Approaches to transitioning women into and out of prevention of mother-to-child transmission of HIV services for continued ART: a systematic review

Abstract

Introduction: Women living with HIV are required to transition into the prevention of mother-to-child transmission of HIV (PMTCT) services when they become pregnant and back to ART services after delivery. Transition can be a vulnerable time when many women are lost from HIV care yet there is little guidance on the optimal transition approaches to ensure continuity of care. We reviewed the available evidence on existing approaches to transitioning women into and out of PMTCT, outcomes following transition and factors influencing successful transition.

Methods: We searched PubMed and SCOPUS, as well as abstracts from international HIV-focused meetings, from January 2006 to July 2020. Studies were included that examined three points of transition: pregnant women already on ART into PMTCT (transition 1), pregnant women living with HIV not yet on ART into treatment services (transition 2) and postpartum women from PMTCT into general ART services after delivery (transition 3). Results were grouped and reported as descriptions of transition approach, comparison of outcomes following transition and factors influencing successful transition.

Results & discussion: Out of 1809 abstracts located, 36 studies (39 papers) were included in this review. Three studies included transition 1, 26 transition 2 and 17 transition 3. Approaches to transition were described in 26 studies and could be grouped into the provision of information at the point of transition (n = 8), strengthened communication or linkage of data between services (n = 4), use of transition navigators (n = 12), and combination approaches (n = 4). Few studies were designed to directly assess transition and only nine compared outcomes between transition approaches, with substantial heterogeneity in study design, setting and outcomes. Four themes were identified in 25 studies reporting on factors influencing successful transition: fear, knowledge and preparedness, clinic characteristics and the transition requirements and process.

Conclusions: This review highlights that, despite the need for women to transition into and out of PMTCT services for continued ART in many settings, there is very limited evidence on optimal transition approaches. Ongoing operational research is required to identify sustainable and acceptable transition approaches and service delivery models that support continuity of HIV care during and after pregnancy.

Keywords: antiretroviral therapy; continuity of care; linkage; prevention of mother-to-child transmission; transfer; transition.

Figure 1

Transition points, models of care and timing of transition into and out of PMTCT for pregnant and postpartum women. Dashed lines represent continued care with no transition needed. ART, antiretroviral therapy; ANC, antenatal care.

Figure 2

PRISMA flow diagram summarising the literature search. Note each included study may appear in multiple results groups and transition points. ANC, antenatal care; ART, antiretroviral therapy; PMTCT, prevention of mother‐to‐child transmission of HIV.

Figure 3

Summary of factors influencing transition into or out of PMTCT for ART services. ANC, antenatal care; ART, antiretroviral therapy; NA, not applicable; PMTCT, prevention of mother‐to‐child transmission of HIV.