Abstractobjectives Despite the success of Prevention of Mother-to-Child Transmission of HIV (PMTCT) programmes, low uptake of services and poor retention pose a formidable challenge to achieving the elimination of vertical HIV transmission in low-and middle-income countries. This systematic review summarises interventions that demonstrate statistically significant improvements in service uptake and retention of HIV-positive pregnant and breastfeeding women and their infants along the PMTCT cascade.methods Databases were systematically searched for peer-reviewed studies. Outcomes of interest included uptake of services, such as antiretroviral therapy (ART) such as initiation, early infant diagnostic testing, and retention of HIV-positive pregnant and breastfeeding women and their infants. Interventions that led to statistically significant outcomes were included and mapped to the PMTCT cascade. An eight-item assessment tool assessed study rigour. PROSPERO ID: CRD42017063816.results Of 686 citations reviewed, 11 articles met inclusion criteria. Ten studies detailed maternal outcomes and seven studies detailed infant outcomes in PMTCT programmes. Interventions to increase access to antenatal care (ANC) and ART services (n = 4) and those using lay cadres (n = 3) were most common. Other interventions included quality improvement (n = 2), mHealth (n = 1), and counselling (n = 1). One study described interventions in an Option B+ programme. Limitations included lack of HIV testing and counselling and viral load monitoring outcomes, small sample size, geographical location, and non-randomized assignment and selection of participants.conclusions Interventions including ANC/ART integration, family-centred approaches, and the use of lay healthcare providers are demonstrably effective in increasing service uptake and retention of HIV-positive mothers and their infants in PMTCT programmes. Future studies should include control groups and assess whether interventions developed in the context of earlier 'Options' are effective in improving outcomes in Option B+ programmes.

Introduction The COVID‐19 pandemic reached the African continent in less than three months from when the first cases were reported from mainland China. As COVID‐19 preparedness and response plans were rapidly instituted across sub‐Saharan Africa, many governments and donor organizations braced themselves for the unknown impact the COVID‐19 pandemic would have in under‐resourced settings with high burdens of PLHIV. The potential negative impact of COVID‐19 in these countries is uncertain, but is estimated to contribute both directly and indirectly to the morbidity and mortality of PLHIV, requiring countries to leverage existing HIV care systems to propel COVID‐19 responses, while safeguarding PLHIV and HIV programme gains. In anticipation of COVID‐19‐related disruptions, PEPFAR promptly established guidance to rapidly adapt HIV programmes to maintain essential HIV services while protecting recipients of care and staff from COVID‐19. This commentary reviews PEPFAR’s COVID‐19 technical guidance and provides country‐specific examples of programme adaptions in sub‐Saharan Africa. Discussion The COVID‐19 pandemic may pose significant risks to the continuity of HIV services, especially in countries with high HIV prevalence and weak and over‐burdened health systems. Although there is currently limited understanding of how COVID‐19 affects PLHIV, it is imperative that public health systems and academic centres monitor the impact of COVID‐19 on PLHIV. The general principles of the HIV programme adaptation guidance from PEPFAR prioritize protecting the gains in the HIV response while minimizing in‐person home and facility visits and other direct contact when COVID‐19 control measures are in effect. PEPFAR‐supported clinical, laboratory, supply chain, community and data reporting systems can play an important role in mitigating the impact of COVID‐19 in sub‐Saharan Africa. Conclusions As community transmission of COVID‐19 continues and the number of country cases rise, fragile health systems may be strained. Utilizing the adaptive, data‐driven programme approaches in facilities and communities established and supported by PEPFAR provides the opportunity to strengthen the COVID‐19 response while protecting the immense gains spanning HIV prevention, testing and treatment reached thus far.

The population results of the ecological analyses complement the person-specific results of the epidemiological analyses in finding no evidence of a teratogenic effect from the use of Bendectin.