Missed opportunities to prevent mother-to-child-transmission

Abstract

Objectives To determine magnitude and reasons of loss to programme and poor antiretroviral prophylaxis coverage in prevention of mother-to-child transmission (PMTCT) programmes in sub-Saharan Africa. Design Systematic review and meta-analysis. Methods We searched PubMed and Embase databases for PMTCT studies in sub-Saharan Africa published between January 2002 and March 2012. Outcomes were the percentage of pregnant women (i) tested for HIV, (ii) initiating antiretroviral prophylaxis, (iii) having a CD4 cell count measured, and (iv) initiating antiretroviral combination therapy (cART) if eligible. In children outcomes were (v) early infant diagnosis for HIV, and (vi) cART initiation. We combined data using random-effects meta-analysis and identified predictors of uptake of interventions. Results Forty-four studies from 15 countries including 75,172 HIV-infected pregnant women were analyzed. HIV-testing uptake at antenatal care services was 94% (95% confidence intervals [CI] 92-95%) for opt-out and 58% (95% CI 40-75%) for opt-in testing. Coverage with any antiretroviral prophylaxis was 70% (95% CI 64-76%) and 62% (95% CI 50-73%) of pregnant women eligible for cART received treatment. Sixty-four percent (95% CI 48-81%) of HIV exposed infants had early diagnosis performed and 55% (95% CI 36-74%) were tested between 12 and 18 months. Uptake of PMTCT interventions was improved if cART was provided at the antenatal clinic and if the male partner was involved. Conclusions In sub-Saharan Africa, uptake of PMTCT interventions and early infant diagnosis is unsatisfactory. An integrated family-centered approach seems to improve retention.

Uptake of prevention of mother-to-child-transmission using Option B+ in northern rural Malawi: a retrospective cohort study

“…The high level of HIV testing uptake in ANC is similar to that observed in a recent meta-analysis of opt-out testing strategies in sub-Saharan Africa 7. In our population failure to test was largely due to refusal rather than programmatic issues such as staff shortage or unavailability of test kits, as observed elsewhere 8.…”

Maximizing adherence and retention for women living with HIV and their infants in Kenya (MOTIVATE! study): study protocol for a randomized controlled trial

“…Further, among women who initiate ART and are later transferred from PMTCT clinics in the postpartum period to general adult ART clinics, about 25% disengage from care after referral [11]. A systematic review and meta-analysis of 44 studies from 15 sub-Saharan African countries reported significant drop-offs along the cascade of PMTCT care for mother-baby pairs: 70% of HIV-positive pregnant women received antiretroviral prophylaxis, 64% of HIV-exposed infants were tested for HIV using DNA polymerase chain reaction (PCR) at 6 weeks after birth, and 55% were tested between 1 year and 18 months of age [12]. These high rates of attrition reflect the precarious steps along the cascade of care and treatment for pregnant and breastfeeding women living with HIV and their infants.…”

Factors associated with HIV testing and receiving results during antenatal care in Tanzania

“…Tanzania response included adoption of PMTCT guiding goal to eliminate new HIV pediatric infections and keep mothers alive through improved maternal, newborn and child health and survival programs by 2015. However, access to comprehensive PMTCT is contingent upon taking HIV test during antenatal period and collecting results followed with access to PMTCT interventions (Watson-Jones, Balira et al 2012;Wettstein, Mugglin et al 2012).…”