Impact of point-of-care diagnostics on maternal outcomes in HIV-infected women: Systematic review and meta-analysis

Article type
Authors
Mashamba-Thompson T1, Morgan R2, Sartorius B1, Dennis B3, Drain P4, Thabane L5
1University of KwaZulu-Natal
2University of McMaster University
3University St Georges
4University of Washington
5University of McMaster
Abstract
Background:World Health Organization advocates for increased accessibility of HIV-related point-of-care (POC) diagnostics in settings that lack laboratory infrastructure.

Objectives: The objective of this study is to assess the impact of POC diagnostics on maternal health outcomes in HIV-infected women.

Methods:Systematic literature review using multiple data sources: Cochrane Infectious Disease Group Specialized Register; Cochrane Central Register of Control Trials, published in the Cochrane Library; PubMed; EBSCOhost and LILACS from January 2000 to October 2015. References of included studies were hand searched. Randomised-controlled trials (RCTs) and observational studies examining health outcomes of HIV-infected women were eligible for inclusion in this review. The Cochrane Risk-of-Bias tool was used for bias assessment of the included studies. PRISMA guidelines were used for reporting.

Results:Of the 695 studies identified, six retrievable studies (five cross-sectional studies and one case-control study) met the inclusion criteria and were included in this study. The included studies examined a total of 167 HIV-infected women in different study settings. No studies reported evidence of CD4 count, viral load and TB and the syphilis POC test impact on HIV-infected women was not found by this study. Included studies reported the impact of various HIV rapid tests across the following five maternal outcomes: Timely receipt of results with pooled effect size (ES) = 1.00 (95% confidence interval [CI]: (0.98; 1.02); enabling partner testing, ES = 0.95 (0.85; 1.04); prevention of mother-to-child transmission of HIV, ES = 0.86 (0.79; 0.93); linkage to antiretroviral treatment (ART), ES = 0.76 (0.69; 0.84) and; linkage to HIV care, ES = 0.50 (0.18; 0.82). No studies reported evidence of the impact of POC testing on maternal mortality or maternal and child morbidity of HIV-infected women.

Conclusions:The review provides an international overview of the impact of HIV POC diagnostics on maternal outcomes in HIV-infected women.