title: The uptake of integrated perinatal prevention of mother-to-child HIV transmission programs in low- and middle-income countries: a systematic review.
abstract: BACKGROUND
  The objective of this review was to assess the uptake of WHO recommended integrated perinatal prevention of mother-to-child transmission (PMTCT) of HIV interventions in low- and middle-income countries.
  
  
  RESULTS
  We searched 21 databases for observational studies presenting uptake of integrated PMTCT programs in low- and middle-income countries. Forty-one studies on programs implemented between 1997 and 2006, met inclusion criteria. The proportion of women attending antenatal care who were counseled and who were tested was high; 96% (range 30-100%) and 81% (range 26-100%), respectively. However, the overall median proportion of HIV positive women provided with antiretroviral prophylaxis in antenatal care and attending labor ward was 55% (range 22-99%) and 60% (range 19-100%), respectively. The proportion of women with unknown HIV status, tested for HIV at labor ward was 70%. Overall, 79% (range 44-100%) of infants were tested for HIV and 11% (range 3-18%) of them were HIV positive. We designed two PMTCT cascades using studies with outcomes for all perinatal PMTCT interventions which showed that an estimated 22% of all HIV positive women attending antenatal care and 11% of all HIV positive women delivering at labor ward were not notified about their HIV status and did not participate in PMTCT program. Only 17% of HIV positive antenatal care attendees and their infants are known to have taken antiretroviral prophylaxis.
  
  
  CONCLUSIONS
  The existing evidence provides information only about the initial PMTCT programs which were based on the old WHO PMTCT guidelines. The uptake of counseling and HIV testing among pregnant women attending antenatal care was high, but their retention in PMTCT programs was low. The majority of women in the included studies did not receive ARV prophylaxis in antenatal care; nor did they attend labor ward. More studies evaluating the uptake in current PMTCT programs are urgently needed.
authors.affiliation: Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom.
authors.forename: Lorainne
authors.initials: L
authors.lastname: Tudor Car
authors.forename: Serena
authors.initials: S
authors.lastname: Brusamento
authors.forename: Hoda
authors.initials: H
authors.lastname: Elmoniry
authors.forename: Michelle H M M T
authors.initials: MH
authors.lastname: van Velthoven
authors.forename: Utz J
authors.initials: UJ
authors.lastname: Pape
authors.forename: Vivian
authors.initials: V
authors.lastname: Welch
authors.forename: Peter
authors.initials: P
authors.lastname: Tugwell
authors.forename: Azeem
authors.initials: A
authors.lastname: Majeed
authors.forename: Igor
authors.initials: I
authors.lastname: Rudan
authors.forename: Josip
authors.initials: J
authors.lastname: Car
authors.forename: Rifat
authors.initials: R
authors.lastname: Atun
mesh_terms: D002648:Child; D003219:Confidentiality; D019033:Delivery of Health Care, Integrated / Q000191:economics; D003906:Developing Countries / Q000191:economics*; D005260:Female; D015658:HIV Infections / Q000191:economics* / Q000517:prevention & control / Q000635:transmission*; D006284:Health Plan Implementation; D006295:Health Resources; D006801:Humans; D007182:Income; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000191:economics / Q000517:prevention & control*; D007743:Labor, Obstetric; D009035:Mothers; D018743:Perinatal Care / Q000191:economics*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012959:Socioeconomic Factors