PMID- 31362959 OWN - NLM STAT- MEDLINE DCOM- 20200723 LR - 20240214 IS - 2044-6055 (Electronic) IS - 2044-6055 (Linking) VI - 9 IP - 7 DP - 2019 Jul 29 TI - What interventions are effective in improving uptake and retention of HIV-positive pregnant and breastfeeding women and their infants in prevention of mother to child transmission care programmes in low-income and middle-income countries? A systematic review and meta-analysis. PG - e024907 LID - 10.1136/bmjopen-2018-024907 [doi] LID - e024907 AB - OBJECTIVE: This review was conducted to identify interventions effective in improving uptake and retention of HIV-positive mothers and their infants in prevention of mother to child transmission (PMTCT) services in low-income and middle-income countries (LMICs) in order to inform programme planning. METHODS: We conducted a systematic review of studies comparing usual care with any intervention to improve uptake and retention of HIV-positive pregnant or breastfeeding women and their children from birth to 2 years of age in PMTCT services in LMICs. Twenty-two electronic databases were searched from inception to 15 January 2018, for randomised, quasi-randomised and non-randomised controlled trials, and interrupted time series studies; reference lists of included articles were searched for relevant articles. Risk of bias was assessed using the Cochrane Effective Practice and Organisation of Care group criteria. Random-effects meta-analysis was conducted for studies reporting similar interventions and outcomes. RESULTS: We identified 29 837 articles, of which 18 studies were included in our review. Because of heterogeneity in interventions and outcome measures, only one meta-analysis of two studies and one outcome was conducted; we found a statistically significant increase in antiretroviral therapy (ART) use during pregnancy for integration of HIV and antenatal care relative to standard non-integrated care (pooled AOR=2.69; 95% CI 1.25 to 5.78, p=0.0113). The remaining studies assessing other patient, provider or health system interventions were synthesised narratively, with small effects seen across intervention categories for both maternal and infant PMTCT outcomes based predominately on evidence with moderate to high risk of bias. CONCLUSIONS: Evidence on the effectiveness of interventions to improve uptake and retention of mothers and infants in PMTCT care is lacking. Our findings suggest that integration of HIV and antenatal care may improve ART use during pregnancy. Future studies to replicate promising approaches are needed. Improved reporting of key methodological criteria will facilitate interpretation of findings and improve the utility of evidence to PMTCT programme planners. PROSPERO REGISTRATION NUMBER: CRD42015020829. CI - (c) Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. FAU - Puchalski Ritchie, Lisa M AU - Puchalski Ritchie LM AD - Department of Medicine, Division of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada. AD - Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada. AD - Department of Emergency Medicine, University Health Network, Toronto, Ontario, Canada. FAU - van Lettow, Monique AU - van Lettow M AD - Dignitas International, Zomba, Malawi. AD - University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada. FAU - Pham, Ba AU - Pham B AD - Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada. FAU - Straus, Sharon E AU - Straus SE AD - Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada. AD - Department of Medicine, University of Toronto, Toronto, Ontario, Canada. FAU - Hosseinipour, Mina C AU - Hosseinipour MC AD - Division of Infectious Disease, University of North Carolina, Chapel Hill, North Carolina, USA. AD - University of North Carolina Project, Lilongwe, Malawi. FAU - Rosenberg, Nora E AU - Rosenberg NE AD - Division of Infectious Disease, University of North Carolina, Chapel Hill, North Carolina, USA. AD - University of North Carolina Project, Lilongwe, Malawi. AD - Department of Health Behavior, School of Public Health, University of North Carolina, Chapel Hill, North Carolina, USA. FAU - Phiri, Sam AU - Phiri S AD - Division of Infectious Disease, University of North Carolina, Chapel Hill, North Carolina, USA. AD - Lighthouse Trust, Lilongwe, Malawi. AD - Department of global health, University of washington, seattle, washington, united states. AD - Department of public health, college of medicine, school of public health and family medicine, university of malawi, malawi. FAU - Landes, Megan AU - Landes M AD - Department of Emergency Medicine, University Health Network, Toronto, Ontario, Canada. AD - Dignitas International, Zomba, Malawi. AD - Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada. FAU - Cataldo, Fabian AU - Cataldo F AD - Dignitas International, Zomba, Malawi. AD - University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada. CN - the PURE consortium LA - eng GR - K99 MH104154/MH/NIMH NIH HHS/United States GR - P30 AI050410/AI/NIAID NIH HHS/United States GR - R01 AI131060/AI/NIAID NIH HHS/United States PT - Journal Article PT - Meta-Analysis PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PT - Systematic Review DEP - 20190729 PL - England TA - BMJ Open JT - BMJ open JID - 101552874 RN - 0 (Anti-HIV Agents) SB - IM EIN - BMJ Open. 2019 Aug 18;9(8):e024907corr1. PMID: 31427347 MH - Anti-HIV Agents/*therapeutic use MH - *Breast Feeding MH - Developing Countries MH - Female MH - HIV Infections/*drug therapy MH - Humans MH - Infant MH - Infectious Disease Transmission, Vertical/*prevention & control MH - Poverty MH - Pregnancy MH - Pregnancy Complications, Infectious/*drug therapy MH - Randomized Controlled Trials as Topic PMC - PMC6677958 OTO - NOTNLM OT - HIV OT - interventions OT - prevention of mother to child transmission OT - retention OT - uptake COIS- Competing interests: None declared. EDAT- 2019/08/01 06:00 MHDA- 2020/07/24 06:00 PMCR- 2019/07/29 CRDT- 2019/08/01 06:00 PHST- 2019/08/01 06:00 [entrez] PHST- 2019/08/01 06:00 [pubmed] PHST- 2020/07/24 06:00 [medline] PHST- 2019/07/29 00:00 [pmc-release] AID - bmjopen-2018-024907 [pii] AID - 10.1136/bmjopen-2018-024907 [doi] PST - epublish SO - BMJ Open. 2019 Jul 29;9(7):e024907. doi: 10.1136/bmjopen-2018-024907.