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Interventions to Significantly Improve Service Uptake and Retention of HIV-Positive Pregnant Women and HIV-Exposed Infants Along the PMTCT Continuum of Care: Systematic Review.

Interventions to Significantly Improve Service Uptake and Retention of HIV-Positive Pregnant Women and HIV-Exposed Infants Along the PMTCT Continuum of Care: Systematic Review.
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Vrazo AC, Firth J, Amzel A, Sedillo R, Ryan J, Phelps BR,


Vrazo AC, Firth J, Amzel A, Sedillo R, Ryan J, Phelps BR, (click to view)

Vrazo AC, Firth J, Amzel A, Sedillo R, Ryan J, Phelps BR,

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Tropical medicine & international health : TM & IH 2017 11 22() doi 10.1111/tmi.13014

Abstract
OBJECTIVES
Despite the success of Prevention of Mother-to-Child Transmission of HIV (PMTCT) programs, 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 summarizes 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.

METHODS
Databases were systematically searched for peer-reviewed studies. Outcomes of interest included uptake of services, including ART initiation, EID 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 rigor.

PROSPERO ID
CRD42017063816.

RESULTS
Of 686 citations reviewed, 11 articles met inclusion criteria. Ten studies detailed maternal outcomes and seven studies detailed infant outcomes in PMTCT programs. Interventions to increase access to ANC and ART services (n=4) and using lay cadres (n=3) were most common. Other interventions included quality improvement (n=2), mHealth (n=1) and counseling (n=1). One study described interventions in an Option B+ program. Limitations include lack of HTC and viral load monitoring outcomes, small sample size, geographical location, and non-randomized assignment and selection of participants.

CONCLUSIONS
Interventions including ANC/ART integration, family-centered 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 programs. 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+ programs. This article is protected by copyright. All rights reserved.

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