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Abstract
Background: Prevention of mother-to-child transmission (PMTCT) of HIV interventions can significantly reduce transmission rates, responsible for more than 90% of HIV infections in children. The World Health Organisation recommends integration of PMTCT programmes with other healthcare services to increase access and improve uptake of these interventions.
Objectives: To assess the effect of integrated PMTCT interventions compared to stand-alone or partially integrated services on PMTCT uptake in low- and middle-income countries.
Methods: We searched for experimental, quasi-experimental and controlled observational studies in any language in 21 databases and grey literature sources. We also scanned reference lists of included articles and relevant systematic reviews.
Results: Out of 28,654 citations retrieved, five studies met inclusion criteria (Figure1; Table1). A cluster randomised controlled trial reported higher probability of nevirapine uptake at the labour wards implementing HIV testing and structured nevirapine adherence assessment. A stepped wedge study showed marked improvement in antiretroviral therapy (ART) enrolment and initiation in integrated care, but the median gestational age of ART initiation, ART duration or 90days ART retention did not differ significantly. A retrospective cohort study reported no significant difference either in the ART coverage or eight weeks of ART duration before the delivery 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, were tested and learned their HIV status. The second study also reported significant increase in HIV testing uptake after integration.
Conclusions: Limited evidence supports the effectiveness of PMTCT programmes compared to partially integrated care. More research measuring coverage and other relevant outcomes is urgently needed to inform the design of services delivering PMTCT programmes.
Objectives: To assess the effect of integrated PMTCT interventions compared to stand-alone or partially integrated services on PMTCT uptake in low- and middle-income countries.
Methods: We searched for experimental, quasi-experimental and controlled observational studies in any language in 21 databases and grey literature sources. We also scanned reference lists of included articles and relevant systematic reviews.
Results: Out of 28,654 citations retrieved, five studies met inclusion criteria (Figure1; Table1). A cluster randomised controlled trial reported higher probability of nevirapine uptake at the labour wards implementing HIV testing and structured nevirapine adherence assessment. A stepped wedge study showed marked improvement in antiretroviral therapy (ART) enrolment and initiation in integrated care, but the median gestational age of ART initiation, ART duration or 90days ART retention did not differ significantly. A retrospective cohort study reported no significant difference either in the ART coverage or eight weeks of ART duration before the delivery 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, were tested and learned their HIV status. The second study also reported significant increase in HIV testing uptake after integration.
Conclusions: Limited evidence supports the effectiveness of PMTCT programmes compared to partially integrated care. More research measuring coverage and other relevant outcomes is urgently needed to inform the design of services delivering PMTCT programmes.
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