Missed opportunities to prevent mother-to-child-transmission: systematic review and meta-analysis

Wettstein, Celinaa; Mugglin, Catrinaa; Egger, Matthiasa,b; Blaser, Nelloa; Vizcaya, Luisa S.a; Estill, Jannea; Bender, Nicolea; Davies, Mary-Annb; Wandeler, Gillesa,c,*; Keiser, Oliviaa,*; for the IeDEA Southern Africa Collaboration

doi: 10.1097/QAD.0b013e328359ab0c
Epidemiology and Social

Objectives: To determine magnitude and reasons of loss to program and poor antiretroviral prophylaxis coverage in prevention of mother-to-child transmission (PMTCT) programs in sub-Saharan Africa.

Design: Systematic review and meta-analysis.

Methods: We searched PubMed and Embase databases for PMTCT studies in sub-Saharan Africa published between January 2002 and March 2012. Outcomes were the percentage of pregnant women tested for HIV, initiating antiretroviral prophylaxis, having a CD4 cell count measured, and initiating antiretroviral combination therapy (cART) if eligible. In children outcomes were early infant diagnosis for HIV, and cART initiation. We combined data using random-effects meta-analysis and identified predictors of uptake of interventions.

Results: Forty-four studies from 15 countries including 75 172 HIV-infected pregnant women were analyzed. HIV-testing uptake at antenatal care services was 94% [95% confidence intervals (CIs) 92–95%] for opt-out and 58% (95% CI 40–75%) for opt-in testing. Coverage with any antiretroviral prophylaxis was 70% (95% CI 64–76%) and 62% (95% CI 50–73%) of pregnant women eligible for cART received treatment. Sixty-four percent (95% CI 48–81%) of HIV exposed infants had early diagnosis performed and 55% (95% CI 36–74%) were tested between 12 and 18 months. Uptake of PMTCT interventions was improved if cART was provided at the antenatal clinic and if the male partner was involved.

Conclusion: In sub-Saharan Africa, uptake of PMTCT interventions and early infant diagnosis is unsatisfactory. An integrated family-centered approach seems to improve retention.

Author Information

aDivision of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland

bSchool of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa

cInfectious Diseases Clinic, Bern University Hospital, Bern, Switzerland.

*Gilles Wandeler and Olivia Keiser contributed equally to the writing of this article.

Correspondence to Olivia Keiser, Institute of Social and Preventive Medicine (ISPM), University of Bern, Finkenhubelweg 11, Bern CH-3012, Switzerland. Tel: +41 31 631 35 15; fax: +41 31 631 35 20; e-mail: okeiser@ispm.unibe.ch

Received 20 June, 2012

Revised 9 August, 2012

Accepted 23 August, 2012

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© 2012 Lippincott Williams & Wilkins, Inc.