Evidence on intervention effectiveness in improving uptake and retention of mothers and infants in the prevention of mother-to-child transmission care in HIV regimens is lacking, according to a review published in BMJ Open.
Mother-to-child transmission is the leading cause of new HIV infections in children, with 15,000 new HIV infections and 110,000 HIV-related deaths occurring globally in 2015 in children <15 years of age. Although HIV regimens to prevent vertical transmission are effective, uptake and retention remain low in low- and middle-income countries. To improve the understanding of barriers to uptake and retention of women and their infants in the prevention of vertically transmitted HIV infection and optimize treatment regimens, further evidence is needed to guide implementers and policy makers in low- and middle-income countries.
Therefore, this systematic review and meta-analysis identified effective interventions for improving uptake and retention of mothers with HIV and their infants in services directed at the prevention of vertical transmission in low- and middle-income countries in order to inform program planning.
From study inception to January 15, 2018, investigators searched 22 electronic databases for randomized, quasi-randomized, and non-randomized controlled studies and interrupted time series studies. After a full review of 95 studies, 18 were included in the study. For studies reporting similar interventions and outcomes, random-effects meta-analyses were performed.
Heterogeneity in interventions and outcome measures limited the researchers’ ability to compare these studies. Results showed that the integration of HIV and antenatal care may improve antiretroviral therapy use during pregnancy with a statistically significant increase (P =.0113) of antiretroviral therapy use during pregnancy for integration of HIV and antenatal care relative to standard non-integrated care. The remaining studies assessed other patient, provider, or health system interventions and were synthesized narratively with small effects seen across the intervention categories but may have a moderate to high risk of bias.
Overall, the review authors concluded that, “Improved reporting of key methodological criteria will facilitate interpretations of findings and improve the utility of evidence to [prevention of mother-to-child HIV transmission] programme planners.”
Ritchie LMP, van Lettow M, Pham B, et al. What interventions are effective in improving uptake and retention of HIV-positive pregnant breastfeeding women and their infants in prevention of mother to child transmission care programmes in low-income and middle-income countries? A systemic review and meta-analysis [published online July, 29, 2019]. BMJ Open. doi:10.1136/bmjopen-2018-024907