title: The effectiveness of interventions to improve uptake and retention of HIV-infected pregnant and breastfeeding women and their infants in prevention of mother-to-child transmission care programs in low- and middle-income countries: protocol for a systematic review and meta-analysis.
abstract: BACKGROUND
  Despite recent improvements, uptake and retention of mothers and infants in prevention of mother-to-child transmission (PMTCT) services remain well below target levels in many low- and middle-income countries (LMICs). Identification of effective interventions to support uptake and retention is the first step towards improvement. We aim to complete a systematic review and meta-analysis to evaluate the effectiveness of interventions at the patient, provider or health system level in improving uptake and retention of HIV-infected mothers and their infants in PMTCT services in LMICs.
  
  
  METHODS
  We will include studies comparing usual care or no intervention to any type of intervention to improve uptake and retention of HIV-infected pregnant or breastfeeding women and their children from birth to 2 years of age attending PMTCT services in LMICs. We will include randomized controlled trials (RCTs), cluster RCTs, non-randomized controlled trials, and interrupted time series. The primary outcomes of interest are percentage of HIV-infected women receiving/initiated on anti-retroviral prophylaxis or treatment, percentage of infants receiving/initiated on anti-retroviral prophylaxis, and percentage of women and infants completing the anti-retroviral regimen/retained in PMTCT care. The following databases will be searched from inception: Ovid MEDLINE and EMBASE, The WHO Global Health Library, CAB abstracts, EBM Reviews, CINAHL, HealthSTAR and Web of Science databases, Scopus, PsychINFO, POPLINE, Sociological Abstracts, ERIC, AIDS Education Global Information System, NLM Gateway, LILACS, Google Scholar, British Library Catalogue, DARE, ProQuest Dissertation & Theses, the New York Academy of Grey Literature, Open Grey, The Cochrane Library, WHO International Clinical Trials Registry, Controlled Clinical Trials, and clinicaltrials.gov. Reference lists of included articles will be hand searched and study authors and content experts contacted to inquire about eligible unpublished or in progress studies. Screening, data abstraction, and risk of bias appraisal using the Cochrane Effective Practice and Organization of Care criteria will be conducted independently by two team members. Results will be synthesized narratively and a meta-analysis conducted using the DerSimonian Laird random effects method if appropriate based on assessment of clinical and statistical heterogeneity.
  
  
  CONCLUSIONS
  Our findings will be useful to PMTCT implementers, policy makers, and implementation researchers working in LMICs.
  
  
  BACKGROUND
  PROSPERO CRD42015020829.
authors.affiliation: Department of Medicine, University of Toronto, Toronto, ON, Canada. lisa.puchalskiritchie@utoronto.ca.|Li Ka Shing Knowledge Institute, St. Michaels Hospital, University of Toronto, Toronto, ON, Canada. lisa.puchalskiritchie@utoronto.ca.|University Health Network, Toronto, ON, Canada. lisa.puchalskiritchie@utoronto.ca.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Puchalski Ritchie
authors.affiliation: Dignitas International, c/o PO Box 1071, Zomba, Malawi. m.vanlettow@dignitasinternational.org.|Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. m.vanlettow@dignitasinternational.org.
authors.forename: Monique
authors.initials: M
authors.lastname: van Lettow
authors.affiliation: Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA. mina_hosseinipour@med.unc.edu.|University of North Carolina Project, Lilongwe, Malawi. mina_hosseinipour@med.unc.edu.
authors.forename: Mina C
authors.initials: MC
authors.lastname: Hosseinipour
authors.affiliation: Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA. Nora_Rosenberg@unc.edu.|University of North Carolina Project, Lilongwe, Malawi. Nora_Rosenberg@unc.edu.
authors.forename: Nora E
authors.initials: NE
authors.lastname: Rosenberg
authors.affiliation: Lighthouse Trust, Lilongwe, Malawi. samphiri@lighthouse.org.mw.
authors.forename: Sam
authors.initials: S
authors.lastname: Phiri
authors.affiliation: University Health Network, Toronto, ON, Canada. mclandes@gmail.com.|Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada. mclandes@gmail.com.
authors.forename: Megan
authors.initials: M
authors.lastname: Landes
authors.affiliation: Dignitas International, c/o PO Box 1071, Zomba, Malawi. f.cataldo@dignitasinternational.org.
authors.forename: Fabian
authors.initials: F
authors.lastname: Cataldo
authors.affiliation: Department of Medicine, University of Toronto, Toronto, ON, Canada. sharon.straus@utoronto.ca.|Li Ka Shing Knowledge Institute, St. Michaels Hospital, University of Toronto, Toronto, ON, Canada. sharon.straus@utoronto.ca.
authors.forename: Sharon E
authors.initials: SE
authors.lastname: Straus
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use; D001942:Breast Feeding; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control* / Q000635:transmission*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D015201:Meta-Analysis as Topic; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000821:virology; D015397:Program Evaluation; D012107:Research Design; D000078202:Systematic Reviews as Topic
chemical_list: D019380:Anti-HIV Agents