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Effect of Point-of-Care Diagnostics on Maternal Outcomes in Human Immunodeficiency Virus–Infected Women: Systematic Review and Meta-analysis

Mashamba-Thompson, Tivani P. PhD*; Morgan, Rebecca L. PhD; Sartorius, Benn PhD*; Dennis, Brittany PhD†‡; Drain, Paul K. MD, MPH§∥¶#; Thabane, Lehana PhD†**

doi: 10.1097/POC.0000000000000135
Review Article

Introduction The World Health Organization advocates for increased accessibility of human immunodeficiency virus (HIV)–related point-of-care (POC) diagnostics in settings that lack laboratory infrastructure. The aim of this study was to assess the effect of POC diagnostics on maternal health outcomes in HIV-infected women.

Methods A systematic literature review used the following multiple data sources: Cochrane Infectious Disease Group Specialized Register, Cochrane Central Register of Control Trials, published in The Cochrane Library, PubMed, Elton B. Stephens Co Host, and Latin American and Caribbean Health Sciences Literature from January 2000 to October 2015. References of included studies were hand-searched. Randomized controlled trials 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. Preferred reporting items for systematic reviews and meta-analyses guidelines were used for reporting.

Results Of 695 studies identified, 6 retrievable studies (5 cross-sectional studies and 1 case-control study) met the inclusion criteria and were included in this study. These studies examined a total of 167 HIV-infected women in different study settings. No studies reported evidence of CD4 count, viral load, and tuberculosis, and the syphilis POC test effect on HIV-infected women was not found by this study. Included studies reported the effect of various HIV rapid tests across the following 5 maternal outcomes: timely receipt of results with a pooled effect size (ES) of 1.00 (95% confidence interval [CI], 0.98–1.02); enabling partner testing with an ES of 0.95 (95% CI, 0.85–1.04); prevention of mother-to-child transmission of HIV with an ES of 0.86 (95% CI, 0.79–0.93); linkage to antiretroviral treatment with an ES of 0.76 (95 CI, 0.69–0.84); and linkage to HIV care with an ES of 0.50 (95% CI, 0.18–0.82). No studies reported evidence of the effect of POC testing on maternal mortality or maternal and child morbidity of HIV-infected women.

Conclusions The review provides an international overview of the effect of HIV POC diagnostics on maternal outcomes in HIV-infected women, showing the evidence that the HIV POC test is significantly associated with decreased mother-to-child transmission of HIV and increased linkage to antiretroviral treatment and HIV care for HIV-infected women. It also revealed a gap in the literature aimed at assessing the effect of POC diagnostics on maternal morbidity and mortality in HIV-infected women.

PROSPERO registration number: CRD42014015439

From the *Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa; †Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; ‡Department of Medicine, St George's University of London, Tooting, London, United Kingdom; §International Clinical Research Center, Department of Global Health, ∥Division of Infectious Diseases, Department of Medicine, and ¶Department of Epidemiology, University of Washington, Seattle, WA; #Department of Surgery, Massachusetts General Hospital, Boston, MA; and **Biostatistics Unit/FSORC, St Joseph's Healthcare, Hamilton, Ontario, Canada.

Reprints: Tivani P. Mashamba-Thompson, PhD, Discipline of Public Health Medicine, School of Nursing and Public Health, 2nd Floor George Campbell Building, Howard College Campus, University of KwaZulu-Natal, Durban, 4001, South Africa. E-mail: Mashamba-Thompson@ukzn.ac.za.

The authors declare no conflict of interest.

Authors' contribution: T.P.M.T. conceptualized and designed the study and prepared the draft of the research proposal under the supervision of B.S. and P.K.D. T.P.M.T., B.D., R.M., and L.T. contributed to developing the background and planned output of the review and the design of the study. R.M. and B.S. contributed synthesis of data and design of the sifting and data extraction processes. B.D., B.S., and R.M. assisted with the manuscript preparation. All authors reviewed draft versions of the manuscript and approved the final version.

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