Puchalski Ritchie Lisa M, van Lettow Monique, Hosseinipour Mina C, Rosenberg Nora E, Phiri Sam, Landes Megan, Cataldo Fabian, Straus Sharon E
Department of Medicine, University of Toronto, Toronto, ON, Canada.
Li Ka Shing Knowledge Institute, St. Michaels Hospital, University of Toronto, Toronto, ON, Canada.
Syst Rev. 2015 Nov 3;4:144. doi: 10.1186/s13643-015-0136-x.
Despite recent improvements, uptake and retention of mothers and infants in prevention of mother-to-child transmission (PMTCT) services remain well below target levels in many low- and middle-income countries (LMICs). Identification of effective interventions to support uptake and retention is the first step towards improvement. We aim to complete a systematic review and meta-analysis to evaluate the effectiveness of interventions at the patient, provider or health system level in improving uptake and retention of HIV-infected mothers and their infants in PMTCT services in LMICs.
METHODS/DESIGN: We will include studies comparing usual care or no intervention to any type of intervention to improve uptake and retention of HIV-infected pregnant or breastfeeding women and their children from birth to 2 years of age attending PMTCT services in LMICs. We will include randomized controlled trials (RCTs), cluster RCTs, non-randomized controlled trials, and interrupted time series. The primary outcomes of interest are percentage of HIV-infected women receiving/initiated on anti-retroviral prophylaxis or treatment, percentage of infants receiving/initiated on anti-retroviral prophylaxis, and percentage of women and infants completing the anti-retroviral regimen/retained in PMTCT care. The following databases will be searched from inception: Ovid MEDLINE and EMBASE, The WHO Global Health Library, CAB abstracts, EBM Reviews, CINAHL, HealthSTAR and Web of Science databases, Scopus, PsychINFO, POPLINE, Sociological Abstracts, ERIC, AIDS Education Global Information System, NLM Gateway, LILACS, Google Scholar, British Library Catalogue, DARE, ProQuest Dissertation & Theses, the New York Academy of Grey Literature, Open Grey, The Cochrane Library, WHO International Clinical Trials Registry, Controlled Clinical Trials, and clinicaltrials.gov. Reference lists of included articles will be hand searched and study authors and content experts contacted to inquire about eligible unpublished or in progress studies. Screening, data abstraction, and risk of bias appraisal using the Cochrane Effective Practice and Organization of Care criteria will be conducted independently by two team members. Results will be synthesized narratively and a meta-analysis conducted using the DerSimonian Laird random effects method if appropriate based on assessment of clinical and statistical heterogeneity.
Our findings will be useful to PMTCT implementers, policy makers, and implementation researchers working in LMICs.
PROSPERO CRD42015020829.
尽管最近有所改善，但在许多低收入和中等收入国家（LMICs），母婴在预防母婴传播（PMTCT）服务中的参与率和留存率仍远低于目标水平。确定有效的干预措施以支持参与率和留存率是实现改善的第一步。我们旨在完成一项系统评价和荟萃分析，以评估在患者、提供者或卫生系统层面采取的干预措施，对提高LMICs中感染HIV的母亲及其婴儿在PMTCT服务中的参与率和留存率的有效性。
方法/设计：我们将纳入比较常规护理或无干预措施与任何类型干预措施的研究，这些干预措施旨在提高LMICs中接受PMTCT服务的感染HIV的孕妇或哺乳期妇女及其出生至2岁儿童的参与率和留存率。我们将纳入随机对照试验（RCTs）、整群RCTs、非随机对照试验和中断时间序列研究。感兴趣的主要结局包括接受/开始抗逆转录病毒预防或治疗的感染HIV妇女的百分比、接受/开始抗逆转录病毒预防的婴儿的百分比，以及完成抗逆转录病毒治疗方案/留在PMTCT护理中的妇女和婴儿的百分比。将从数据库建立之初开始检索以下数据库：Ovid MEDLINE和EMBASE、世界卫生组织全球卫生图书馆、CAB文摘、循证医学综述、护理学与健康照护领域数据库（CINAHL）、健康之星数据库（HealthSTAR）、科学引文索引数据库（Web of Science）、Scopus、心理学文摘数据库（PsychINFO）、人口信息数据库（POPLINE）、社会学文摘数据库、教育资源信息中心数据库（ERIC）、艾滋病教育全球信息系统、美国国立医学图书馆网关、拉丁美洲及加勒比地区卫生科学数据库（LILACS）、谷歌学术、大英图书馆目录、效果摘要数据库（DARE）、ProQuest学位论文数据库、纽约科学院灰色文献库、Open Grey、考克兰图书馆、世界卫生组织国际临床试验注册平台、对照临床试验数据库和美国国立医学图书馆临床试验数据库（clinicaltrials.gov）。将人工检索纳入文章的参考文献列表，并与研究作者和内容专家联系，询问是否有符合条件的未发表或正在进行的研究。两名团队成员将独立进行筛选、数据提取，并使用考克兰有效实践与护理组织标准进行偏倚风险评估。结果将进行叙述性综合分析，如果根据临床和统计异质性评估认为合适，将使用DerSimonian Laird随机效应方法进行荟萃分析。
我们的研究结果将对在LMICs工作的PMTCT实施者、政策制定者和实施研究人员有用。
国际系统评价前瞻性注册库（PROSPERO）注册号CRD42015020829。
