Integrating antiretroviral therapy into antenatal care and maternal and child health settings: a systematic review and meta-analysis
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Authors
Suthar, Amitabh B; Hoos, David; Beqiri, Alba; Lorenz-Dehne, Karl; McClure, Craig;Duncombe, Chris
Issue Date
2013
Type
Journal / periodical articles
Language
Keywords
Systematic Reviews;Antenatal care;Maternal and child health
Alternative Title
Abstract
Description
Objective To determine whether integrating antiretroviral therapy (ART) into antenatal care (ANC) and maternal and child health (MCH)
clinics could improve programmatic and patient outcomes.
Methods The authors systematically searched PubMed, Embase, African Index Medicus and LiLACS for randomized controlled trials,
prospective cohort studies, or retrospective cohort studies comparing outcomes in ANC or MCH clinics that had and had not integrated
ART. The outcomes of interest were ART coverage, ART enrolment, ART retention, mortality and transmission of human immunodeficiency
virus (HIV).
Findings Four studies met the inclusion criteria. All were conducted in ANC clinics. Increased enrolment of pregnant women in ART was
observed in ANC clinics that had integrated ART (relative risk, RR: 2.09; 95% confidence interval, CI; 1.78–2.46; I
2
: 15%). Increased ART coverage
was also noted in such clinics (RR: 1.37; 95% CI: 1.05–1.79; I
2
: 83%). Sensitivity analyses revealed a trend for the national prevalence of HIV
infection to explain the heterogeneity in the size of the effect of ART integration on ART coverage (P=0.13). Retention in ART was similar
in ANC clinics with and without ART integration.
Conclusion Although few data were available, ART integration in ANC clinics appears to lead to higher rates of ART enrolment and ART
coverage. Rates of retention in ART remain similar to those observed in referral-based models
Citation
Publisher
WHO