| Ezeanolue, 2015 | Patient | · Outreach services. | Monthly baby showers. | Usual care. |
ART during pregnancy: 24/41 (65%). Retention in care at 6–8 weeks post partum: 33/41 (81%).
|
ART use during pregnancy: 12/32 (50%). Retention in care at 6–8 weeks post partum: 28/32 (88%).
|
1.56 (0.93 to 2.62) 0.92 (0.75 to 1.12)
|
AOR 2.8 (1.02 to 4.79) AOR 0.39 (0.04 to 3.99)
|
| Reynolds, 2010 | Patient | · Self-management.
· Educational outreach. | Take-home infant nevirapine dose. | Usual care. |
Infant ART prophylaxis at birth: 80/85 (94%).
|
Infant ART prophylaxis at birth: 66/75 (88%).
|
1.07 (0.97 to 1.18)
|
–
|
| Weiss, 2014 | Patient | · Group (couple) vs individual care. | Couples HIV risk reduction and PMTCT education sessions. | Time-matched general education sessions. |
ART detected in mothers’ blood samples at birth: 9/12 (75%). ART detected in infants’ blood at birth: 12/13 (92%). Infant HIV-positive at 6 weeks: 1/30 (3.3%).
|
ART detected in mothers’ blood samples at birth: 6/12 (50%). ART detected in infants’ blood at birth: 9/12 (75%). Infant HIV-positive: 3/39 (7.7%).
|
1.50 (0.78 to 2.88) 1.23 (0.86 to 1.77) 0.43 (0.05 to 3.96)
|
– – –
|
| Yotebieng, 2016 | Patient | · Conditional cash transfer. | Cash payments for clinic attendance and acceptance of recommended services. | Usual care. |
Retention in care at 6 weeks post partum: 174/216 (80.6%). Uptake of PMTCT services through to 6 weeks post partum: 146/216 (67.6%). HIV-positive infants at 6 weeks: 5/169 (3.0%).
|
Retention in care at 6 weeks post partum: 157/217 (72.4%). Uptake of PMTCT services through to 6 weeks post partum: 116/217 (53.5%). HIV-positive infants at 6 weeks: 6/156 (3.9%).
|
1.11 (1.00 to 1.23) 1.26 (1.08 to 1.48) 0.77 (0.24 to 2.47)
|
ARD 1.13 (1.02 to 1.26) ARD 1.31 (1.12 to 1.54) –
|
| Richter, 2014 | Patient/Provider | · Role expansion or task shifting.
· Educational meetings. | Peer mentor-led educational meetings. | Usual care. |
ART from the 28th week of pregnancy (AZT or HAART): 340/377 (90.2%). ART during labour (AZT or HAART): 282/377 (74.8%). NVP or HAART during labour: 361/377 (95.8%). Infant NVP at birth: 364/377 (96.6%). AZT dispensed for infant and medicated as prescribed: 348/377 (92.3%).
|
ART from the 28th week of pregnancy (AZT or HAART): 455/466 (95.5%). ART during labour (AZT or HAART): 334/466 (71.7%). NVP or HAART during labour: 456/466 (97.9%). Infant NVP at birth: 451/466 (96.8%). AZT dispensed for infant and medicated as prescribed: 374/466 (80%).
|
0.92 (0.89 to 0.96) 1.04 (0.96 to 1.13) 0.98 (0.95 to 1.00) 1.00 (0.97 to 1.02) 1.15 (1.09 to 1.21)
|
AOR 0.44 (0.26 to 0.74) AOR 1.16 (0.44 to 3.02) AOR 0.53 (0.20 to 1.41) AOR 1.00 (0.36 to 2.79) AOR 2.98 (0.78 to 11.30)
|
| Kieffer, 2011 | Provider | · Educational meetings. | 1-day PMTCT training for nurses and midwives. | No additional training. |
NVP in cord blood: 373/465 (80%).
|
NVP in cord blood: 325/472 (69%).
|
1.17 (1.08 to 1.26)
|
–
|
| Dryden-Peterson, 2015 | Provider/System | · The use of information and communication technology.
· Educational meetings. | Staff training in point-of-care CD4 testing and automated SMS results reporting to staff, support for patient tracing. | Usual care. |
ART initiated by 30 weeks’ gestation: 56/154 (36.4%).
|
ART initiated by 30 weeks’ gestation: 37/153 (24.2%).
|
1.50 (1.06 to 2.13)
|
AOR 1.06 (0.53 to 2.13)
|
| Mwapasa, 2017 | Provider/System | · Integration.
