Integrating prevention of mother-to-child HIV transmission programs to improve uptake: a systematic review.

<h4>Background</h4>We performed a systematic review to assess the effect of integrated perinatal prevention of mother-to-child transmission of HIV interventions compared to non- or partially integrated services on the uptake in low- and middle-income countries.<h4>Methods</h4>...

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Autores principales:	Lorainne Tudor Car, Michelle H M M T Van Velthoven, Serena Brusamento, Hoda Elmoniry, Josip Car, Azeem Majeed, Peter Tugwell, Vivian Welch, Ana Marusic, Rifat Atun
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2012
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/c519986b58ab4a11be171975d5415cab
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spelling	oai:doaj.org-article:c519986b58ab4a11be171975d5415cab2021-11-18T07:20:36ZIntegrating prevention of mother-to-child HIV transmission programs to improve uptake: a systematic review.1932-620310.1371/journal.pone.0035268https://doaj.org/article/c519986b58ab4a11be171975d5415cab2012-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/22558134/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>We performed a systematic review to assess the effect of integrated perinatal prevention of mother-to-child transmission of HIV interventions compared to non- or partially integrated services on the uptake in low- and middle-income countries.<h4>Methods</h4>We searched for experimental, quasi-experimental and controlled observational studies in any language from 21 databases and grey literature sources.<h4>Results</h4>Out of 28 654 citations retrieved, five studies met our inclusion criteria. A cluster randomized controlled trial reported higher probability of nevirapine uptake at the labor wards implementing HIV testing and structured nevirapine adherence assessment (RRR 1.37, bootstrapped 95% CI, 1.04-1.77). A stepped wedge design study showed marked improvement in antiretroviral therapy (ART) enrolment (44.4% versus 25.3%, p<0.001) and initiation (32.9% versus 14.4%, p<0.001) in integrated care, but the median gestational age of ART initiation (27.1 versus 27.7 weeks, p = 0.4), ART duration (10.8 versus 10.0 weeks, p = 0.3) or 90 days ART retention (87.8% versus 91.3%, p = 0.3) did not differ significantly. A cohort study reported no significant difference either in the ART coverage (55% versus 48% versus 47%, p = 0.29) or eight weeks of ART duration before the delivery (50% versus 42% versus 52%; p = 0.96) between integrated, proximal and distal partially integrated care. Two before and after studies assessed the impact of integration on HIV testing uptake in antenatal care. The first study reported that significantly more women received information on PMTCT (92% versus 77%, p<0.001), were tested (76% versus 62%, p<0.001) and learned their HIV status (66% versus 55%, p<0.001) after integration. The second study also reported significant increase in HIV testing uptake after integration (98.8% versus 52.6%, p<0.001).<h4>Conclusion</h4>Limited, non-generalizable evidence supports the effectiveness of integrated PMTCT programs. More research measuring coverage and other relevant outcomes is urgently needed to inform the design of services delivering PMTCT programs.Lorainne Tudor CarMichelle H M M T Van VelthovenSerena BrusamentoHoda ElmoniryJosip CarAzeem MajeedPeter TugwellVivian WelchAna MarusicRifat AtunPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 7, Iss 4, p e35268 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Lorainne Tudor Car Michelle H M M T Van Velthoven Serena Brusamento Hoda Elmoniry Josip Car Azeem Majeed Peter Tugwell Vivian Welch Ana Marusic Rifat Atun Integrating prevention of mother-to-child HIV transmission programs to improve uptake: a systematic review.
description	<h4>Background</h4>We performed a systematic review to assess the effect of integrated perinatal prevention of mother-to-child transmission of HIV interventions compared to non- or partially integrated services on the uptake in low- and middle-income countries.<h4>Methods</h4>We searched for experimental, quasi-experimental and controlled observational studies in any language from 21 databases and grey literature sources.<h4>Results</h4>Out of 28 654 citations retrieved, five studies met our inclusion criteria. A cluster randomized controlled trial reported higher probability of nevirapine uptake at the labor wards implementing HIV testing and structured nevirapine adherence assessment (RRR 1.37, bootstrapped 95% CI, 1.04-1.77). A stepped wedge design study showed marked improvement in antiretroviral therapy (ART) enrolment (44.4% versus 25.3%, p<0.001) and initiation (32.9% versus 14.4%, p<0.001) in integrated care, but the median gestational age of ART initiation (27.1 versus 27.7 weeks, p = 0.4), ART duration (10.8 versus 10.0 weeks, p = 0.3) or 90 days ART retention (87.8% versus 91.3%, p = 0.3) did not differ significantly. A cohort study reported no significant difference either in the ART coverage (55% versus 48% versus 47%, p = 0.29) or eight weeks of ART duration before the delivery (50% versus 42% versus 52%; p = 0.96) between integrated, proximal and distal partially integrated care. Two before and after studies assessed the impact of integration on HIV testing uptake in antenatal care. The first study reported that significantly more women received information on PMTCT (92% versus 77%, p<0.001), were tested (76% versus 62%, p<0.001) and learned their HIV status (66% versus 55%, p<0.001) after integration. The second study also reported significant increase in HIV testing uptake after integration (98.8% versus 52.6%, p<0.001).<h4>Conclusion</h4>Limited, non-generalizable evidence supports the effectiveness of integrated PMTCT programs. More research measuring coverage and other relevant outcomes is urgently needed to inform the design of services delivering PMTCT programs.
format	article
author	Lorainne Tudor Car Michelle H M M T Van Velthoven Serena Brusamento Hoda Elmoniry Josip Car Azeem Majeed Peter Tugwell Vivian Welch Ana Marusic Rifat Atun
author_facet	Lorainne Tudor Car Michelle H M M T Van Velthoven Serena Brusamento Hoda Elmoniry Josip Car Azeem Majeed Peter Tugwell Vivian Welch Ana Marusic Rifat Atun
author_sort	Lorainne Tudor Car
title	Integrating prevention of mother-to-child HIV transmission programs to improve uptake: a systematic review.
title_short	Integrating prevention of mother-to-child HIV transmission programs to improve uptake: a systematic review.
title_full	Integrating prevention of mother-to-child HIV transmission programs to improve uptake: a systematic review.
title_fullStr	Integrating prevention of mother-to-child HIV transmission programs to improve uptake: a systematic review.
title_full_unstemmed	Integrating prevention of mother-to-child HIV transmission programs to improve uptake: a systematic review.
title_sort	integrating prevention of mother-to-child hiv transmission programs to improve uptake: a systematic review.
publisher	Public Library of Science (PLoS)
publishDate	2012
url	https://doaj.org/article/c519986b58ab4a11be171975d5415cab
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Integrating prevention of mother-to-child HIV transmission programs to improve uptake: a systematic review.

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