Systematic review of public health research on prevention of mother-to-child transmission of HIV in India with focus on provision and utilization of cascade of PMTCT services

Abstract

BackgroundIn spite of effective strategies to eliminate mother-to-child-transmission of HIV, the implementation of such strategies remains a major challenge in developing countries. In India, programs for the prevention of mother-to-child transmission (PMTCT) have been scaled up widely since 2005. However, these programs reach only a small percentage of pregnant women, and their overall effectiveness is low. Evidence-based program planning and implementation could significantly improve their effectiveness. This study sought to systematically retrieve, thematically categorize and review published research on PMTCT of HIV in India, focusing on research related to the provision and/or utilization of the cascade of services provided in a PMTCT program, in order to direct further research to enhance program implementation and effectiveness.MethodsA systematic search using MEDLINE, US National Library of Medicine Gateway system (PubMed) and ISI Web of Knowledge resulted in 1,944 abstracts, of which 167 met our inclusion criteria.ResultsA huge share of the empirical literature on PMTCT in India (N = 134) deals with epidemiological studies (N = 60). The 46 papers related to utilization/provision of the cascade of PMTCT services were mostly from the four high HIV prevalence states in southern India and from the public sector. Studies on experiences of implementing a PMTCT program (N = 20) show high rates of drop out of women in the cascade particularly prior to receiving ARV. Studies on individual components of the cascade (N = 26) show that HIV counseling and testing is acceptable and feasible. Literature on other components of the cascade - such as pregnant women’s access to ANC care, HIV infected women’s immunological assessment using CD4 testing, repeat HIV testing among pregnant women, early infant diagnosis and factors related to linking HIV infected women and children to postnatal care – is lacking.ConclusionsWhile the scale of the Indian PMTCT program is large, comprehensive understanding of the context-driven factors affecting its efficiency is lacking. Systematic and more focused public health research output is needed on the issues related to reduction of drop outs of women in the cascade, role of PMTCT programs in improving maternal and child health indicators and role of private sector in delivering PMTCT services.

Effectiveness of a prevention of mother-to-child HIV transmission program in Guangdong province from 2007 to 2010

“…Turan et al found that PMTCT of HIV and antenatal care integration in pregnancy might improve the implementation and effectiveness of PMTCT in rural area [24]. All of above mentioned illustrated that it was important to strengthen the implementation of PMTCT program to increase the availability of interventions in Guangdong province for achieving the goal of elimination of new infections among children by 2015, which was similar to the problems of developing country [25]. …”

The Role of Maternal, Health System, and Psychosocial Factors in Prevention of Mother-to-Child Transmission Failure in the Era of Programmatic Scale Up in Western Kenya: A Case Control Study

“…4 Despite the strides in virtual elimination of new HIV infections in infants, preventable transmissions continue to occur. 5,6 In order to reach the global target of reducing by at least 90% the number of new infections among infants by 2015 (using a 2009 baseline), governments and other program implementers will need to critically appraise barriers and facilitators to uptake of PMTCT services, even as they accelerate scale up.…”

Counselling services in prevention of mother-to-child transmission (PMTCT) in Delhi, India: An assessment through a modified version of UNICEF-PPTCT tool

“…Evaluation of these services might suggest ways for their improvement [3]. The literature on PPTCT services is quite low from India, and the available evidence indicates that the acceptance of the programme is slow and delayed [11]. Thus, the present study is taken up with an objective to assessing the counselling services provided to the women attending the PPTCT services.…”