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. 2012;7(4):e35268.
doi: 10.1371/journal.pone.0035268. Epub 2012 Apr 27.

Integrating prevention of mother-to-child HIV transmission programs to improve uptake: a systematic review

Lorainne Tudor Car  1 , Michelle H M M T Van Velthoven, Serena Brusamento, Hoda Elmoniry, Josip Car, Azeem Majeed, Peter Tugwell, Vivian Welch, Ana Marusic, Rifat Atun
Affiliations

Integrating prevention of mother-to-child HIV transmission programs to improve uptake: a systematic review

Lorainne Tudor Car et al. PLoS One. 2012.

Abstract

Background: We performed a systematic review to assess the effect of integrated perinatal prevention of mother-to-child transmission of HIV interventions compared to non- or partially integrated services on the uptake in low- and middle-income countries.

Methods: We searched for experimental, quasi-experimental and controlled observational studies in any language from 21 databases and grey literature sources.

Results: Out of 28 654 citations retrieved, five studies met our inclusion criteria. A cluster randomized controlled trial reported higher probability of nevirapine uptake at the labor wards implementing HIV testing and structured nevirapine adherence assessment (RRR 1.37, bootstrapped 95% CI, 1.04-1.77). A stepped wedge design study showed marked improvement in antiretroviral therapy (ART) enrolment (44.4% versus 25.3%, p<0.001) and initiation (32.9% versus 14.4%, p<0.001) in integrated care, but the median gestational age of ART initiation (27.1 versus 27.7 weeks, p = 0.4), ART duration (10.8 versus 10.0 weeks, p = 0.3) or 90 days ART retention (87.8% versus 91.3%, p = 0.3) did not differ significantly. A cohort study reported no significant difference either in the ART coverage (55% versus 48% versus 47%, p = 0.29) or eight weeks of ART duration before the delivery (50% versus 42% versus 52%; p = 0.96) between integrated, proximal and distal partially integrated care. Two before and after studies assessed the impact of integration on HIV testing uptake in antenatal care. The first study reported that significantly more women received information on PMTCT (92% versus 77%, p<0.001), were tested (76% versus 62%, p<0.001) and learned their HIV status (66% versus 55%, p<0.001) after integration. The second study also reported significant increase in HIV testing uptake after integration (98.8% versus 52.6%, p<0.001).

Conclusion: Limited, non-generalizable evidence supports the effectiveness of integrated PMTCT programs. More research measuring coverage and other relevant outcomes is urgently needed to inform the design of services delivering PMTCT programs.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flow-diagram of the study selection process.
See this image and copyright information in PMC

References

    1. United Nations General Assembly Special Session. New York; 2001. Declaration of Commitment on HIV/AIDS.
    1. UNAIDS Global report: UNAIDS report on the global AIDS epidemic. 2010.
    1. Townsend CL, Cortina-Borja M, Peckham CS, de Ruiter A, Lyall H, et al. Low rates of mother-to-child transmission of HIV following effective pregnancy interventions in the United Kingdom and Ireland, 2000–2006. AIDS. 2008;22:973–981. - PubMed
    1. Mazia G, Narayanan I, Warren C, Mahdi M, Chibuye P, et al. Integrating quality postnatal care into PMTCT in Swaziland. GlobPublic Health. 2009;4:253–270. - PubMed
    1. Nkonki LL, Doherty TM, Hill Z, Chopra M, Schaay N, et al. Missed opportunities for participation in prevention of mother to child transmission programmes: simplicity of nevirapine does not necessarily lead to optimal uptake, a qualitative study. AIDS Res Ther. 2007;4:27. - PMC - PubMed

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