Prevention of mother-to-child HIV transmission cascade in China: a systematic review and meta-analysis.
BACKGROUND
The Chinese government has invested US$140 million annually on prevention of mother-to-child transmission (PMTCT) of HIV. This study evaluates the programme by examining the improvements in programme coverage HIV testing and provision of antiviral drugs along the PMTCT cascade.


METHODS
Data for PMTCT cascade indicators were collected through a comprehensive systematic review of published peer-reviewed English and Chinese literature during 2003-2011. Meta-analysis was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.


RESULTS
This study included 113 publications. HIV prevalence among pregnant women in China who accessed antenatal care (ANC) remained below 0.1% during the past decade. HIV testing coverage in pregnant women attending ANC and in HIV-exposed infants at 18 months significantly increased from 62.4% (95% CI 4.7% to 98.2%) and 22.1% (16.3% to 32.3%) in 2003 to 90.3% (88.4% to 91.8%) and 82.8% (66.9% to 99.5%) in 2011 respectively, whereas antiretroviral (ARV) prophylaxis uptake increased from 35.2% (12.2% to 47.3%) and 26.9% (24.3% to 28.9%) to 86.2% (53.2% to 97.2%) and 90.3% (85.5% to 93.7%). HIV vertical transmission rate substantially decreased from 31.8% (25.7% to 38.6%) prior to the programme to 2.3% (1.4% to 3.8%) in 2011. During 2003-2011, among 25,312 (23,995-26,644) infants born to HIV-positive mothers who received ARV prophylaxis, 975 (564-1395) were diagnosed with HIV, corresponding to an average transmission rate of 3.9% (3.2% to 4.6%). However, while including transmissions among HIV-positive pregnant women who were lost along the cascade, the average transmission rate during 2003-2011 was 17.4% (15.8% to 19.0%).


CONCLUSIONS
PMTCT programmes have reduced HIV mother-to-child transmission in China. Further improvements in the continuum of care remain essential in realising the full potential of the programme.
School of Public Health and Management, Chongqing Medical University, Chongqing, China China Effective Health Care Network, Chongqing, China Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China.
Huan
H
Zeng
The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia Faculty of Medicine, Nursing and Health Sciences, Central Clinical School, Monash University, Melbourne, Australia Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.
Eric P F
EP
Chow
School of Public Health and Management, Chongqing Medical University, Chongqing, China China Effective Health Care Network, Chongqing, China Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China.
Yong
Y
Zhao
School of Public Health and Management, Chongqing Medical University, Chongqing, China China Effective Health Care Network, Chongqing, China Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China.
Yang
Y
Wang
School of Pediatrics, Chongqing Medical University, Chongqing, China.
Maozhi
M
Tang
School of Pediatrics, Chongqing Medical University, Chongqing, China.
Leyu
L
Li
School of Pediatrics, Chongqing Medical University, Chongqing, China.
Xue
X
Tang
School of Pediatrics, Chongqing Medical University, Chongqing, China.
Xi
X
Liu
School of Pediatrics, Chongqing Medical University, Chongqing, China.
Yi
Y
Zhong
Women's Health Department, National Center for Women's and Children's Health, China CDC, Beijing, China.
Ailing
A
Wang
Department of HIV&STI, WHO Regional Office for the Western Pacific, Manila, The Philippines.
Ying-Ru
YR
Lo
Faculty of Medicine, Nursing and Health Sciences, Central Clinical School, Monash University, Melbourne, Australia Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia School of Medicine, Research Center for Public Health, Tsinghua University, Beijing, China.
Lei
L
Zhang
D000328:Adult; D002681:China / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000635:transmission*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D009035:Mothers; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control*; D011295:Prenatal Care / Q000458:organization & administration*
AIDS; ANTIRETROVIRAL THERAPY; HIV; WOMEN