Avtor/Urednik     Tudor-Car, Lorainne; Van Velthoven, Michelle; Brusamento, Serena; Elmoniry, Hoda; Car, Josip; Majeed, Azeem; Tugwell, Peter; Welch, Vivian; Marušič, Ana; Atun, Rifat
Naslov     Integrating prevention of mother-to-child HIV transmission programs to improve uptake: a systematic review
Tip     članek
Vir     PLoS One
Vol. in št.     Letnik 7, št. 4
Leto izdaje     2012
Obseg     str. 1-8, e35268
Jezik     eng
Abstrakt     Background: We performed a systematic review to assess the effect of integrated perinatal prevention of mother-to-child transmission of HIV interventions compared to non- or partially integrated services on the uptake in low- and middle-income countries. Methods: We searched for experimental, quasi-experimental and controlled observational studies in any language from 21 databases and grey literature sources. Results: Out of 28 654 citations retrieved, five studies met our inclusion criteria. A cluster randomized controlled trial reported higher probability of nevirapine uptake at the labor wards implementing HIV testing and structured nevirapine adherence assessment (RRR 1.37, bootstrapped 95% CI, 1.04-1.77). A stepped wedge design study showed marked improvement in antiretroviral therapy (ART) enrolment (44.4% versus 25.3%, p<0.001) and initiation (32.9% versus 14.4%, p<0.001) in integrated care, but the median gestational age of ART initiation (27.1 versus 27.7 weeks, p = 0.4), ART duration (10.8 versus 10.0 weeks, p = 0.3) or 90 days ART retention (87.8% versus 91.3%, p = 0.3) did not differ significantly. A cohort study reported no significant difference either in the ART coverage (55% versus 48% versus 47%, p = 0.29) or eight weeks of ART duration before the delivery (50% versus 42% versus 52%; p = 0.96) 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 (92% versus 77%, p<0.001), were tested (76% versus 62%, p<0.001) and learned their HIV status (66% versus 55%, p<0.001) after integration. The second study also reported significant increase in HIV testing uptake after integration (98.8% versus 52.6%, p<0.001). Conclusion: Limited, non-generalizable evidence supports the effectiveness of integrated PMTCT programs. (Abs. trunc. at 2000 ch.)
Deskriptorji     HIV INFECTIONS
MATERNAL-FETAL EXCHANGE
CHEMOPREVENTION
ANTI-HIV AGENTS
AIDS SERODIAGNOSIS
ADULT
INFANT, NEWBORN
COHORT STUDIES
QUALITY ASSURANCE, HEALTH CARE
RANDOMIZED CONTROLLED TRIALS