Maternal ART Retention and HIV-Exposed Infant Testing Under PMTCT Options B and B Strategies: A Systematic Review and Meta-Analysis

Abstract

Objective: To estimate maternal ART retention and infant testing coverage in PMTCT programs offering option B or B strategies. Methods: For this systematic review and meta-analysis, we searched electronic databases and the grey literature for studies published from January 2010 to May 2017. Estimates were calculated in the presence and absence of interventions aiming to improve retention or infant testing. Random-effects models were fitted to obtain pooled estimates of outcomes and statistical heterogeneity was addressed with I2 statistics. Results: Thirty-three studies representing 59,178 HIV women and 5,655 HIV-exposed infants were included. The pooled 6-month maternal ART retention was 79% (95% CI:77-81; I2=92% n=51,610 women) in settings without intervention to improve follow-up and 77% (95% CI:74-80; I2=62%; n=2,184) with interventions. Pooled 12-month ART retention was 74% (95% CI:70-77; I2=93%; n=30,506) and 69% (95% CI:64-75; I2=87%; n=2,686) with and without interventions, respectively. The proportion of infants benefiting from rapid HIV testing at 12-18 months was 79% (95% CI:70-86; n=1,080) and 60% (95% CI: 17-96; n=3,104) with and without interventions, respectively. Heterogeneity was extremely high (I2 statistics range 89-100%). Conclusion: Pooled retention estimates were low. Study outcomes did not differ according to the presence or absence of targeted interventions. Heterogeneity was substantial, mainly due to the variety of outcome definitions used across studies. Multipronged actions should be taken to achieve better outcomes, otherwise the implementation of PMTCT option B/B will remain sub-optimal despite its originally deemed effectiveness and pediatric HIV elimination will remain out of reach. Funding Statement: The authors state: There was no funding source for this study. Declaration of Interests: The authors state: We declare no competing interests. Ethics Approval Statement: The systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines.