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Implementation effectiveness of revised (post-2010) World Health Organization guidelines on prevention of mother-to-child transmission of HIV using routinely collected data in sub-Saharan Africa: A systematic literature review.
Medicine. 2017 Oct; 96(40):e8055.BACKGROUND: To synthesize and evaluate the impact of implementing post-2010 World Health Organization (WHO) prevention of mother-to-child transmission (PMTCT) guidelines on attainment of PMTCT targets. METHODS: Retrospective and prospective cohort study designs that utilized routinely collected data with a focus on provision and utilization of the cascade of PMTCT services were included. The outcomes included the proportion of pregnant women who were tested during their antenatal clinic (ANC) visits; mother-to-child transmission (MTCT) rate; adherence; retention rate; and loss to follow-up (LTFU). RESULTS: Of the 1210 references screened, 45 met the inclusion criteria. The studies originated from 14 countries in sub-Saharan Africa. The highest number of studies originated from Malawi (10) followed by Nigeria and South Africa with 7 studies each. More than half of the studies were on option A while the majority of option B+ studies were conducted in Malawi. These studies indicated a high uptake of human immunodeficiency virus (HIV) testing ranging from 75% in Nigeria to over 96% in Zimbabwe and South Africa. High proportions of CD4 count testing were reported in studies only from South Africa despite that in most of the countries CD4 testing was a prerequisite to access treatment. MTCT rate ranged from 1.1% to 15.1% and it was higher in studies where data were collected in the early days of the WHO 2010 PMTCT guidelines. During the postpartum period, adherence and retention rate decreased, and LTFU increased for both HIV-positive mothers and exposed infants. CONCLUSION: Irrespective of which option was followed, uptake of antenatal HIV testing was high but there was a large drop off along later points in the PMTCT cascade. More research is needed on how to improve later components of the PMTCT cascade, especially of option B+ which is now the norm throughout sub-Saharan Africa.
The uptake of integrated perinatal prevention of mother-to-child HIV transmission programs in low- and middle-income countries: a systematic review.
PloS One. 2013; 8(3):e56550.BACKGROUND: The objective of this review was to assess the uptake of WHO recommended integrated perinatal prevention of mother-to-child transmission (PMTCT) of HIV interventions in low- and middle-income countries. METHODS AND FINDINGS: We searched 21 databases for observational studies presenting uptake of integrated PMTCT programs in low- and middle-income countries. Forty-one studies on programs implemented between 1997 and 2006, met inclusion criteria. The proportion of women attending antenatal care who were counseled and who were tested was high; 96% (range 30-100%) and 81% (range 26-100%), respectively. However, the overall median proportion of HIV positive women provided with antiretroviral prophylaxis in antenatal care and attending labor ward was 55% (range 22-99%) and 60% (range 19-100%), respectively. The proportion of women with unknown HIV status, tested for HIV at labor ward was 70%. Overall, 79% (range 44-100%) of infants were tested for HIV and 11% (range 3-18%) of them were HIV positive. We designed two PMTCT cascades using studies with outcomes for all perinatal PMTCT interventions which showed that an estimated 22% of all HIV positive women attending antenatal care and 11% of all HIV positive women delivering at labor ward were not notified about their HIV status and did not participate in PMTCT program. Only 17% of HIV positive antenatal care attendees and their infants are known to have taken antiretroviral prophylaxis. CONCLUSION: The existing evidence provides information only about the initial PMTCT programs which were based on the old WHO PMTCT guidelines. The uptake of counseling and HIV testing among pregnant women attending antenatal care was high, but their retention in PMTCT programs was low. The majority of women in the included studies did not receive ARV prophylaxis in antenatal care; nor did they attend labor ward. More studies evaluating the uptake in current PMTCT programs are urgently needed.
Evidence behind the WHO guidelines: Hospital care for children: What are the risks of HIV transmission through breastfeeding?
Journal of Tropical Pediatrics. 2007 Oct; 53(5):298-302.The World Health Organization (WHO) has produced guidelines for the management of common illnesses in hospitals with limited resources. This series reviews the scientific evidence behind WHO's recommendations. This review addresses the question: What are the risks of HIV transmission through breastfeeding? The WHO Pocketbook of Hospital Care for Children estimates the additional risk of mother-to-child transmission (MTCT) of HIV through breastfeeding without interventions to be 5-20%. This risk varies depending on duration and method of breastfeeding, and also because of differences in population characteristics, such as maternal and CD4+ cell counts and RNA viral load. (excerpt)
Geneva, Switzerland, WHO, 2002.  p. (WHO/HIV/2002.08)HIV among children is a growing problem, particularly in the countries hardest hit by the AIDS epidemic. The overwhelming majority of infected children acquire the infection through mother-to-child transmission. Prevention of HIV infection in infants and young children is now a high priority and has been the rallying point for enhanced prevention efforts. While HIV infection among infants is a problem all over the world, it is most acute in sub-Saharan Africa, where almost 90% of all HIV infected children live. HIV/AIDS is wiping out years of progress in improving child survival. It is already responsible for substantially increasing the mortality rates of children under 5 years of age, which could double in some countries by the year 2010 due to the impact of AIDS. (excerpt)
Family planning and the prevention of mother-to-child transmission of HIV: a review of the literature.
Research Triangle Park, North Carolina, Family Health International [FHI], 2004 Apr.  p. (Working Paper Series No. WP04-01)This review summarizes the literature on integrating family planning services with other services to prevent HIV-positive births. In particular, it addresses efforts to prevent initial or later pregnancy among HIV-infected women, focusing on: 1) HIV-infected nonpregnant women likely accessing either family planning or VCT services and 2) HIV-infected pregnant women accessing ANC services, the usual site for PMTCT interventions. The review also addresses opportunities and efforts to prevent HIV-positive births by preventing infection among: 1) uninfected nonpregnant women who likely access family planning or VCT services and 2) uninfected pregnant women accessing ANC services. The organizational structure and scope of this review involves the intersection of two key variables: a woman’s HIV status and her pregnancy status. The discussion that follows will describe opportunities for PMTCT interventions involving family planning services in these contexts. (excerpt)