Sconza, Rebecca Rose; (2023) Optimizing prevention of vertical transmission of HIV in the Russian Federation. Doctoral thesis (Ph.D), UCL (University College London).

Text PhD Thesis_Rebecca Rose Sconza_2023_redacted.pdf - Accepted Version Access restricted to UCL open access staff until 1 December 2024. Download (12MB)

Abstract

Over the last decade, there has been a significant increase in the incidence of HIV in Eastern Europe and Central Asia. The vast majority of new HIV infections have occurred in the Russian Federation, where HIV prevalence is now roughly 1% among adults aged 15 to 49 years and national treatment coverage for people living with HIV is reportedly less than 50%. Women of reproductive age account for an increasing proportion of new diagnoses in Russia’s expanding epidemic, and the resulting rise in national antenatal HIV prevalence has serious public health implications: untreated HIV in pregnancy is associated with increased maternal morbidity and mortality and risk of pregnancy complications, adverse outcomes, and vertical HIV transmission. Roll-out of effective interventions to prevent vertical HIV transmission has led to a significant reduction in the national rate of vertical HIV transmission, but rates over 2% in many regions suggest that gaps in care may be perpetuating poor health outcomes among women and children, particularly in the most complex groups. This thesis uses secondary observational data to investigate the health and care of women living with HIV giving birth under the care of three clinical sites participating in the European Pregnancy and Paediatrics Infections Cohort Collaboration, an international network of cohort and surveillance studies coordinated by Penta Child Health. Data on over 3,000 births in 2017-2019 among women living with HIV receiving care in St Petersburg and Irkutsk were used to describe the epidemiology of HIV among pregnant women and the rate and circumstances of vertical HIV transmission; investigate clinical markers of HIV disease stage and management, co-infections, and adverse birth outcomes; and assess the receipt of prevention of vertical HIV transmission interventions, including timely HIV diagnosis, provision of antiretroviral therapy, and use of neonatal antiretroviral prophylaxis.

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