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

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 20002018 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.