Abstract
IntroductionIdentification and retention of HIV‐exposed infants in early infant diagnosis (EID) services helps to ensure optimal health outcomes. This systematic review and meta‐analysis examines the magnitude of attrition from EID services in low‐ and middle‐income countries (LMICs).MethodsWe performed a comprehensive database search through April 2016. We included original studies reporting retention/attrition data for HIV‐exposed infants in LMICs. Outcomes included loss to follow‐up (LTFU), death and overall attrition (LTFU + death) at time points along the continuum of EID services. At least two authors determined study eligibility, performed data extraction and made quality assessments. We used random‐effects meta‐analytic methods to aggregate effect sizes and perform meta‐regression analyses. This study adhered to PRISMA reporting guidelines.ResultsWe identified 3040 unique studies, of which 92 met eligibility criteria and were included in the quantitative synthesis. The included studies represent data from 110,805 HIV‐exposed infants, the majority of whom were from Africa (77%). LTFU definitions varied widely, and there was significant variability in outcomes across studies. The bulk of attrition occurred in the first six months of follow‐up, with additional losses over time. Overall, 39% of HIV‐exposed infants were no longer in care at 18 months. When restricted to non‐intervention studies, 43% were not retained at 18 months.ConclusionsThese findings underscore the high attrition of HIV‐exposed infants from EID services in LMICs and the urgent need for implementation research and resources to improve retention among this vulnerable population.
Highlights
Identification and retention of HIV-exposed infants in early infant diagnosis (EID) services helps to ensure optimal health outcomes
According to the Joint United Nations Programme on HIV/ AIDS (UNAIDS), in 2016 there was an estimated 2.1 million children living with HIV, 160,000 children newly infected with HIV and 120,000 children who died of HIV/AIDS [1]
By quantifying the magnitude of attrition from these programmes, these results might serve as a benchmark for programmatic successes and weaknesses that may be useful for HIV programme directors in lowand middle-income countries (LMICs) and global policymakers
Summary
Identification and retention of HIV-exposed infants in early infant diagnosis (EID) services helps to ensure optimal health outcomes. We included original studies reporting retention/attrition data for HIV-exposed infants in LMICs. Outcomes included loss to follow-up (LTFU), death and overall attrition (LTFU + death) at time points along the continuum of EID services. The included studies represent data from 110,805 HIV-exposed infants, the majority of whom were from Africa (77%). Conclusions: These findings underscore the high attrition of HIV-exposed infants from EID services in LMICs and the urgent need for implementation research and resources to improve retention among this vulnerable population. Success of paediatric HIV programmes relies on the timely identification of HIV-exposed and HIV-positive infants and children, enrolling them in care, and retaining them in care in order to maintain their health with life-saving antiretroviral medications (ARVs). Infants confirmed to be HIV-positive should be started on life-long antiretroviral therapy (ART) [4]
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