Office of HIV/AIDS, United States Agency for International Development, Washington, DC, USA.
Department of Medicine, University of California, San Francisco, CA, USA.
Trop Med Int Health. 2018 Feb;23(2):136-148. doi: 10.1111/tmi.13014. Epub 2017 Dec 8.
Despite the success of Prevention of Mother-to-Child Transmission of HIV (PMTCT) programmes, low uptake of services and poor retention pose a formidable challenge to achieving the elimination of vertical HIV transmission in low- and middle-income countries. This systematic review summarises interventions that demonstrate statistically significant improvements in service uptake and retention of HIV-positive pregnant and breastfeeding women and their infants along the PMTCT cascade.
Databases were systematically searched for peer-reviewed studies. Outcomes of interest included uptake of services, such as antiretroviral therapy (ART) such as initiation, early infant diagnostic testing, and retention of HIV-positive pregnant and breastfeeding women and their infants. Interventions that led to statistically significant outcomes were included and mapped to the PMTCT cascade. An eight-item assessment tool assessed study rigour.
CRD42017063816.
Of 686 citations reviewed, 11 articles met inclusion criteria. Ten studies detailed maternal outcomes and seven studies detailed infant outcomes in PMTCT programmes. Interventions to increase access to antenatal care (ANC) and ART services (n = 4) and those using lay cadres (n = 3) were most common. Other interventions included quality improvement (n = 2), mHealth (n = 1), and counselling (n = 1). One study described interventions in an Option B+ programme. Limitations included lack of HIV testing and counselling and viral load monitoring outcomes, small sample size, geographical location, and non-randomized assignment and selection of participants.
Interventions including ANC/ART integration, family-centred approaches, and the use of lay healthcare providers are demonstrably effective in increasing service uptake and retention of HIV-positive mothers and their infants in PMTCT programmes. Future studies should include control groups and assess whether interventions developed in the context of earlier 'Options' are effective in improving outcomes in Option B+ programmes.
尽管预防母婴传播艾滋病毒（PMTCT）项目取得了成功，但服务利用率低和保留率低仍然是在中低收入国家消除垂直艾滋病毒传播的巨大挑战。本系统综述总结了那些在 PMTCT 级联中能够显著提高艾滋病毒阳性孕妇和哺乳期妇女及其婴儿服务利用率和保留率的干预措施。
系统地在同行评审的研究数据库中进行检索。感兴趣的结果包括服务利用率，如抗逆转录病毒疗法（ART）的启动、早期婴儿诊断检测以及艾滋病毒阳性孕妇和哺乳期妇女及其婴儿的保留率。纳入了导致具有统计学意义的结果的干预措施，并将其映射到 PMTCT 级联。使用八项评估工具评估研究的严谨性。
PROSPERO 标识符：CRD42017063816。
在审查的 686 条引文中有 11 篇文章符合纳入标准。十项研究详细说明了 PMTCT 项目中母亲的结局，七项研究详细说明了婴儿的结局。最常见的干预措施是增加获得产前护理（ANC）和 ART 服务的机会（n=4）和使用非专业卫生工作者（n=3）。其他干预措施包括质量改进（n=2）、移动医疗（n=1）和咨询（n=1）。一项研究描述了在 Option B+ 方案中的干预措施。局限性包括缺乏 HIV 检测和咨询以及病毒载量监测结果、样本量小、地理位置以及非随机分配和参与者选择。
ANC/ART 整合、以家庭为中心的方法以及利用非专业医疗保健提供者的干预措施，在 PMTCT 项目中明显有效地提高了艾滋病毒阳性母亲及其婴儿的服务利用率和保留率。未来的研究应包括对照组，并评估在早期“选项”背景下开发的干预措施是否在改善 Option B+ 方案的结果方面有效。
