Prevention of mother-to-child transmission of human immunodeficiency virus among pregnant women using injecting drugs in Ukraine, 2000-10

Aims To compare clinical status, mother‐to‐child transmission (MTCT) rates, use of prevention of (PMTCT) interventions and pregnancy outcomes between HIV‐infected injecting drug users (IDUs) and non‐IDUs. Design and setting Prospective cohort study conducted in seven human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) Centres in Ukraine, 2000–10. Participants Pregnant HIV‐infected women, identified before/during pregnancy or intrapartum, and their live‐born infants (n = 6200); 1028 women followed post‐partum. Measurements Maternal and delivery characteristics, PMTCT prophylaxis, MTCT rates, preterm delivery (PTD) and low birth weight (LBW). Findings Of 6200 women, 1111 (18%) reported current/previous IDU. The proportion of IDUs diagnosed with HIV before conception increased from 31% in 2000/01 to 60% in 2008/09 (P < 0.01). Among women with undiagnosed HIV at conception, 20% of IDUs were diagnosed intrapartum versus 4% of non‐IDUs (P < 0.01). At enrolment, 14% of IDUs had severe/advanced HIV symptoms versus 6% of non‐IDUs (P < 0.001). IDUs had higher rates of PTD and LBW infants than non‐IDUs, respectively, 16% versus 7% and 22% versus 10% (P < 0.001). IDUs were more likely to receive no neonatal or intrapartum PMTCT prophylaxis compared with non‐IDUs (OR 2.81, p < 0.001). MTCT rates were 10.8% in IDUs versus 5.9% in non‐IDUs; IDUs had increased MTCT risk (adjusted odds ratio 1.32, P = 0.049). Fewer IDUs with treatment indications received HAART compared with non‐IDUs (58% versus 68%, P = 0.03). Conclusions Pregnant human immunodeficiency virus‐infected injecting drug users in Ukraine have worse clinical status, poorer access to prevention of mother‐to‐child transmission prophylaxis and highly active antiretroviral therapy, more adverse pregnancy outcomes and higher risk of mother‐to‐child transmission than non‐injecting drug user women.