Effect of Point-of-Care Diagnostics on Maternal Outcomes in Human Immunodeficiency Virus–Infected Women

Abstract

Introduction The World Health Organization advocates for increased accessibility of HIV-related point-of-care (POC) diagnostics in settings that lack laboratory infrastructure. The aim of this study is to assess the impact of POC diagnostics on maternal health outcomes in HIV-infected women. Methods A systematic literature review used multiple data sources as follows: Cochrane Infectious Disease Group Specialized Register; Cochrane Central Register of Control Trials, published in The Cochrane Library; PubMed; EBSCOhost and LILACS from January 2000 to October 2015. References of included studies were hand searched. Randomized controlled trials (RCTs) and observational studies examining health outcomes of HIV-infected women were eligible for inclusion in this review. The Cochrane Risk of Bias tool was used for bias assessment of the included studies. PRISMA guidelines were used for reporting. Results Of the 695 studies identified, six retrievable studies (five cross-sectional studies and one case control study) met the inclusion criteria and were included in this study. These studies examined a total of 167 HIV-infected women in different study settings. No studies reported evidence of CD4 count, viral load and TB, and the syphilis POC test impact on HIV-infected women was not found by this study. Included studies reported the impact of various HIV rapid tests across the following five maternal outcomes: timely receipt of results with pooled effect size (ES) = 1.00 (95% confidence interval [CI]: (0.98; 1.02); enabling partner testing, ES = 0.95 (0.85; 1.04); prevention of mother-to-child transmission of HIV, ES = 0.86 (0.79; 0.93); linkage to antiretroviral treatment (ART), ES = 0.76 (0.69; 0.84); and linkage to HIV care, ES = 0.50 (0.18; 0.82). No studies reported evidence of the impact of POC testing on maternal mortality or maternal and child morbidity of HIV-infected women. Conclusions The review provides an international overview of the impact of HIV POC diagnostics on maternal outcomes in HIV-infected women, showing the evidence that the HIV POC test is significantly associated with decreased mother-to-child transmission of HIV and increased linkage to ART and HIV care for HIV-infected women. It also revealed a gap in the literature aimed at assessing the impact of POC diagnostics on maternal morbidity and mortality in HIV-infected women.

Evaluating quality management systems for HIV rapid testing services in primary healthcare clinics in rural KwaZulu-Natal, South Africa

“…Since the introduction of this strategy, the role of HIV rapid tests in diagnosing and facilitating linkage to treatment in various settings cannot be undermined. HIV rapid tests has been associated with decreased mother-to-child transmission of HIV, increased linkage to antiretroviral treatment and care for HIV-infected women [ 18 ].…”

Impact of Implementing Antenatal Syphilis Point-of-Care Testing on Maternal Mortality in KwaZulu-Natal, South Africa: An Interrupted Time Series Analysis

“…To the best of our knowledge, this is the first study that has evaluated the impact of syphilis POC testing on MMR in a high HIV prevalence resource-limited setting. Our recent systematic review has shown a lack of evidence on the impact of syphilis POC diagnostics on maternal outcomes of HIV-infected patients [4]. A quasi-experimental interrupted time series design was employed to determine the impact of syphilis POC testing on maternal mortality ratio (MMR) in KZN.…”

“…The report also shows that over a fifth of South African women in their reproductive ages (15-49 years) are HIV positive [3]. A recent report on maternal health indicates that non-pregnancy-related infections due to HIV/AIDS contribute to 43.7% of the total maternal mortality in South Africa [4]. The 2014 Amnesty International report on maternal health in KwaZulu-Natal (KZN) and Mpumalanga 2008-2010 highlights the barriers, such as poor access to health care, resulting in women and girls delaying or avoiding antenatal care in and maternal deaths [5].…”

“…Despite this, little is known about the impact of syphilis POC testing on maternal mortality, particularly in high HIV settings. The results of our systematic review revealed that there is limited evidence on the impact of syphilis POC diagnostics on maternal outcomes of HIV-infected women [4]. The main aim of this study is to determine the impact of antenatal syphilis POC diagnostics on maternal mortality in KwaZulu-Natal, South Africa, using a time series study design.…”

Improving the Accessibility and Efficiency of Point-of-Care Diagnostics Services in Low- and Middle-Income Countries: Lean and Agile Supply Chain Management

“…For example, POC testing in emergency departments may result in timely discharge of patients, expediting triage of patients, and early treatment initiation, as well as alleviate the negative impacts of overcrowding [ 12 ]. Studies have demonstrated that POC testing has the potential to reduce the time to obtain test results and accelerate the diagnosis and initiation of treatment, particularly where healthcare infrastructure is weak and access to quality and timely medical care is a challenge [ 2 , 6 , 13 , 14 ]. Other studies have also proven that rapid POC testing delivers prompt results as well as early referrals when compared to standard laboratory testing [ 4 , 6 , 15 ].…”