Your browser doesn't support javascript.
loading
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.
Puchalski Ritchie, Lisa M; van Lettow, Monique; Pham, Ba; Straus, Sharon E; Hosseinipour, Mina C; Rosenberg, Nora E; Phiri, Sam; Landes, Megan; Cataldo, Fabian.
Afiliação
  • Puchalski Ritchie LM; Department of Medicine, Division of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada.
  • van Lettow M; Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.
  • Pham B; Department of Emergency Medicine, University Health Network, Toronto, Ontario, Canada.
  • Straus SE; Dignitas International, Zomba, Malawi.
  • Hosseinipour MC; University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada.
  • Rosenberg NE; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.
  • Phiri S; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.
  • Landes M; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
  • Cataldo F; Division of Infectious Disease, University of North Carolina, Chapel Hill, North Carolina, USA.
BMJ Open ; 9(7): e024907, 2019 07 29.
Article em En | MEDLINE | ID: mdl-31362959
ABSTRACT

OBJECTIVE:

This 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.

METHODS:

We 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.

RESULTS:

We 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.

CONCLUSIONS:

Evidence 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 NUMBER CRD42015020829.
Assuntos
Palavras-chave

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Complicações Infecciosas na Gravidez / Aleitamento Materno / Infecções por HIV / Transmissão Vertical de Doenças Infecciosas / Fármacos Anti-HIV Tipo de estudo: Clinical_trials / Prognostic_studies / Systematic_reviews Limite: Female / Humans / Infant / Pregnancy Idioma: En Ano de publicação: 2019 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Complicações Infecciosas na Gravidez / Aleitamento Materno / Infecções por HIV / Transmissão Vertical de Doenças Infecciosas / Fármacos Anti-HIV Tipo de estudo: Clinical_trials / Prognostic_studies / Systematic_reviews Limite: Female / Humans / Infant / Pregnancy Idioma: En Ano de publicação: 2019 Tipo de documento: Article