title: Missed opportunities to prevent mother-to-child-transmission:  systematic review and meta-analysis.
abstract: OBJECTIVE
  To determine magnitude and reasons of loss to program and poor antiretroviral prophylaxis coverage in prevention of mother-to-child transmission (PMTCT) programs in sub-Saharan Africa.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  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 tested for HIV, initiating antiretroviral prophylaxis, having a CD4 cell count measured, and initiating antiretroviral combination therapy (cART) if eligible. In children outcomes were early infant diagnosis for HIV, and cART initiation. We combined data using random-effects meta-analysis and identified predictors of uptake of interventions.
  
  
  RESULTS
  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 (CIs) 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.
  
  
  CONCLUSIONS
  In sub-Saharan Africa, uptake of PMTCT interventions and early infant diagnosis is unsatisfactory. An integrated family-centered approach seems to improve retention.
authors.affiliation: Division of International and Environmental Health, Institute of Social and Preventive Medicine, University of Bern, Switzerland.
authors.forename: Celina
authors.initials: C
authors.lastname: Wettstein
authors.forename: Catrina
authors.initials: C
authors.lastname: Mugglin
authors.forename: Matthias
authors.initials: M
authors.lastname: Egger
authors.forename: Nello
authors.initials: N
authors.lastname: Blaser
authors.forename: Luisa S
authors.initials: LS
authors.lastname: Vizcaya
authors.forename: Janne
authors.initials: J
authors.lastname: Estill
authors.forename: Nicole
authors.initials: N
authors.lastname: Bender
authors.forename: Mary-Ann
authors.initials: MA
authors.lastname: Davies
authors.forename: Gilles
authors.initials: G
authors.lastname: Wandeler
authors.forename: Olivia
authors.initials: O
authors.lastname: Keiser
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control* / Q000706:statistics & numerical data; D008297:Male; D009035:Mothers; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D056990:Post-Exposure Prophylaxis / Q000379:methods*; D011247:Pregnancy; D011295:Prenatal Care; D011296:Prenatal Diagnosis; D015397:Program Evaluation
chemical_list: D019380:Anti-HIV Agents