title: Integrating antiretroviral therapy into antenatal care and maternal and child health settings: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To determine whether integrating antiretroviral therapy (ART) into antenatal care (ANC) and maternal and child health (MCH) clinics could improve programmatic and patient outcomes.
  
  
  METHODS
  The authors systematically searched PubMed, Embase, African Index Medicus and LiLACS for randomized controlled trials, prospective cohort studies, or retrospective cohort studies comparing outcomes in ANC or MCH clinics that had and had not integrated ART. The outcomes of interest were ART coverage, ART enrolment, ART retention, mortality and transmission of human immunodeficiency virus (HIV).
  
  
  RESULTS
  Four studies met the inclusion criteria. All were conducted in ANC clinics. Increased enrolment of pregnant women in ART was observed in ANC clinics that had integrated ART (relative risk, RR: 2.09; 95% confidence interval, CI; 1.78-2.46; I(2): 15%). Increased ART coverage was also noted in such clinics (RR: 1.37; 95% CI: 1.05-1.79; I(2): 83%). Sensitivity analyses revealed a trend for the national prevalence of HIV infection to explain the heterogeneity in the size of the effect of ART integration on ART coverage (P = 0.13). Retention in ART was similar in ANC clinics with and without ART integration.
  
  
  CONCLUSIONS
  Although few data were available, ART integration in ANC clinics appears to lead to higher rates of ART enrolment and ART coverage. Rates of retention in ART remain similar to those observed in referral-based models.
authors: Department of HIV/AIDS, World Health Organization, 20 avenue Appia, 1211 Geneva 27, Switzerland. amitabh.suthar@gmail.com
authors: Amitabh B
authors: AB
authors: Suthar
authors: David
authors: D
authors: Hoos
authors: Alba
authors: A
authors: Beqiri
authors: Karl
authors: K
authors: Lorenz-Dehne
authors: Craig
authors: C
authors: McClure
authors: Chris
authors: C
authors: Duncombe
mesh_terms: D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008430:Maternal-Child Health Centers / Q000458:organization & administration; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D011295:Prenatal Care
references: J Int AIDS Soc. 2010 Jan 20;13:3
references: 20180975
references: J Acquir Immune Defic Syndr. 2010 May 1;54(1):35-41
references: 20216425
references: J Acquir Immune Defic Syndr. 2010 May 1;54(1):102-6
references: 19864957
references: AIDS. 2010 Jan 2;24(1):85-91
references: 19809271
references: J Int AIDS Soc. 2010 Sep 23;13:37
references: 20863399
references: J Acquir Immune Defic Syndr. 2007 May 1;45(1):125-7
references: 17460478
references: PLoS One. 2012;7(4):e35268
references: 22558134
references: Lancet. 2011 Jul 16;378(9787):209-11
references: 21353697
references: J Clin Epidemiol. 2000 Nov;53(11):1119-29
references: 11106885
references: Clin Infect Dis. 2009 Dec 15;49(12):1936-45
references: 19916796
references: Stat Med. 2002 Jun 15;21(11):1539-58
references: 12111919
references: West Indian Med J. 2008 Jun;57(3):204-15
references: 19583118
references: Int J STD AIDS. 2011 Mar;22(3):165-70
references: 21464455
references: J Acquir Immune Defic Syndr. 2006 Dec 15;43(5):577-81
references: 17031321
references: J Acquir Immune Defic Syndr. 2011 Apr 15;56(5):e122-8
references: 21224736
references: PLoS Med. 2009 Jul 21;6(7):e1000100
references: 19621070
references: AIDS Res Ther. 2011 Mar 03;8:10
references: 21371301
references: J Int AIDS Soc. 2010 Oct 06;13:38
references: 20925943
references: Trop Med Int Health. 2010 Jul;15(7):825-32
references: 20497405
references: PLoS Med. 2011 Jul;8(7):e1001056
references: 21811403
references: Trop Med Int Health. 2010 Jun;15 Suppl 1:1-15
references: 20586956
references: J Acquir Immune Defic Syndr. 2011 Oct 1;58(2):224-8
references: 21709566
references: J Acquir Immune Defic Syndr. 2012 Sep 1;61(1):83-9
references: 22592589
references: J Acquir Immune Defic Syndr. 2008 Nov 1;49(3):276-81
references: 18845949
references: BMC Pregnancy Childbirth. 2009 Aug 11;9:34
references: 19671156
references: AIDS. 2009 Jan 28;23(3):293-6
references: 19114853
references: Lancet. 2011 Jul 16;378(9787):282-4
references: 21763940
references: N Engl J Med. 2006 Nov 30;355(22):2283-96
references: 17135583
references: PLoS One. 2010 Nov 09;5(11):e13891
references: 21085479
references: BMC Public Health. 2010 Dec 06;10:753
references: 21134259
references: Cochrane Database Syst Rev. 2011 Jun 15;(6):CD008741
references: 21678382
references: MMWR Morb Mortal Wkly Rep. 2006 Jun 2;55(21):592-7
references: 16741495
references: AIDS. 2007 May 11;21(8):965-71
references: 17457090
references: AIDS. 2011 Jul 31;25(12):1535-41
references: 21610487
references: Glob Public Health. 2012;7(2):149-63
references: 22043837
references: J Acquir Immune Defic Syndr. 2010 Nov;55(3):404-10
references: 20595905
references: Trans R Soc Trop Med Hyg. 2008 Dec;102(12):1195-200
references: 18485431
references: J Acquir Immune Defic Syndr. 2012 Jul 1;60(3):e90-7
references: 22421747
references: AIDS. 2008 May 11;22(8):973-81
references: 18453857
references: J Acquir Immune Defic Syndr. 2010 Nov;55(3):287-9
references: 20714271
references: J Acquir Immune Defic Syndr. 2011 Jan 1;56(1):69-75
references: 21099692
references: BMJ. 2003 Sep 6;327(7414):557-60
references: 12958120