Implementation and Operational Research

Herlihy, Julie M.; Hamomba, Leoda; Bonawitz, Rachael; Goggin, Caitlin; Sambambi, Kennedy; Mwale, Jonas; Musonda, Victor; Musokatwane, Kebby; Hopkins, Kathryn L.; Semrau, Katherine; Hammond, Emily E.; Duncan, Julie; Knapp, A; Thea, Donald M.

doi:10.1097/qai.0000000000000760

Cited by 38 publications

(17 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Most studies measured several outcomes on the PMTCT cascade. Most studies were conducted in sub-Saharan Africa: 13 in South Africa [5–17]; eight in Kenya [18–25]; two studies each in Malawi [26,27], Zambia [28,29] and Mozambique [30,31]; and one study each in Democratic Republic of Congo [32], Swaziland [33], Tanzania [34], Rwanda [35] and Ethiopia [36]. Only one study was conducted in United States of America [37].…”

Section: Resultsmentioning

confidence: 99%

“…Structural interventions were defined as interventions that aimed to improve PMTCT service delivery by modifying the structural context of a health facility. Eight studies integrated antenatal care (ANC) and HIV treatment services in a single clinic to increase uptake of HIV care and treatment for women and infants [9,10,18,20,24,28,29,35]. One study that integrated HIV and ANC services also trained ANC nurses and midwives, employed lab courier to expedite CD4 count receipt, and conducted home visits and active tracing of mother-infant pairs by lay counsellors [29].…”

Section: Resultsmentioning

confidence: 99%

“…Eight studies integrated antenatal care (ANC) and HIV treatment services in a single clinic to increase uptake of HIV care and treatment for women and infants [9,10,18,20,24,28,29,35]. One study that integrated HIV and ANC services also trained ANC nurses and midwives, employed lab courier to expedite CD4 count receipt, and conducted home visits and active tracing of mother-infant pairs by lay counsellors [29]. In one study, maternity nurses offered direct accompaniment to the location of exposed infant testing after the birth of a child so as to increase the proportions of HEIs who return for HIV testing and continued monitoring [30].…”

Section: Resultsmentioning

confidence: 99%

“…One study [29] evaluated an integrated approach of providing ANC and PMTCT services, trained ANC nurses and midwives, had lab courier to expedite CD4 counts and implemented community-based follow-up of women-infant pairs. This study reported significant results (RR 2.6 95% CI 1.95 to 3.45).…”

Section: Resultsmentioning

confidence: 99%

“…Out of the seven studies with a home visiting component, six reported statistically significant results [14,16,26,29,36,38]. These studies were very heterogeneous, and no meta-analysis was done.…”

Section: Resultsmentioning

confidence: 99%

See 4 more Smart Citations

A systematic review of interventions to improve prevention of mother‐to‐child HIV transmission service delivery and promote retention

Ambia

Mandala

2016

Journal of the International AIDS Society

128

115

View full text Add to dashboard Cite

IntroductionThe success of prevention of mother-to-child transmission of HIV (PMTCT) is dependent upon high retention of mother-infant pairs within these programmes. This is a systematic review to evaluate the effectiveness of interventions that aim to improve PMTCT service delivery and promote retention throughout the PMTCT steps.MethodsSelected databases were searched for studies published in English (up to September 2015). Outcomes of interest included antiretroviral (ARV) drugs or antiretroviral therapy (ART) initiation among HIV-positive pregnant and/or breastfeeding women and their infants, retention into PMTCT programs, the uptake of early infant diagnosis (EID) of HIV and infant HIV status. Risk ratios and random-effect meta-analysis were used in the analysis.ResultsInterventions assessed in the 34 identified studies included male partner involvement in PMTCT, peer mentoring, the use of community health workers (CHWs), mobile phone-based reminders, conditional cash transfer, training of midwives, integration of PMTCT services and enhanced referral. Five studies (two randomized) that evaluated mobile phone-based interventions showed a statistically significant increase (pooled RR 1.18; 95% CI 1.05 to 1.32, I2=83%) in uptake of EID of HIV at around six weeks postpartum. Male partner involvement in PMTCT was associated with reductions in infant HIV transmission (pooled RR 0.61; 95% CI 0.39 to 0.94, I2=0%) in four studies (one randomized). Four studies (three randomized) that were grounded on psychological interventions reported non-significant results (pooled RR 1.01; 95% CI 0.93 to 1.09, I2=69%) in increasing ARV/ART uptake among HIV-positive pregnant and/or breastfeeding women and infant HIV testing (pooled RR 1.00; 95% CI 0.94 to 1.07, I2=45%). The effect of the other interventions on the effectiveness of improving PMTCT uptake was unclear. Heterogeneity of interventions limits these findings.ConclusionsOur findings indicate that mobile phone-based reminders may increase the uptake of EID of HIV. Studies on male partner involvement in PMTCT reported reductions in infant HIV transmission. Stronger evidence is needed and future studies should determine the long-term effects of these interventions in improving retention throughout the PMTCT steps.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

A systematic review of interventions to improve prevention of mother‐to‐child HIV transmission service delivery and promote retention

