Externalities of Prevention of Mother-to-Child Transmission Programs: A Systematic Review

Nutman, Sarah; McKee, Douglas; Khoshnood, Kaveh

doi:10.1007/s10461-012-0228-8

Cited by 9 publications

(17 citation statements)

References 59 publications

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“…The Government of Kenya's Ministry of Health (MOH) PMTCT program was launched in 2000 and has achieved nearly universal facility‐based coverage, with 4,000 of the 4,400 (90%) health facilities offering maternal, newborn, and child health (MNCH) services including PMTCT services [5]. However, there have been challenges to the full scale‐up of PMTCT in Kenya that included: late prenatal care attendance; low utilization of prenatal care services and facility‐based births; lack of integration of PMTCT services with reproductive health and family planning services; and lack of integration of early infant diagnosis in the MNCH continuum, resulting in missed opportunities for pediatric diagnosis, care, and treatment [6,7].…”

Section: Introductionmentioning

confidence: 99%

RED for PMTCT: An adaptation of immunization's Reaching Every District approach increases coverage, access, and utilization of PMTCT care in Bondo District, Kenya

Kanyuuru¹,

Kabue²,

Ashengo³

et al. 2015

Intl J Gynecology & Obste

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a b s t r a c t a r t i c l e i n f oKeywords: Access Coverage Maternal and child health Prevention of mother-to-child transmission (PMTCT) Reaching Every District approach Utilization Gaps exist in coverage, early access, and utilization of prevention of mother-to-child transmission of HIV (PMTCT) services in Kenya. The Maternal and Child Health Integrated Program, led by Jhpiego, piloted an adaptation of immunization's Reaching Every District (RED) approach in Bondo District as a way of improving PMTCT care. Routine district-level monthly summary service delivery pre-and post-implementation data were analyzed. Marked improvements resulted in the proportion of HIV-infected and non-infected pregnant women completing four focused prenatal care visits, from 25% to 41%, and the proportion of HIV-exposed infants (HEIs) tested at six weeks, from 27% to 78% (P b 0.001). The proportion of HEIs tested for HIV infection at 12 months was 52%, while 77% of HEIs were issued antiretroviral prophylaxis by the end of the pilot. Implementation of RED for PMTCT demonstrated that PMTCT services can be delivered effectively in the context of the existing community strategy and resulted in increased coverage, access, and utilization of care for HIV-positive pregnant women and their children.

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Section: Introductionmentioning

confidence: 99%

RED for PMTCT: An adaptation of immunization's Reaching Every District approach increases coverage, access, and utilization of PMTCT care in Bondo District, Kenya

Kanyuuru¹,

Kabue²,

Ashengo³

et al. 2015

Intl J Gynecology & Obste

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“…The programmes progressively won the interest of governments and are now increasingly supported through public funding in many countries, while still requiring substantial donor support [ 15 ]. With time, the strong links this cascade has with maternal and child health services required closer collaboration with and increasing integration into broader services towards sustainable outcomes [ 14 , 16 ].…”

Section: Overview: Hiv Pmtct and Health System Integrationmentioning

confidence: 99%

The impact of programs for prevention of mother-to-child transmission of HIV on health care services and systems in sub-Saharan Africa - A review