· The use of information and communication technology. | MIP: integration of antenatal and HIV care, routine patient tracing.
MIP+SMS: integrated care and use of SMS enhanced tracing. | Usual non-integrated care and patient tracing. |
Maternal retention in care at 12 months using MOH definition: MIP: 334/461 (72.4%), MIP+SMS: 332/493 (67%) . Maternal retention in care at 12 months postpartum trial data: MIP: 89/461 (19.3%), MIP+SMS: 115/493 (23.3%). Infant retention in care at 12 months postpartum trial data: MIP: 32/386 (8.3%), MIP+SMS: 82/399 (20.1%). Infant retention in care at 12 months using MOH definition: MIP: 291/386 (75.4%), MIP+SMS: 323/399 (80.9%).
|
Maternal retention in care at 12 months using MOH definition: SOC 274/396 (69.1%). Maternal retention in care at 12 months postpartum trial data: SOC 90/396 (22.7%). Infant retention in care at 12 months postpartum trial data: SOC 32/300 (10.7 %). Infant retention in care at 12 months using MOH definition: SOC 234/300 (78.0%).
|
MIP vs SPC 1.05 (0.96 to 1.14), MIP+SMS vs SOC 0.97 (0.89 to 1.06) MIP vs SOC 0.85 (0.65 to 1.10), MIP+SMS vs SOC 1.03 (0.81 to 1.31) MIP vs SOC 0.78 (0.49 to 1.24), MIP+SMS vs SOC 1.93 (1.32 to 2.82) MIP vs SOC 0.97 (0.89 to 1.05), MIP+SMS vs SOC 1.04 (0.96 to 1.12)
|
MIP vs SOC ARR 1.05 (0.93 to 1.18), MIP+SMS vs SOC ARR 0.99 (0.93 to 1.05) MIP vs SOC ARR 0.85 (0.56 to 1.30), MIP+SMS vs SOC ARR 1.08 (0.87 to 1.35) MIP vs SPC ARR 0.89 (0.31 to 2.58), MIP+SMS vs SOC ARR 1.40 (0.85 to 2.31) MIP vs SOC ARR 0.98 (0.89 to 1.09), MIP+SMS vs SOC ARR 1.01 (0.96 to 1.07)
|
| Oyeledun, 2017 | Provider/System | · Continuous quality improvement. | QI teams established, coaching and collaborative meetings. | Routine MOH support. |
ART initiated within 2 weeks of enrolment: 261/264 (98.9%). Retention in care at 6 months: 117/264 (44.3%). Infants starting prophylaxis within 72 hours: 138/209 (66%).
Infant HIV testing at 6–10 weeks: 102/209 (48.8%).
|
ART initiated within 2 weeks of enrolment: 233/247 (94.3%). Retention in care at 6 months: 102/247 (41.3%). Infants starting prophylaxis within 72 hours: 145/194 (74.7%). Infant HIV testing at 6–10 weeks: 49/194 (25.3%).
|
1.05 (1.01 to 1.08) 1.07 (0.88 to 1.31) 0.88 (0.78 to 1.00) 1.93 (1.46 to 2.55)
|
– ARR 1.08 (0.78 to 1.49) ARR 0.95 (0.84 to 1.07) ARR 1.76 (1.27 to 2.42)
|
| Phiri, 2017 | Provider/System | · Role expansion or task shifting
Outreach services.
· The use of information and communication technology. | FBPS from mentor mothers.
CBPS from mentor mothers. | SOC. |
ART uptake: FBPS: 366/428 (52%), CBPS:355/394 (90%) Retained in care at 1 year: FBPS: 277/366(78%), CBPS258/355(74%) Retained in care at 2 years (trial data): FBPS: 223/428 (52%), CBPS: 211/394 (54%). Retained in care at 2 years (MOH definition): FBPS 298/428 (70%), CBPS 292/394 (74%). Infant HIV test at 6 weeks: FBPS 200/289 (69%): CBPS: 195/286 (68%) . Infant HIV-positive at 6 weeks: FBPS: 1/199 (1%), CBPS: 2/195 (2%).
