Abstract
BackgroundIn spite of effective strategies to eliminate mother-to-child-transmission of HIV, the implementation of such strategies remains a major challenge in developing countries. In India, programs for the prevention of mother-to-child transmission (PMTCT) have been scaled up widely since 2005. However, these programs reach only a small percentage of pregnant women, and their overall effectiveness is low. Evidence-based program planning and implementation could significantly improve their effectiveness. This study sought to systematically retrieve, thematically categorize and review published research on PMTCT of HIV in India, focusing on research related to the provision and/or utilization of the cascade of services provided in a PMTCT program, in order to direct further research to enhance program implementation and effectiveness.MethodsA systematic search using MEDLINE, US National Library of Medicine Gateway system (PubMed) and ISI Web of Knowledge resulted in 1,944 abstracts, of which 167 met our inclusion criteria.ResultsA huge share of the empirical literature on PMTCT in India (N = 134) deals with epidemiological studies (N = 60). The 46 papers related to utilization/provision of the cascade of PMTCT services were mostly from the four high HIV prevalence states in southern India and from the public sector. Studies on experiences of implementing a PMTCT program (N = 20) show high rates of drop out of women in the cascade particularly prior to receiving ARV. Studies on individual components of the cascade (N = 26) show that HIV counseling and testing is acceptable and feasible. Literature on other components of the cascade - such as pregnant women’s access to ANC care, HIV infected women’s immunological assessment using CD4 testing, repeat HIV testing among pregnant women, early infant diagnosis and factors related to linking HIV infected women and children to postnatal care – is lacking.ConclusionsWhile the scale of the Indian PMTCT program is large, comprehensive understanding of the context-driven factors affecting its efficiency is lacking. Systematic and more focused public health research output is needed on the issues related to reduction of drop outs of women in the cascade, role of PMTCT programs in improving maternal and child health indicators and role of private sector in delivering PMTCT services.
Highlights
In spite of effective strategies to eliminate mother-to-child-transmission of HIV, the implementation of such strategies remains a major challenge in developing countries
Systematic and more focused public health research output is needed on the issues related to reduction of drop outs of women in the cascade, role of prevention of motherto-child transmission (PMTCT) programs in improving maternal and child health indicators and role of private sector in delivering PMTCT services
Eligibility criteria For our review of literature on PMTCT of HIV in India, studies were considered relevant if 1) the study was related to HIV and the study population comprised of pregnant women or HIV-exposed children, or 2) the stated objective of the research was directly linked to provision and/or utilization of services provided in a PMTCT project, such as counseling and HIV testing, ARV, obstetric care, infant feeding and infant testing, or 3) the stated objective of the research was directly linked to the planning or provision of PMTCT services, and 4) the study was conducted in India
Summary
In spite of effective strategies to eliminate mother-to-child-transmission of HIV, the implementation of such strategies remains a major challenge in developing countries. This study sought to systematically retrieve, thematically categorize and review published research on PMTCT of HIV in India, focusing on research related to the provision and/or utilization of the cascade of services provided in a PMTCT program, in order to direct further research to enhance program implementation and effectiveness. It has been more than 16 years since a breakthrough clinical trial (ACTG 076) demonstrated that the administration of prophylactic antiretroviral medicine - Zidovudine - to HIV-infected mothers and infants can reduce mother-to-child transmission (MTCT) of HIV by almost 68 percent [1]. In June 2011, a new global plan to eliminate HIV infections among children was launched at the UN [4]
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