What interventions are effective in improving uptake and retention of HIV-positive pregnant and breastfeeding women and their infants in prevention of mother to child transmission care programmes in low-income and middle-income countries? A systematic review and meta-analysis

Abstract

ObjectiveThis review was conducted to identify interventions effective in improving uptake and retention of HIV-positive mothers and their infants in prevention of mother to child transmission (PMTCT) services in low-income and middle-income countries (LMICs) in order to inform programme planning.MethodsWe conducted a systematic review of studies comparing usual care with any intervention to improve uptake and retention of HIV-positive pregnant or breastfeeding women and their children from birth to 2 years of age in PMTCT services in LMICs. Twenty-two electronic databases were searched from inception to 15 January 2018, for randomised, quasi-randomised and non-randomised controlled trials, and interrupted time series studies; reference lists of included articles were searched for relevant articles. Risk of bias was assessed using the Cochrane Effective Practice and Organisation of Care group criteria. Random-effects meta-analysis was conducted for studies reporting similar interventions and outcomes.ResultsWe identified 29 837 articles, of which 18 studies were included in our review. Because of heterogeneity in interventions and outcome measures, only one meta-analysis of two studies and one outcome was conducted; we found a statistically significant increase in antiretroviral therapy (ART) use during pregnancy for integration of HIV and antenatal care relative to standard non-integrated care (pooled AOR=2.69; 95% CI 1.25 to 5.78, p=0.0113). The remaining studies assessing other patient, provider or health system interventions were synthesised narratively, with small effects seen across intervention categories for both maternal and infant PMTCT outcomes based predominately on evidence with moderate to high risk of bias.ConclusionsEvidence on the effectiveness of interventions to improve uptake and retention of mothers and infants in PMTCT care is lacking. Our findings suggest that integration of HIV and antenatal care may improve ART use during pregnancy. Future studies to replicate promising approaches are needed. Improved reporting of key methodological criteria will facilitate interpretation of findings and improve the utility of evidence to PMTCT programme planners.PROSPERO registration numberCRD42015020829.

Loss to follow up of pregnant women with HIV and infant HIV outcomes in the prevention of maternal to child transmission of HIV programme in two high-burden provinces in Papua New Guinea: a retrospective clinical audit

“…Although prevention of mother to child transmission programmes have received considerable research attention, recent systematic reviews on effective interventions highlight that quality evidence is still lacking to guide intervention design in improving uptake of ART and retention in programmes among mothers and their infants. 32 33 Success along the HIV care cascade has been achieved with comprehensive approaches. Using a comprehensive integrated approach involving point-of-care CD4 testing, integrated services and male community champions, a study in Nigeria demonstrated that mothers with access to comprehensively integrated system were more than three times likely to initiate ART and were more likely to be retained in care at 6 and 12 weeks post partum compared with mothers receiving usual care.…”

Which public health interventions are effective in reducing morbidity, mortality and health inequalities from infectious diseases amongst children in low- and middle-income countries (LMICs): An umbrella review

“…The vast majority of included reviews covered interventions aiming at preventing infectious diseases in children [ 49 , 50 , 54 – 59 , 62 , 64 , 65 , 68 , 69 , 71 – 82 , 84 – 99 , 101 , 102 , 104 , 106 , 108 – 110 ]. Over a quarter included health promoting interventions [ 48 , 49 , 60 – 64 , 66 , 67 , 70 , 72 , 78 , 83 , 92 , 103 , 107 ] and only two covered health protection interventions [ 100 , 105 ].…”

Role of temporal discounting in a conditional cash transfer (CCT) intervention to improve engagement in the prevention of mother-to-child transmission (PMTCT) cascade

“…Notably, CCT is one of several potentially effective strategies to improve engagement in PMTCT care. Many structural support interventions (e.g., integration of routine antenatal care and ART services) and social support interventions (e.g., peer support 'buddies' or groups) can improve engagement in HIV and PMTCT care among women in lower-and middle-income countries [43][44][45]. Tailored interventions, which may involve a combination of structural and social support interventions, could help address the specific needs and multifaceted barriers to care faced by pregnant and breastfeeding women living with HIV [44].…”