|
ART uptake SOC: 361/447 (81%) Reatined in care at 1 year: SOC: 261/361 (74%) Retained in care at 2 years (trial data): SOC 169/447 (38%). Retained in care at 2 years (MOH definition): SOC 255/447 (57%). Infant HIV tested at 6 weeks: SOC 169/273 (62%). Infant HIV-positive at 6 weeks: SOC 2/169 (1%).
|
SOC vs FBPS 1.06 (1.00 to 1.12), SOC vs CBPS 1.12 (1.06 to 1.18) SOC vs FBPS 1.05 (0.96 to 1.14), SOC vs CBPS 1.01 (0.92 to 1.10) SOC vs FBPS 1.38 (1.19 to 1.60), SOC vs CBPS 1.42 (1.22 to 1.65) SOC vs FBPS 1.22 (1.10 to 1.35), SOC vs CBPS 1.30 (1.18 to 1.43) SOC vs FBPS 1.12 (0.99 to 1.26), SOC vs CBPS 1.23 (1.11 to 1.38) SOC vs FBPS 0.42 (0.04 to 4.64), SOC vs CBPS 0.87 (0.12 to 6.09)
|
ARD 0.06 (−0.03 to 0.15), ARD 0.09 (0.01 to 0.18) ARD 0.06 (−0.06 to 0.18), ARD 0.08 (0.04 to 0.20) ARD 0.13 (−0.01 to 0.26), 0.16 (0.03 to 0.30) – – –
|
| Tomlinson, 2014 | Provider/System | · Role expansion or task shifting.
· Outreach services. | 10 structured home visits from community health workers addressing PMTCT and newborn care. | 3 home visits from community health workers providing support in accessing social welfare grants. |
Infant HIV testing by 6 weeks: 420/571 (73.6%). Infant HIV-positive at 12 weeks: 28/568 (4.9%).
|
Infant HIV testing by 6 weeks: 465/698 (66.6%). Infant HIV-positive at 12 weeks: 32/697 (4.6%).
|
1.10 (1.03 to 1.19) 1.07 (0.65 to 1.76)
|
ARR 1.10 (0.97 to 1.25) ARR 1.07 (0.69 to 1.66)
|
| Aliyu, 2016 | System |
| Integrated package of PMTCT services, family/male partner participation, community champions. | Usual care. |
Maternal ART initiation for PMTCT: 166/172 (97%). Maternal-infant retention in care at 6 weeks post partum:125/150 pairs (83%). Maternal–infant retention 12 weeks post partum: 112/150 pairs (75%).
|
Maternal ART initiation for PMTCT: 77/197 (39%). Maternal-infant retention at 6 weeks post partum: 15/170 pairs (9%). Maternal–infant retention 12 weeks post partum: 11/168 pairs (7%).
|
2.47 (2.07 to 2.95) 9.44 (5.60 to 15.40) 11.40 (6.40 to 20.34)
|
ARR 3.3 (1.4 to 7.8) ARR 9.1 (5.2 to 15.9) ARR 10.3 (5.4 to 19.7)
|
| Geelhoed, 2013 | System | · Integration.
· Educational meetings | Integrated maternal child health and HIV care. | Usual non-integrated care. |
ART in labour: postintervention: 112/121 (93%). Infants receiving prophylaxis within 48 hours: postintervention: 117/126 (93%). Infants HIV-positive: postintervention: 9/123 (7%).
|
ART in labour: intervention phase: 93/96 (97%). Infants receiving prophylaxis within 48 hours: intervention phase: 95/95 (100%). Infants HIV-positive: intervention phase: 7/60 (12%).
|
0.96 (0.90 to 1.02) 0.93 (0.88 to 0.97) 0.63 (0.25 to 1.60)
|
– – –
|
| Killam, 2010 | System | · Integration. | Integration of antenatal and HIV care. | Usual non-integrated care. |
ART initiation during pregnancy: 278/846 (32.9%).
|
ART initiation during pregnancy: 103/716 (14.4%).
|
2.28 (1.86 to 2.80)
|
AOR 2.01 (1.37 to 2.95)
|
| Odeny, 2014 | System | · The use of information and communication technology. | SMS text messages during pregnancy and after delivery. | Usual care. |
Maternal postpartum clinic attendance: 38/194 (19.6%). Infant HIV testing by 8 weeks: I172/187 (92.0%).
|
Maternal postpartum clinic attendance: 22/187 (11.8%). Infant HIV testing by 8 weeks: 154/181 (85.1%).
|
1.66 (1.03 to 2.70) 1.08 (1.00 to 1.16)
|
– –
|
| Rotheram-Borus, 2014 | System | · Role expansion or task shifting.
