[The certain aspects of organization of medical care of women in period of pregnancy and delivery in the Republic of Bashkortostan]

Health protection of women of reproductive age is a priority direction of state policy. In protection of reproductive health of women no small importance is played by development of organization of primary medical sanitary care and specialized medical care of women during pregnancy and delivery. The study was carried out in the Republic of Bashkortostan and covered period of 2017-2021. It was established that the number of women of fertility age decreased up to 3,9% that became one of causes of reduction of birth rate from 12.1‰ to 9.8‰ respectively. At that, the level of maternal mortality increased up to 8.9 times (from 4.1 to 36.8 per 100,000 born alive). In 2021, out of 37,775 women who completed their pregnancy, 99.3% were examined by therapist and only 92.2% passed such an examination prior to 12 weeks of their pregnancy. On the gestation period of 11-4 weeks, 91.3 % of pregnant women were subjected to ultrasound examination of fetus with detection of maternal serum markers and 94.4% of pregnant women were examined at the 19-21 weeks of pregnancy. Among pregnant women, rate of diseases and pathological conditions that preceded or developed during pregnancy slightly increased. Increasing of morbidity of anemia, diseases of endocrine system, including diabetes mellitus, was noted. The deterioration of particular indicators of organization of medical care of women according to profile "obstetrics and gynecology" occurred during period of COVID-19 pandemic. The implementation of three-level system of organization of medical care resulted in significant reduction of number of obstetric and gynecological hospital beds.

Impact of Option B+ Combination Antiretroviral Therapy on Mother-to-Child Transmission of HIV-1, Maternal and Infant Virologic Responses to Combination Antiretroviral Therapy, and Maternal and Infant Mortality Rates: A 24-Month Prospective Follow-Up Study at a Primary Health Care Clinic, in Harare, Zimbabwe

We conducted a 24-month prospective follow-up study, at a primary health care clinic in Harare, Zimbabwe, to determine cumulative mother-to-child transmission of HIV-1 (MTCT) rate and the contributions of intrauterine (IU), intrapartum (IP), and postpartum (PP) to MTCT, as well as maternal and infant mortality rates in the era of Option B⁺ combination antiretroviral therapy (cART). Plasma for viral load (VL) quantitation was obtained from 475 mothers enrolled into the study. VL was quantified at enrolment and every 6 months thereafter up to 24 months using the Cepheid GeneXpert HIV-1 Quantitative test. Dried blood spots were collected from 453 infants at birth, 4–6 weeks, 3 months, and every 3 months thereafter up to 24 months. HIV-1 infant diagnosis was conducted using the Cepheid GeneXpert HIV-1 Qualitative test. Absolute, cumulative MTCT rates and mortality rate were calculated. Seven mothers (1.55%) transmitted HIV-1 infection to their infants by 24 months. Four infants (0.88%; 95% CI 0.26–2.33%), one infant (0.22%; 95% CI 0–1.4%), and two infants (0.44%; 95% CI 0.01–1.7%) were infected IU, IP, and PP, respectively. By 24 months, 88.94% of the mothers and 80% of the infants had undetectable VL. The maternal and infant mortality rates were 0.21% and 1.78%, respectively. In the first 24 months of life, IU transmission is the major route of MTCT. The cumulative MTCT rate of 1.55% and low maternal and infant mortality rates of 0.21% and 1.78%, respectively, contribute to growing evidence that Option B⁺ cART not only drastically reduces MTCT but also maternal and infant mortality.