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Objective: The objective of this paper is to review experience in prevention of mother-to-child transmission (PMTCT) of HIV in Georgia.Background: PMTCT is one of the strategic priorities in Georgia. The first case of HIV infection in pregnant women was reported in 1999. Starting 2005 the National Programme on PMTCT became operational.Materials and Methods: One hundred sixteen HIV voluntary counselling and testing (VCT) centers operate throughout the country at antenatal clinics. According to the National PMTCT protocol, all first time attending pregnant women are offered Voluntary Counselling and Testing (VCT). Testing on HIV/AIDS is based on identification of HIV antibodies by screening method and all positive results are referred to the Infectious Diseases, AIDS and Clinical Immunology Research Center (IDACIRC) for the further investigation (confirmation by Western Blot assay) and further management. Data collection was made retrospectively, using information from IDACIRC National HIV/AIDS Data Base, VRF for the period 1999-2007.Results: Prevalence of HIV among pregnant women availing VCT services in 2006 was 0.03%. As of December, 2007 total 69 pregnancies of 64 women were registered at the IDACIRC. Fifty eight women (90.6%) acquired infection through heterosexual contact. None of the HIV positive women reported intravenous injection of illicit drugs. The majority of the HIV infected pregnant women had one sexual partner (90.6%). Of children delivered by 51 positive partners 41(80%) were infected through injecting drugs intravenously and 10 (20%) persons through heterosexual contacts. Throughout the period 1999-2007 14 pregnant women received PMTCT services only partially. In 2 cases children were HIV-infected. In 12 pregnancies women received AZT in about the 28th week of pregnancy. No case of HIV transmission to child was recorded in this group. In 32 cases pregnant women received full prophylaxis therapy and all children were negative for HIV infection. Among 6 pregnant women admitted at IDACIRC later than the 28th week of pregnancy only 1 child was infected. As of December 2007, 5 women are still pregnant. Three of them receive antiretroviral drugs (ARV) prophylaxis with AZT+3TC+SQV/r. Two women are under 28 weeks of gestational age.Conclusion: Over the last several years the national response to AIDS in Georgia achieved significant progress. The provision of comprehensive packages of PMTCT services in Georgia has been shown to minimize the risk of vertical transmission. As described above none of the women completing full course of ARV prophylaxis, combined with appropriate infant feeding, transmitted HIV to their children. PMTCT programmes are indisputably the main entry point not only for HIV related care and treatment for women, but also for other comprehensive care and prevention. [ABSTRACT FROM AUTHOR]

Teenage pregnancy has been a target for prevention in many countries. Teen motherhood may adversely influence social determinants of health, including education attainment, employment and reliance on welfare support. We compared socioeconomic factors and geographical influencers affecting teenage pregnancy and birth outcomes across Georgia and Australia. Georgia has a teenage pregnancy rate three times higher than Australia. However, there are similar proportions of contraceptive use between Georgian and Australian teenagers as well as increasing rates of sexual health literacy in both countries. Both countries, however, show a comparative deficiency in sexual health literacy for rural populations resulting in earlier sexual experiences in Georgia and higher teenage pregnancy rates in Australia with Indigenous teenage mothers over-represented. More age-appropriate sexual health and contraception education is required in both Georgia and Australia, especially for rural areas, Indigenous populations and ethnic minorities. Further research is needed to supply teenage pregnancy and birth data from Georgian population.

The review compares a few reproductive indicators - fertility, abortion and contraception in both a developing (Georgia) and a developed (Australia) country. Fertility, abortion and contraception figures in both countries tend to reflect the attitude and the degree of development of each countries sexual health education and their use of effective contraception. Further research is required to accurately evaluate the need and access of Georgian women to modern methods of family planning and their knowledge of the benefits of modern contraception that can assist to reduce pregnancy termination rate. In Australia better insight is needed on how to facilitate a shift to more efficacious long-term contraceptives across all age groups.

To review the existing experience in prevention of Mother-To-Child Transmission (PMTCT) of HIV in Georgia the comprehensive PMTCT state program was started in 2005. Georgia was the first among the former Soviet Countries that ensured the universal access to PMTCT throughout the Country. According to the National PMTCT protocol, all pregnant women are offered Voluntary Counseling and Testing for HIV infection at Women Health Centers, maternity hospitals, and regional hospitals of Georgia. Positive results are referred to the Infectious Diseases, AIDS and Clinical Immunology Research Center (IDACIRC) for the confirmation and management that implies: antiretroviral therapy, caesarean section, infant feeding by formula and PCP prophylaxis by TMP-CTX. Data were collected using National HIV/AIDS Data Base. Prevalence of HIV among pregnant women attending VCT services in 2005-2008 years was 0.03%. Throughout the period 1999-2008 total 84 pregnancies were registered at the IDACIRC, among them 77 pregnancies were monitored by IDACIRC. Prophylactic strategy was tailored individually according to the national acting guideline, women gestation age, HIV disease stage, ARV's availability, etc. Totally 36 pregnant women received full PMTCT service. In this group no vertical transmission of HIV infection was recorded. 33 pregnant women received partial PMTCT service. The reasons were: late HIV diagnosis, limited access to ARV (from 1999 till 2004), refusal by pregnant woman. Number of HIV transmission cases was 3 in this group. As of November, 2008 eight women are still pregnant. Since 2005 Georgia ensured comprehensive and sustainable PMTCT service throughout the Country and universal access for all pregnant women. Provision of full package of this service minimized the risk of vertical transmission.

Cross-sectional study was performed in all maternity units of Tbilisi, Georgia, with delivering 18,554 women between 1 January 2004 and 1 January 2005. There were 267 cases of severe obstetric morbidity giving a prevalence of 14,2 per 1000 deliveries (95% CI 12,6-16,0). During the study there were 3 maternal deaths. Disease specific morbidities per 1000 deliveries were: severe pre - eclampsia - 5,0 (95% CI 4,1-6,2); hysterectomy during 24 hours after delivery - 4,5 (95% CI 3,6-5,6); hemorrhage - 2,3 (95% CI 1,7-3,1), sepsis 1,3 (95% CI 0,9-2,0); eclampsia - 0,74 (95% CI 0,44-1,25); uterine rupture - 0,16 (95% CI 0,05-0,47); HELLP-syndrome - 0,11 (95% CI 0,03-0,39). Severe obstetric morbidity and its relation to mortality may be more sensitive measures of pregnancy outcome than mortality alone and allows for an effective audit system of maternal care.