Integrating interventions for prevention of transmission of HIV from mothers to infants during pregnancy, delivery and breastfeeding with other healthcare services to increase the coverage

Ninety per cent of HIV infections in children under the age of 15 are a consequence of mother-to-child transmission of HIV during pregnancy, delivery and breastfeeding. In high-income countries introduction of prevention of mother-to-child HIV transmission (PMTCT) programmes reduced the rate of transmission of HIV from mothers to infants to 1%. These programmes consist of HIV testing, antiretroviral prophylaxis or therapy, safe obstetric practices and infant feeding counselling. PMTCT programmes have been implemented in low- and middle-income countries with variable success. One of the World Health Organization’s proposed strategies to increase the coverage and quality of PMTCT programmes is to provide them within other healthcare services used by pregnant women, mothers and children: e.g. maternal and child health care services. We assessed the effectiveness of integrated PMTCT programmes compared to non-integrated and partially integrated care. We defined effectiveness as increased PMTCT programme uptake. We searched a number of databases for relevant studies. From the initial list of 28,654 references, only one study met the inclusion criteria. This study was conducted in 12 antenatal clinics in Zambia. Six intervention clinics implemented HIV testing of women of unknown serostatus and assessment of antiretroviral prophylaxis adherence of HIV positive women. In six control clinics, HIV testing was not performed at labour ward and HIV positive women were informally asked if they took antiretroviral prophylaxis. In all 12 clinics, women were provided with antiretroviral prophylaxis at labour ward if found to be HIV positive and non-adherent to antiretroviral prophylaxis. All children born to HIV positive women were also given antiretroviral prophylaxis. A significant increase in proportion of women and children receiving antiretroviral prophylaxis was observed in the clinics that implemented the PMTCT interventions (of HIV testing and assessment of adherence to antiretroviral prophylaxis) compared to the control clinics. Women and children were more likely to receive antiretroviral prophylaxis at labour wards in the intervention clinics compared to control clinics. Although this one study showed that integrated care improved nevirapine coverage of women and infants more than non-integrated care, the paucity of evidence to confirm or refute this finding more widely suggests more research is urgently needed in other settings to allow a definitive conclusion about the effectiveness of integration of PMTCT interventions with other health services.