· Outreach services. | Antenatal and postnatal home visits from community health workers. | Usual care. |
ART prior to labour: 169/179 (94.4%). AZT or HAART during labour: I164/179 (91.6%). NVP or HAART at onset of labour: 166/179 (92.7%). Infant prophylaxis within 24 hours of birth: 171/179 (95.5%). Infant ART after birth: 172/179 (96.1%). Infant HIV testing at 6 weeks: 155/160 (96.9%).
|
ART prior to labor: 149/159 (93.7%). AZT or HAART during labour: 147/159 (92.5%) NVP or HAART at onset of labour: 142/159 (89.3%). Infant porophylaxis within 24 hours of birth: 141/159 (88.7%). Infant ART after birth: 142/159 (89.3%). Infant HIV testing at 6 weeks: 132/140 (94.3%).
|
1.01 (0.95 to 1.06) 0.99 (0.93 to 1.06) 1.04 (0.97 to 1.11) 1.08 (1.01 to 1.15) 1.08 (1.01 to 1.14) 1.03 (0.98 to 1.08)
|
AOR 1.08 (0.42 to 2.80) AOR 0.87 (0.39 to 1.95) AOR 1.52 (0.70 to 3.31) AOR 2.94 (1.41 to 6.12) AOR 2.95 (1.12 to 7.73) AOR 1.80 (0.62 to 5.28)
|
| Rustagi, 2016 | System | · Continuous quality improvement. | Facility-level systems analysis and improvement intervention. | No
intervention. |
ART in pregnancy: 575/839 (69%). Infant HIV tested by 6–8 weeks: 283/604.4 (47%).
|
ART in pregnancy: 664/1037 (64%). Infant HIV tested by 6–8 weeks: 270/710.6 (38%).
|
1.07 (1.00 to 1.14) 1.23 (1.09 to 1.40)
|
– –
|
| Turan, 2015 | System | · Integration. | Integrated HIV and antenatal care. | Usual, non-integrated care. |
ART during pregnancy: 138/173 (80%). ART during labour: 28/173 (16%). ART after birth: 22/173 (13%). Infant ART after birth: 50/173 (29%). ART throughout all 3 PMTCT periods: 37/176 (21.0%). Infant HIV testing before 3 months: 143/569 (25%). Infant HIV testing at 9 months: 361/569 (63%). Infants HIV tested by 6 weeks: 143/568 (25%). Infants HIV-positive at 6 weeks: I6/143 (4.2%). Infants HIV tested by end of study (up to 12 months): 382/568 (67.3%). Infants HIV-positive at 9 months: 28/382 (7.3%).
|
ART during pregnancy: 75/152 (49%). ART during labour: 84/152 (55%). ART after birth: 57/152 (38%). Infant ART after birth: 106/152 (70%)rocj ART throughout all 3 PMTCT periods: 23/153 (15%). Infant HIV testing before 3 months: 106/603 (18%). Infant HIV testing at 9 months: 326/603 (54%). Infants HIV tested by 6 weeks: 106/594 (18%). Infants HIV-positive at 6 weeks: 7/106 (6.6%). Infants HIV tested by end of study (up to 12 months): 338/594 (57.0%). Infants HIV-positive at 9 months: 27/338 (8.0%).
|
1.61 (1.35 to 1.93) 0.29 (0.20 to 0.42) 0.34 (0.22 to 0.53) 0.41 (0.32 to 0.54) 1.40 (0.87 to 2.24) 1.43 (1.14 to 1.79) 1.17 (1.07 to 1.29) 1.41 (1.13 to 1.76) 0.64 (0.22 to 1.84) 1.18 (1.08 to 1.29) 0.92 (0.55 to 1.53)
|
AOR 4.05 (2.0 to 8.0) AOR 0.16 (0.04 to 0.68) AOR 0.24 (0.08 to 0.70) AOR 0.18 (0.09 to 0.35) AOR 1.72 (0.85 to 3.48) AOR 1.57 (0.61 to 4.07) AOR 1.47 (0.76 to 2.86) AOR 1.57 (0.61 to 4.07) AOR 0.62 (0.20 to 1.98) AOR 1.45 (0.71 to 2.82) AOR 0.89 (0.56 to 1.43)
|