05 December 2012
Only 58% of women seeking antenatal care agreed to opt-in testing in a meta-analysis of sub-Saharan countries. The testing rate was 94% with opt-out testing.
The first step in prevention of mother-to-child transmission (PMTCT) of HIV is testing pregnant women, followed by antiretroviral prophylaxis for HIV-positive women. Early infant diagnosis should be available for children born to positive mothers, and HIV-positive infants should begin combination antiretroviral therapy (cART) immediately.
In opt-out testing people are told they will be tested for HIV unless they actively decline testing. In opt-in testing people are asked if they want to be tested.
To determine the magnitude and reasons for failure to receive HIV testing, antiretroviral prophylaxis, early infant diagnosis, and infant cART, researchers scoured electronic databases for mother-to-child transmission studies in sub-Saharan Africa published between January 2002 and March 2012. They collated data from studies that addressed the target outcomes.
The investigators identified 44 studies from 15 countries including 75,172 HIV-positive pregnant women. HIV testing uptake at antenatal care services was 94% (95% confidence interval [CI] 92% to 95%) for opt-out testing and 58% (95% CI 40% to 75%) for opt-in testing.
Antiretroviral prophylaxis began in 70% of HIV-positive women (95% CI 64% to 76%), including 62% of women (95% CI 50% to 73%) eligible for ART.
Among HIV-exposed infants, 64% (95% CI 48% to 81%) had early infant diagnosis, and 55% (95% CI 36% to 74%) were tested for HIV between 12 and 18 months of age.
Two factors raised chances that PMTCT would be provided—availability of combination ART at the antenatal clinic and involvement of the male partner.
“In sub-Saharan Africa,” the researchers conclude, “uptake of PMTCT interventions and early infant diagnosis is unsatisfactory.” They add that “an integrated family-centered approach seems to improve retention.”
Source: Celina Wettstein, Catrina Mugglin, Matthias Egger, Nello Blaser, Luisa S. Vizcaya, Janne Estill, Nicole Bender, Mary-Ann Davies, Gilles Wandeler, Olivia Keiser, for the IeDEA Southern Africa Collaboration. Missed opportunities to prevent mother-to-child-transmission: systematic review and meta-analysis. AIDS. 2012; 26: 2361-2373.
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