g.”. (Information bulletin No. 74 “HIV infection in the Volga Federal District in 2018”.) FBUN “Nizhegorodskij nauchno-issledovatel'skij institut jepidemiologii i mikrobiologii im. I.N. Blohinoj”. 2019: 14. (In Russ.)

[37] ФБУН «Нижегородский научно-исследовательский институт эпидемиологии и микробиологии им. И.Н.Блохиной». Информационный бюллетень №74 «ВИЧ-инфекция в Приволжском федеральном округе в 2018 г.». Нижний Новгород: Нижегородский НИИ эпидемиологии и микробиологии им. И.Н. Блохиной. 2019; 14.

RIGHTS & PERMISSIONS

Khamidulina R.M., Katyagina M.G., Zolotova I.S., Ziganshina L.E.