2017

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BackgroundThe global scale-up of Prevention of mother-to-child transmission (PMTCT) services is credited for a 52% worldwide decline in new HIV infections among children between 2001 and 2012. However, the epidemic continues to challenge maternal and paediatric HIV control efforts in Sub Saharan Africa (SSA), with repercussions on other health services beyond those directly addressing HIV and AIDS. This systematised narrative review describes the effects of PMTCT programs on other health care services and the implications for improving health systems in SSA as reported in the existing articles and scientific literature. The following objectives framed our review:To describe the effects of PMTCT on health care services and systems in SSA and assess whether the PMTCT has strengthened or weakened health systems in SSATo describe the integration of PMTCT and its extent within broader programs and health systems. MethodsArticles published in English and French over the period 1st January 2007 (the year of publication of WHO/UNICEF guidelines on global scale-up of the PMTCT) to 31 November 2016 on PMTCT programs in SSA were sought through searches of electronic databases (Medline and Google Scholar). Articles describing the impact (positive and negative effects) of PMTCT on other health care services and those describing its integration in health systems in SSA were eligible for inclusion. We assessed 6223 potential papers, reviewed 225, and included 57.ResultsThe majority of selected articles offered arguments for increased health services utilisation, notably of ante-natal care, and some evidence of beneficial synergies between PMTCT programs and other health services especially maternal health care, STI prevention and early childhood immunisation. Positive and negative impact of PMTCT on other health care services and health systems are suggested in thirty-two studies while twenty-five papers recommend more integration and synergies. However, the empirical evidence of impact of PMTCT integration on broader health systems is scarce. Underlying health system challenges such as weak physical and human resource infrastructure and poor working conditions, as well as social and economic barriers to accessing health services, affect both PMTCT and the health services with which PMTCT interacts.ConclusionsPMTCT services increase to some extent the availability, accessibility and utilisation of antenatal care and services beyond HIV care. Vertical PMTCT programs work, when well-funded and well-managed, despite poorly functioning health systems. The beneficial synergies between PMTCT and other services are widely suggested, but there is a lack of large-scale evidence of this.

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“… 55 , 56 Reviews of integration of interventions needed to prevent vertical HIV transmission with other maternal and child health (MCH) services have identified generally positive results in terms of coverage, but few studies provide information on health outcomes. 57 , 58 Similarly, provision of contraceptives in HIV services and as a routine part of postnatal care has shown increased uptake by WLWH, 59 – 61 but information about how these interventions affect unintended pregnancies or other health outcomes is lacking. 62 Despite the overall positive impact, individual studies that identify negative effects in some settings, for instance, drops in child immunization rates in rural clinics when offer of HIV testing was added to immunization visits, 63 deserve attention.…”

Section: Health System: Integrated Health Service Deliverymentioning

confidence: 99%

Eliminating Preventable HIV-Related Maternal Mortality in Sub-Saharan Africa

Kendall¹,

Danel

Cooper³

et al. 2014

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Introduction:HIV makes a significant contribution to maternal mortality, and women living in sub-Saharan Africa are most affected. International commitments to eliminate preventable maternal mortality and reduce HIV-related deaths among pregnant and postpartum women by 50% will not be achieved without a better understanding of the links between HIV and poor maternal health outcomes and improved health services for the care of women living with HIV (WLWH) during pregnancy, childbirth, and postpartum.Methods:This article summarizes priorities for research and evaluation identified through consultation with 30 international researchers and policymakers with experience in maternal health and HIV in sub-Saharan Africa and a review of the published literature.Results:Priorities for improving the evidence about effective interventions to reduce maternal mortality and improve maternal health among WLWH include better quality data about causes of maternal death among WLWH, enhanced and harmonized program monitoring, and research and evaluation that contributes to improving: (1) clinical management of pregnant and postpartum WLWH, including assessment of the impact of expanded antiretroviral therapy on maternal mortality and morbidity, (2) integrated service delivery models, and (3) interventions to create an enabling social environment for women to begin and remain in care.Conclusions:As the global community evaluates progress and prepares for new maternal mortality and HIV targets, addressing the needs of WLWH must be a priority now and after 2015. Research and evaluation on maternal health and HIV can increase collaboration on these 2 global priorities, strengthen political constituencies and communities of practice, and accelerate progress toward achievement of goals in both areas.

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Externalities of Prevention of Mother-to-Child Transmission Programs: A Systematic Review

Cited by 9 publications

References 59 publications

RED for PMTCT: An adaptation of immunization's Reaching Every District approach increases coverage, access, and utilization of PMTCT care in Bondo District, Kenya

RED for PMTCT: An adaptation of immunization's Reaching Every District approach increases coverage, access, and utilization of PMTCT care in Bondo District, Kenya

The impact of programs for prevention of mother-to-child transmission of HIV on health care services and systems in sub-Saharan Africa - A review

Eliminating Preventable HIV-Related Maternal Mortality in Sub-Saharan Africa

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