Missed opportunities to prevent mother-to-child-transmission: systematic review and meta-analysis.
Missed opportunities to prevent mother-to-child-transmission: systematic review and meta-analysis.
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错过的机会防止母亲到孩子交流：系统的审查和荟萃分析。
DOI：
10.1097/qad.0b013e328359ab0c
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发表时间：
2012-11-28
期刊：
影响因子：
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通讯作者：
IeDEA Southern Africa Collaboration
中科院分区：
文献类型：
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作者：
Wettstein C;Mugglin C;Egger M;Blaser N;Vizcaya LS;Estill J;Bender N;Davies MA;Wandeler G;Keiser O;IeDEA Southern Africa Collaboration
确定撒哈拉以南非洲预防母婴传播(母婴传播)方案中方案损失和抗逆转录病毒预防覆盖率低的程度和原因。系统综述和荟萃分析。我们在PubMed和Embase数据库中搜索2002年1月至2012年3月期间发表的撒哈拉以南非洲防止母婴传播研究。结果是孕妇的百分比(I)艾滋病毒检测，(Ii)开始抗逆转录病毒预防，(Iii)测量了CD4细胞计数，以及(Iv)开始抗逆转录病毒联合治疗(CART)(如果符合条件)。在儿童中，结果是(V)婴儿早期诊断出艾滋病毒，和(Vi)启动CART。我们使用随机效应荟萃分析将数据结合起来，并确定了接受干预的预测因素。对来自15个国家的44项研究进行了分析，其中包括75,172名感染艾滋病毒的孕妇。选择退出的产前护理服务的艾滋病毒检测接受率为94%(95%可信区间[CI]92-95%)，选择加入检测的接受率为58%(95%可信区间40-75%)。任何抗逆转录病毒预防措施的覆盖率为70%(95%CI-76%)，符合CART条件的孕妇接受治疗的覆盖率为62%(95%CI 50-73%)。64%(95%可信区间48-81%)的HIV暴露婴儿进行了早期诊断，55%(95%可信区间36-74%)的婴儿在12至18个月之间进行了检测。如果产前诊所提供CART并且男性伴侣参与，则预防母婴传播干预措施的接受度会提高。在撒哈拉以南非洲，预防母婴传播干预措施和婴儿早期诊断的情况并不令人满意。以家庭为中心的综合方法似乎可以提高保留率。
To determine magnitude and reasons of loss to programme and poor antiretroviral prophylaxis coverage in prevention of mother-to-child transmission (PMTCT) programmes in sub-Saharan Africa. Systematic review and meta-analysis. We searched PubMed and Embase databases for PMTCT studies in sub-Saharan Africa published between January 2002 and March 2012. Outcomes were the percentage of pregnant women (i) tested for HIV, (ii) initiating antiretroviral prophylaxis, (iii) having a CD4 cell count measured, and (iv) initiating antiretroviral combination therapy (cART) if eligible. In children outcomes were (v) early infant diagnosis for HIV, and (vi) cART initiation. We combined data using random-effects meta-analysis and identified predictors of uptake of interventions. Forty-four studies from 15 countries including 75,172 HIV-infected pregnant women were analyzed. HIV-testing uptake at antenatal care services was 94% (95% confidence intervals [CI] 92-95%) for opt-out and 58% (95% CI 40-75%) for opt-in testing. Coverage with any antiretroviral prophylaxis was 70% (95% CI 64-76%) and 62% (95% CI 50-73%) of pregnant women eligible for cART received treatment. Sixty-four percent (95% CI 48-81%) of HIV exposed infants had early diagnosis performed and 55% (95% CI 36-74%) were tested between 12 and 18 months. Uptake of PMTCT interventions was improved if cART was provided at the antenatal clinic and if the male partner was involved. In sub-Saharan Africa, uptake of PMTCT interventions and early infant diagnosis is unsatisfactory. An integrated family-centered approach seems to improve retention.