Mutabazi Jean Claude, Zarowsky Christina, Trottier Helen
1Département de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, Pavillon 7101, Avenue du Parc, Montreal, QC H3N 1X7 Canada.
2Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Tour Saint-Antoine, 3rd Floor, Room: S03.516, 900, Rue St-Denis, Montreal, QC H2X 0A9 Canada.
Public Health Rev. 2017 Dec 5;38:28. doi: 10.1186/s40985-017-0072-5. eCollection 2017.
The global scale-up of Prevention of mother-to-child transmission (PMTCT) services is credited for a 52% worldwide decline in new HIV infections among children between 2001 and 2012. However, the epidemic continues to challenge maternal and paediatric HIV control efforts in Sub Saharan Africa (SSA), with repercussions on other health services beyond those directly addressing HIV and AIDS. This systematised narrative review describes the effects of PMTCT programs on other health care services and the implications for improving health systems in SSA as reported in the existing articles and scientific literature. The following objectives framed our review:To describe the effects of PMTCT on health care services and systems in SSA and assess whether the PMTCT has strengthened or weakened health systems in SSATo describe the integration of PMTCT and its extent within broader programs and health systems.
Articles published in English and French over the period 1st January 2007 (the year of publication of WHO/UNICEF guidelines on global scale-up of the PMTCT) to 31 November 2016 on PMTCT programs in SSA were sought through searches of electronic databases (Medline and Google Scholar). Articles describing the impact (positive and negative effects) of PMTCT on other health care services and those describing its integration in health systems in SSA were eligible for inclusion. We assessed 6223 potential papers, reviewed 225, and included 57.
The majority of selected articles offered arguments for increased health services utilisation, notably of ante-natal care, and some evidence of beneficial synergies between PMTCT programs and other health services especially maternal health care, STI prevention and early childhood immunisation. Positive and negative impact of PMTCT on other health care services and health systems are suggested in thirty-two studies while twenty-five papers recommend more integration and synergies. However, the empirical evidence of impact of PMTCT integration on broader health systems is scarce. Underlying health system challenges such as weak physical and human resource infrastructure and poor working conditions, as well as social and economic barriers to accessing health services, affect both PMTCT and the health services with which PMTCT interacts.
PMTCT services increase to some extent the availability, accessibility and utilisation of antenatal care and services beyond HIV care. Vertical PMTCT programs work, when well-funded and well-managed, despite poorly functioning health systems. The beneficial synergies between PMTCT and other services are widely suggested, but there is a lack of large-scale evidence of this.
预防母婴传播（PMTCT）服务在全球范围内的推广，使2001年至2012年间全球儿童中新发艾滋病毒感染病例减少了52%。然而，这一流行病仍在挑战撒哈拉以南非洲（SSA）地区控制孕产妇和儿童艾滋病毒的努力，并对除直接应对艾滋病毒和艾滋病之外的其他卫生服务产生影响。本系统叙述性综述描述了现有文章和科学文献中所报道的PMTCT项目对其他卫生保健服务的影响以及对改善SSA地区卫生系统的意义。以下目标构成了我们的综述：描述PMTCT对SSA地区卫生保健服务和系统的影响，并评估PMTCT是加强还是削弱了SSA地区的卫生系统；描述PMTCT在更广泛项目和卫生系统中的整合情况及其程度。
通过检索电子数据库（Medline和谷歌学术），查找2007年1月1日（世卫组织/联合国儿童基金会关于全球推广PMTCT的指南发布年份）至2016年11月31日期间以英文和法文发表的关于SSA地区PMTCT项目的文章。描述PMTCT对其他卫生保健服务的影响（正面和负面影响）以及描述其在SSA地区卫生系统中整合情况的文章均符合纳入标准。我们评估了6223篇潜在论文，审阅了225篇，最终纳入57篇。
大多数入选文章提出了增加卫生服务利用的观点，特别是产前保健的利用，并提供了一些证据表明PMTCT项目与其他卫生服务之间存在有益的协同作用，尤其是孕产妇保健、性传播感染预防和幼儿免疫。32项研究表明了PMTCT对其他卫生保健服务和卫生系统的正面和负面影响，25篇论文建议加强整合与协同作用。然而，关于PMTCT整合对更广泛卫生系统影响的实证证据很少。诸如物质和人力资源基础设施薄弱、工作条件差等潜在的卫生系统挑战，以及获得卫生服务的社会和经济障碍，既影响了PMTCT，也影响了与PMTCT相互作用的卫生服务。
PMTCT服务在一定程度上提高了产前保健以及艾滋病毒护理以外服务的可及性、可获得性和利用率。尽管卫生系统运作不佳，但资金充足且管理良好的垂直PMTCT项目仍能发挥作用。广泛认为PMTCT与其他服务之间存在有益的协同作用，但缺乏这方面的大规模证据。
