Malawi Liverpool Research Programme, Blantyre, Malawi.
Kamuzu University of Health Sciences, Blantyre, Malawi.
J Int AIDS Soc. 2024 Jul;27 Suppl 1(Suppl 1):e26284. doi: 10.1002/jia2.26284.
Antiretroviral therapy (ART) initiation in infants living with HIV before 12 weeks of age can reduce the risk of mortality by 75%. Point-of-care (POC) diagnostic testing is critical for prompt ART initiation; however, despite its availability, rates of ART initiation are still relatively low before 12 weeks of age. This systematic review describes the barriers to ART initiation in infants before 12 weeks of age, despite the availability of POC.
This systematic review used a narrative synthesis methodology. We searched PubMed and Scopus using search strategies that combined terms of multiple variants of the keywords "early infant initiation on antiretroviral therapy," "barriers" and "sub-Saharan Africa" (initial search 18th January 2023; final search 1st August 2023). We included qualitative, observational and mixed methods studies that reported the influences of early infant initiation on ART. We excluded studies that reported influences on other components of the Prevention of Mother to Child Transmission cascade. Using a deductive approach guided by the updated Consolidated Framework of Implementation Research, we developed descriptive codes and themes around barriers to early infant initiation on ART. We then developed recommendations for interventions for the identified barriers using the action, actor, target and time framework from the codes.
Of the 266 abstracts reviewed, 52 full-text papers were examined, of which 12 papers were included. South Africa had most papers from a single country (n = 3) and the most reported study design was retrospective (n = 6). Delays in ART initiation beyond 12 weeks in infants 0-12 months were primarily associated with health facility and maternal factors. The most prominent barriers identified were inadequate resources for POC testing (including human resources, laboratory facilities and patient follow-up). Maternal-related factors, such as limited male involvement and maternal perceptions of treatment and care, were also influential.
We identified structural barriers to ART initiation at the health system, social and cultural levels. Improvements in the timely allocation of resources for POC testing operations, coupled with interventions addressing social and behavioural barriers among both mothers and healthcare providers, hold a promise for enhancing timely ART initiation in infants.
This paper identifies barriers and proposes strategies for timely ART initiation in infants.
在 12 周龄之前为感染 HIV 的婴儿启动抗逆转录病毒治疗（ART）可将死亡率降低 75%。即时检测（POC）诊断检测对于及时启动 ART 至关重要；然而，尽管有这种检测手段，在 12 周龄之前启动 ART 的比例仍然相对较低。本系统评价描述了尽管存在 POC，但在 12 周龄之前婴儿启动 ART 存在的障碍。
本系统评价采用叙述性综合方法。我们使用结合了多个关键词的搜索策略在 PubMed 和 Scopus 中进行了搜索，这些关键词的变体包括“早期婴儿开始抗逆转录病毒治疗”、“障碍”和“撒哈拉以南非洲”（初始搜索日期为 2023 年 1 月 18 日；最终搜索日期为 2023 年 8 月 1 日）。我们纳入了报告早期婴儿开始 ART 影响的定性、观察性和混合方法研究。我们排除了报告对母婴传播预防链其他组成部分影响的研究。我们使用更新的综合实施研究框架指导的演绎方法，围绕早期婴儿开始 ART 的障碍制定了描述性代码和主题。然后，我们使用代码中的“行动、参与者、目标和时间”框架为确定的障碍制定了干预措施建议。
在审查的 266 篇摘要中，有 52 篇全文论文被审查，其中 12 篇论文被纳入。南非是单个国家报告论文最多的国家（n=3），报告最多的研究设计是回顾性研究（n=6）。0-12 个月大的婴儿在 12 周后延迟开始 ART 主要与卫生机构和产妇因素有关。确定的最主要障碍是即时检测资源不足（包括人力资源、实验室设施和患者随访）。产妇相关因素，如男性参与度有限以及产妇对治疗和护理的看法，也有影响。
我们确定了卫生系统、社会和文化层面上启动 ART 的结构性障碍。即时检测运营中资源的及时分配得到改善，同时针对母婴保健提供者的社会和行为障碍采取干预措施，有望提高婴儿及时开始 ART 的比例。
本文确定了障碍，并提出了及时在婴儿中启动 ART 的策略。
