A systematic review of interventions to improve postpartum retention of women in PMTCT and ART care

Abstract

IntroductionThe World Health Organization recommends lifelong antiretroviral therapy (ART) for all pregnant and breastfeeding women living with HIV. Effective transitioning from maternal and child health to ART services, and long-term retention in ART care postpartum is crucial to the successful implementation of lifelong ART for pregnant women. This systematic review aims to determine which interventions improve (1) retention within prevention of mother-to-child HIV transmission (PMTCT) programmes after birth, (2) transitioning from PMTCT to general ART programmes in the postpartum period, and (3) retention of postpartum women in general ART programmes.MethodsWe searched Medline, Embase, ISI Web of Knowledge, the regional World Health Organization databases and conference abstracts for data published between 2002 and 2015. The quality of all included studies was assessed using the GRADE criteria.Results and DiscussionAfter screening 8324 records, we identified ten studies for inclusion in this review, all of which were from sub-Saharan Africa except for one from the United Kingdom. Two randomized trials found that phone calls and/or text messages improved early (six to ten weeks) postpartum retention in PMTCT. One cluster-randomized trial and three cohort studies found an inconsistent impact of different levels of integration between antenatal care/PMTCT and ART care on postpartum retention. The inconsistent results of the four identified studies on care integration are likely due to low study quality, and heterogeneity in intervention design and outcome measures. Several randomized trials on postpartum retention in HIV care are currently under way.ConclusionsOverall, the evidence base for interventions to improve postpartum retention in HIV care is weak. Nevertheless, there is some evidence that phone-based interventions can improve retention in PMTCT in the first one to three months postpartum.

“I will leave the baby with my mother”: Long‐distance travel and follow‐up care among HIV‐positive pregnant and postpartum women in South Africa

“…The amount provided to patients varies depending on patient characteristics and clinic policy, but often is just 30 days. Numerous interventions to improve postpartum retention overall have drawn recent attention ; our findings particularly support those that improve patient tracking and two‐way communication between patients and facilities.…”

Linkage to care, mobility and retention of HIV‐positive postpartum women in antiretroviral therapy services in South Africa

“…Reported retention in HIV care is often facility specific. Individuals who are transferred to new clinics are often considered retained in care, censored at the time of transfer or excluded from analyses . In contrast, our results are from a cohort where all women were required to transfer care and access to HIV care was traced to any routine primary healthcare clinic in South Africa.…”

Attrition of HIV‐exposed infants from early infant diagnosis services in low‐ and middle‐income countries: a systematic review and meta‐analysis

“…This suggests that the first six months of postpartum follow‐up might represent an especially vulnerable period, and that interventions to mitigate attrition or promote retention of mother‐infant pairs might have a greater impact if focused on and implemented early in the EID cascade. Candidate interventions might include improved integration/linkage of maternal and infant HIV services , earlier and/or point‐of‐care infant virological testing , phone/SMS‐based messaging/reminders , systems engineering and continuous quality improvement approaches , improved information systems for identifying patients who have missed clinical visits and enhanced community outreach and patient tracing during this period of increased vulnerability .…”