title: Linking women who test HIV-positive in pregnancy-related services to long-term HIV care and treatment services: a systematic review.
abstract: OBJECTIVE
  To quantify attrition between women testing HIV-positive in pregnancy-related services and accessing long-term HIV care and treatment services in low- or middle-income countries and to explore the reasons underlying client drop-out by synthesising current literature on this topic.
  
  
  METHODS
  A systematic search in Medline, EMBASE, Global Health and the International Bibliography of the Social Sciences of literature published 2000-2010. Only studies meeting pre-defined quality criteria were included.
  
  
  RESULTS
  Of 2543 articles retrieved, 20 met the inclusion criteria. Sixteen (80%) drew on data from sub-Saharan Africa. The pathway between testing HIV-positive in pregnancy-related services and accessing long-term HIV-related services is complex, and attrition was usually high. There was a failure to initiate highly active antiretroviral therapy (HAART) among 38-88% of known-eligible women. Providing 'family-focused care', and integrating CD4 testing and HAART provision into prevention of mother-to-child HIV transmission services appear promising for increasing women's uptake of HIV-related services. Individual-level factors that need to be addressed include financial constraints and fear of stigma.
  
  
  CONCLUSIONS
  Too few women negotiate the many steps between testing HIV-positive in pregnancy-related services and accessing HIV-related services for themselves. Recent efforts to stem patient drop-out, such as the MTCT-Plus Initiative, hold promise. Addressing barriers and enabling factors both within health facilities and at the levels of the individual woman, her family and society will be essential to improve the uptake of services.
authors.affiliation: Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK. laura.ferguson@lshtm.ac.uk
authors.forename: Laura
authors.initials: L
authors.lastname: Ferguson
authors.forename: Alison D
authors.initials: AD
authors.lastname: Grant
authors.forename: Deborah
authors.initials: D
authors.lastname: Watson-Jones
authors.forename: Tanya
authors.initials: T
authors.lastname: Kahawita
authors.forename: John O
authors.initials: JO
authors.lastname: Ong'ech
authors.forename: David A
authors.initials: DA
authors.lastname: Ross
mesh_terms: D017954:Africa South of the Sahara; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000635:transmission*; D006679:HIV Seropositivity / Q000188:drug therapy / Q000635:transmission; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008134:Long-Term Care / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010352:Patient Dropouts / Q000706:statistics & numerical data; D016742:Preconception Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*
chemical_list: D019380:Anti-HIV Agents