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Home >> Publications >> Missed opportunities to prevent mother-to-child-transmission: systematic review and meta-analysis.

Publication

Author(s):

Wettstein C, Mugglin C, Egger M, Blaser N, Vizcaya LS, Estill J, Bender N, Davies MA, Wandeler G, Keiser O; IeDEA Southern Africa Collaboration.

Pub Title:

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

Pub Date:

Nov 28 2012

Pub Region(s):

Southern Africa

Journal Issue:

18

Page Number:
2361-73

Journal:

Title: 
AIDS
Link: 
http://journals.lww.com/aidsonline/pages/articleviewer.aspx?year=2012&issue=11280&article=00011&type=abstract

PubMed: 22948267
Pub PDF: PDF icon 22948267.pdf

Abstract
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.

PMID: 22948267 [PubMed - indexed for MEDLINE]

PMCID: PMC3741537

 
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Citation:

Wettstein C, Mugglin C, Egger M, Blaser N, Vizcaya LS, Estill J, Bender N, Davies MA, Wandeler G, Keiser O; IeDEA Southern Africa Collaboration. Missed opportunities to prevent mother-to-child-transmission: systematic review and meta-analysis. AIDS. 2012 Nov 28;26(18):2361-73. doi: 10.1097/QAD.0b013e328359ab0c. Review. PubMed PMID: 22948267; PubMed Central PMCID: PMC3741537.