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Open Access Highly Accessed Research article

Five-year trends in epidemiology and prevention of mother-to-child HIV transmission, St. Petersburg, Russia: results from perinatal HIV surveillance

Dmitry M Kissin1*, Michele G Mandel1, Natalia Akatova2, Nikolay A Belyakov2, Aza G Rakhmanova3, Evgeny E Voronin4, Galina V Volkova2, Alexey A Yakovlev5, Denise J Jamieson1, Charles Vitek6, Joanna Robinson7, William C Miller8 and Susan Hillis1

Author Affiliations

1 Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS K-34, Atlanta, Georgia 30341, USA

2 City AIDS Center, 12 Bumazgnaya Street, St. Petersburg 198020, Russia

3 City Health Committee, 12 Bumazgnaya Street, St. Petersburg 198020, Russia

4 Republican Hospital of Infectious Diseases Clinical AIDS Center, January 9th Prospect, Ust Izgora 196645, Russia

5 Botkin Hospital of Infectious Diseases, 3 Mirgorodskaya Street, St. Petersburg 191167, Russia

6 Centers for Disease Control and Prevention, 19 Nizhny Val, Kiev 04071, Ukraine

7 Elizabeth Glaser Pediatric AIDS Foundation, 11150 Santa Monica Boulevard, Suite 1050, Los Angeles, California 90025, USA

8 University of North Carolina at Chapel Hill, 2105F McGavran-Greenberg Hall, Chapel Hill, North Carolina 27599, USA

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BMC Infectious Diseases 2011, 11:292  doi:10.1186/1471-2334-11-292

Published: 27 October 2011

Abstract

Background

The HIV epidemic in Russia has increasingly involved reproductive-aged women, which may increase perinatal HIV transmission.

Methods

Standard HIV case-reporting and enhanced perinatal HIV surveillance systems were used for prospective assessment of HIV-infected women giving birth in St. Petersburg, Russia, during 2004-2008. Trends in social, perinatal, and clinical factors influencing mother-to-child HIV transmission stratified by history of injection drug use, and rates of perinatal HIV transmission were assessed using two-sided χ2 or Cochran-Armitage tests.

Results

Among HIV-infected women who gave birth, the proportion of women who self-reported ever using injection drugs (IDUs) decreased from 62% in 2004 to 41% in 2008 (P < 0.0001). Programmatic improvements led to increased uptake of the following clinical services from 2004 to 2008 (all P < 0.01): initiation of antiretroviral prophylaxis at ≤28 weeks gestation (IDUs 44%-54%, non-IDUs 45%-72%), monitoring of immunologic (IDUs 48%-64%, non-IDUs 58%-80%) and virologic status (IDUs 8%-58%, non-IDUs 10%-75%), dual/triple antiretroviral prophylaxis (IDUs 9%-44%, non-IDUs 14%-59%). After initial increase from 5.3% (95% confidence interval [CI] 3.5%-7.8%) in 2004 to 8.5% (CI 6.1%-11.7%) in 2005 (P < 0.05), perinatal HIV transmission decreased to 5.3% (CI 3.4%-8.3%) in 2006, and 3.2% (CI 1.7%-5.8%) in 2007 (P for trend <0.05). However, the proportion of women without prenatal care and without HIV testing before labor and delivery remained unchanged.

Conclusions

Reduced proportion of IDUs and improved clinical services among HIV-infected women giving birth were accompanied by decreased perinatal HIV transmission, which can be further reduced by increasing outreach and HIV testing of women before and during pregnancy.