Bailey, HR; (2013) HIV-infected childbearing women in Europe: health, treatment and care. Doctoral thesis , UCL (University College London).

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Abstract

This thesis aims to investigate the health of HIV-infected childbearing women living in resource-rich and resource-constrained settings in Europe, and to examine their treatment and care in the context of contemporary policies. HIV prevalence is increasing among childbearing women in Europe and particularly in the Eastern region. Highly effective interventions for the prevention of mother-to-child transmission (PMTCT) have resulted in very low transmission rates in Western Europe, but are less available in Ukraine. This thesis uses data from the European Collaborative Study, an on-going prospective cohort study of HIV-infected pregnant women and their infants (9500 mother-child pairs in Western Europe in 1986-2012, and 9600 in Ukraine in 2000-2012), to examine missed opportunities for PMTCT. Results highlight a decline in mother-to-child transmission rates in Ukraine to 4.1% (95% CI 3.4-4.9) in 2008-2010 (vs. 1.7% (95% CI 1.1-2.5) in the Western Europe sites in 2000-2009), and the importance of maternal marginalisation to continued transmissions in both settings. In Western Europe, a substantial proportion of HIV-positive pregnant women are now conceiving on antiretroviral therapy (ART); factors associated with treatment failure during pregnancy among this group are explored. Prevalence of HIV co-infections is high in Ukraine, and this thesis uses data from a nested postnatal cohort (n=2066) to explore testing coverage and factors associated with hepatitis C virus and chlamydia co-infections. Detection and prevalence of cervical abnormalities (an important potential cause of morbidity in HIV-infected women) are also explored. An additional survey in Ukraine provides data on ART adherence during pregnancy and postnatally (n=418) and highlights gaps in information provision and support. Against a backdrop of overall improvements in HIV care, this thesis identifies groups at heightened risk of mother-to-child transmission and/or poor maternal outcomes, and informs policy for their treatment and care.

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