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Mother-to-Child Transmission of HIV Odessa, Ukraine 2001

Mother-to-Child Transmission of HIV Odessa, Ukraine 2001. Key Institutions. Odessa State Medical University Odessa Oblast Hospital Odessa Women’s Wellness Center Oblast AIDS Center Family Medicine Center Sanitary Epidemiological Station Medicines Sans Frontieres NGOs.

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Mother-to-Child Transmission of HIV Odessa, Ukraine 2001

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  1. Mother-to-Child Transmission of HIVOdessa, Ukraine2001

  2. Key Institutions Odessa State Medical University Odessa Oblast HospitalOdessa Women’s Wellness CenterOblast AIDS CenterFamily Medicine CenterSanitary Epidemiological StationMedicines Sans Frontieres NGOs

  3. Level of vertical transmission in Odessa Oblast - 30% • Lack of necessary drugs for the prevention of vertical transmission • Lack of laboratory capacities for predicting pregnancy outcomes and timely diagnosis of children • Viral load is not identified • Difficulties with measuring CD-4 • Lack of capacities for PCR-testing which determines late diagnostics of children • Lack of rapid-tests • Irregular supply of test systems for women

  4. Up-to-date Issues of HIV Vertical Transmission Prevention • Before 1995-1996, abortion was strongly recommended for HIV-positive women. • СDC 076 prevention protocol, based on application of AZT in pills, was used for the first time in 1996, however, not to its full extent due to the lack of IV medication and syrup for newborns.

  5. Schemes for HIV Vertical Transmission in Ukraine • Retrovir (timozid - AZT analogue) in pills is used in Ukraine for the prevention of vertical HIV transmission. Nevirapin has been used since May 2000, and provided by Doctors Without Borders • There is no IV infusion available to be used during delivery or C-section. • Syrup for infants has not yet been registered in Ukraine. • It is not possible to follow CDC-076 protocol and a short (Thailand) scheme which starts at 36 wks of gestation due to the lack of AZT syrup for newborns.

  6. OB/ GYN Clinic of Odessa Oblast Clinical Hospital • Clinic is a teaching facility for OB/GYN Department of Odessa State Medical University, as well as a training site for residents and those taking post-graduate courses. • Total number of deliveries per year in Odessa Oblast Hospital is 2,000-2,500, 5% of which are HIV-positive.

  7. Composition of Odessa Oblast Hospital OB/ GYN Clinic - OB in-patient department – 120 beds; including 50 observation beds; • neonatal resuscitation department –6 beds; - Center for elective and emergency OB/ GYN care; - Women’s Wellness Center; - Regional Family Planning Center; - GYN department – 50 beds. - Training Centers: - Neonatal Resuscitation - Family Planning and Breast-Feeding Support

  8. Project philosophy: To improve the quality of life for HIV-positive women, their children, and families.

  9. How To Achieve It • Optimization of organizational forms of delivery care for HIV-positive pregnant women and their families; • Provision of access to up-to-date diagnostics and treatment technologies; • Personnel training and protection.

  10. Project Goal The overall goal of the project is to prevent HIV transmission from mother-to-child and infection of healthcare workers in the Odessa oblast.

  11. PROJECT OBJECTIVES1. Decrease HIV-related risk behaviors among women of childbearing age in the Odessa Oblast. • Identify the groups of higher risk for HIV infection among the women of childbearing age in the city of Odessa using the database of oblast AIDS center. • Provide HIV testing for women of high risk groups with pre-and post-test counseling. • Develop and publish information materials on HIV prevention for general population and medical workers. • Conduct training programs for specialists working with youth (i.e. schoolteachers, university professors, psychologists, social workers) to decrease risky sexual behaviors among adolescents and young adults. • Develop and publish recommendations for medical workers and patients on barrier contraception methods

  12. PROJECT OBJECTIVES2.Improve the system of prenatal care and implement necessary drug regimens that are possible in Ukraine to prevent HIV vertical transmission • Study existing schemes of preventing vertical transmission and evaluate their cost-effectiveness and efficacy • Develop protocols of prenatal care for HIV-positive women using possible drug regimens to prevent HIV vertical transmission • Conduct training for the staff of participating institutions on the principles of counseling and prenatal care for HIV-positive pregnant women

  13. PROJECT OBJECTIVES3. Decrease the risk of HIV transmission from mother-to-child during labor and delivery by implementing schemes of optimum obstetrical care protocols • Train physicians and midwives of Odessa Oblast Hospital in the methods of modified obstetrical care during labor an delivery for HIV-positive women • Provide the training for healthcare workers in infection control methods to prevent HIV transmission and provide post-exposure prophylaxis. • Supply participating institutions with necessary barrier means of protection (gloves, gowns, caps, etc.) , disposable instruments, and supplies • Encourage C-section for HIV-positive women and evaluate its utility in preventing HIV vertical transmission

  14. PROJECT OBJECTIVES5. Improve post-natal care for newborns/infants and HIV-positive mothers using the existing family medicine model • Provide a supply of formula for the newborns from HIV-positive mothers for up to 6 months (provided by MSF). • Provide post-delivery pediatric care and post-natal follow-up for infants born to HIV-positive mothers till HIV status is confirmed. • Train family physicians and nurses in post-natal care for HIV-positive women and their infants.

  15. PROJECT OBJECTIVES6. Develop clinical practice guidelines and protocols for pre- and post-natal care for HIV-positive women and their infants, and introduce them into the medical education system in Ukraine • Evaluate and analyze transmission rates of HIV-positive women and their infants and infection rates of healthcare workers in Odessa Oblast. • Develop draft standards for pre-and post-natal care for HIV-positive women and their infants. • Submit a proposal to the Ministry of Health of Ukraine for adopting and incorporating the standards into the system of medical education.

  16. Strengths and Advantages of the Project • Supportof health care administrators at the national and regional levels; • Experience and credibility of AIHA partners in Odessa Oblast; • Prospective approach – for the first time, the international experience will be adapted to the conditions of a specific region;

  17. Strengths and Advantages of the Project • Competence and advanced position make the criteria for selection of facilities and individuals to be involved in the project; • As a result of the project implementation, it will be possible to formulate and influence policy decisions in the organization of activities to stop the HIV epidemic in the country.

  18. All women, including. pregnant Polyclinics FMC WWC Pre- and post-test counseling Oblast SES lab HIV - HIV+ AIDS center Ped clinic Ped hospital WWC Polyclinic Oblast hospital child mother

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