Résumé :
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[BDSP. Notice produite par INIST-CNRS R0xEt8GH. Diffusion soumise à autorisation]. Objective To investigate the scale-up of antenatal combination antiretroviral therapy (cART) in Ukraine since this became part of the national policy for the prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV). Methods Data on 3535 HIV-positive pregnant women who were enrolled into the Ukraine European Collaborative Study in 2008-2010 were analysed. Factors associated with receipt of zidovudine monotherapy (AZTm) - rather than cART - and rates of mother-to-child transmission (MTCT) of HIV were investigated. Findings cART coverage increased significantly, from 22% of deliveries in 2008 to 61% of those in 2010. After adjusting for possible confounders, initiation of antenatal AZTm - rather than cART-was associated with cohabiting (versus being married ; adjusted prevalence ratio, aPR : 1.09 ; 95% confidence interval, CI : 1.02-1.16), at least two previous live births (versus none ; aPR : 1.22 ; 95% CI : 1.11-1.35) and a diagnosis of HIV infection during the first or second trimester (versus before pregnancy ; aPR : 1.11 ; 95% CI : 1.03-1.20). The overall MTCT rate was 4.1% (95% CI : 3.4-4.9) ; 42% (49/116) of the transmissions were from the 8% (n=238) of women without antenatal ART. Compared with AZTm, cART was associated with a 70% greater reduction in the risk of MTCT (adjusted odds ratio : 0.30 ; 95% CI : 0.16-0.56). Conclusion Between 2008 and 2010, access to antenatal cART improved substantially in Ukraine, but implementation of the World Health Organization's Option-B policy was slow. For MTCT to be eliminated in Ukraine, improvements in the retention of women in HIV care and further roll-out of Option B are urgently needed.
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