Ambia

Mandala

2016

Journal of the International AIDS Society

128

115

View full text Add to dashboard Cite

show abstract

Trends in maternal deaths in HIV‐infected women, on a background of changing HIV management guidelines in South Africa: 1997 to 2015

et al. 2017

View full text Add to dashboard Cite

IntroductionAs work begins towards the Sustainable Development Goal target of reducing the global maternal mortality ratio (MMR) to less than 70 deaths per 100,000 live births by 2030, much needs to be done in ending preventable maternal deaths. After 1990, South Africa experienced a reversal of gains in decreasing maternal mortality, with an increase in HIV‐related maternal deaths. In this study, we assessed trends in maternal mortality in HIV‐infected women, on a background of an evolving HIV care programme.MethodsThis was a cross‐sectional, retrospective record review of maternal deaths in the obstetrics unit at Chris Hani Baragwanath Academic Hospital, in Johannesburg, South Africa, a referral hospital in a high HIV prevalence setting where the prevalence among pregnant women has plateaued around 29.0% for the past decade. Trends in HIV diagnosis and management in pregnancy, and causes of maternal deaths in HIV‐infected women were analysed over different time periods (1997 to 2003, 2004 to 2009, 2010 to 2012, and 2013 to 2015) reflecting major guideline changes.ResultsFrom January 1997 to December 2015, there were 692 maternal deaths in the obstetrics unit. Of the 490 (70.8%) maternal deaths with a documented HIV status, 335 (68.4%) were HIV‐infected. A Chi‐squared test for trends showed that the institutional MMR (iMMR) in women known to be HIV‐infected peaked in the period 2004 to 2009 at 380 (95% CI 319 to 446) per 100,000 live births, with a decline to 267 (95% CI 198 to 353) in 2013 to 2015, p = 0.049. This decrease coincided with changes in the South African HIV management guidelines, mainly increased availability of antiretroviral therapy (ART). Non‐pregnancy related infections were the leading cause of death throughout the review period, accounting for 61.5% (206/335) of deaths. Only 23.3% (78/335) of the women who died were on ART at the time of death, this in the context of advanced immune suppression and an overall median CD4 count of 136 cells/μl (interquartile ranges (IQR) 45 to 301).ConclusionIn this 19‐year review of maternal deaths in Johannesburg, South Africa, there was evidence of a decrease in the iMMR among HIV‐infected women, but it remains unacceptably high. Efforts to address drivers of mortality and barriers to accessing ART need to be accelerated if we are to see substantial decreases in maternal mortality.

show abstract

Accelerating progress towards the elimination of mother‐to‐child transmission of HIV: a narrative review

et al. 2020

View full text Add to dashboard Cite

Introduction Findings from biomedical, behavioural and implementation studies provide a rich foundation to guide programmatic efforts for the prevention of mother‐to‐child HIV transmission (PMTCT). Methods We summarized the current evidence base to support policy makers, programme managers, funding agencies and other stakeholders in designing and optimizing PMTCT programmes. We searched the scientific literature for PMTCT interventions in the era of universal antiretroviral therapy for pregnant and breastfeeding women (i.e. 2013 onward). Where evidence was sparse, relevant studies from the general HIV treatment literature or from prior eras of PMTCT programme implementation were also considered. Studies were organized into six categories: HIV prevention services for women, timely access to HIV testing, timely access to ART, programme retention and adherence support, timely engagement in antenatal care and services for infants at highest risk of HIV acquisition. These were mapped to specific missed opportunities identified by the UNAIDS Spectrum model and embedded in UNICEF operational guidance to optimize PMTCT services. Results and discussion From May to November 2019, we identified numerous promising, evidence‐based strategies that, properly tailored and adopted, could contribute to population reductions in vertical HIV transmission. These spanned the HIV and maternal and child health literature, emphasizing the importance of continued alignment and integration of services. We observed overlap between several intervention domains, suggesting potential for synergies and increased downstream impact. Common themes included integration of facility‐based healthcare; decentralization of health services from facilities to communities; and engagement of partners, peers and lay workers for social support. Approaches to ensure early HIV diagnosis and treatment prior to pregnancy would strengthen care across the maternal lifespan and should be promoted in the context of PMTCT. Conclusions A wide range of effective strategies exist to improve PMTCT access, uptake and retention. Programmes should carefully consider, prioritize and plan those that are most appropriate for the local setting and best address existing gaps in PMTCT health services.

show abstract

Implementation and Operational Research

Abstract: Integration of HIV care into ANC and community-based support improved uptake of CD4 counts, proportion of cART-eligible women initiated on cART, and infants tested.

Cited by 38 publications

References 19 publications

A systematic review of interventions to improve prevention of mother‐to‐child HIV transmission service delivery and promote retention

A systematic review of interventions to improve prevention of mother‐to‐child HIV transmission service delivery and promote retention

Trends in maternal deaths in HIV‐infected women, on a background of changing HIV management guidelines in South Africa: 1997 to 2015

Accelerating progress towards the elimination of mother‐to‐child transmission of HIV: a narrative review

Contact Info

Product

Resources

About