title: Antiretroviral therapy among pregnant and postpartum women in China: A systematic review and meta-analysis.
abstract: BACKGROUND
  The objectives of this study were to estimate the antiretroviral therapy (ART) rate and the proportion of women with adequate ART adherence (100%), and to identify the reasons for not initiating ART in HIV-infected pregnant women in China.
  
  
  METHODS
  We searched MEDLINE, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and Wanfang (Chinese) to identify research studies published from 1990-2015. Only descriptive epidemiologic studies were eligible for this study.
  
  
  RESULTS
  A total of 58 eligible studies were included in this meta-analysis. The eligible articles were published from 2006-2015 and covered all Chinese provinces. The estimated ART rate in HIV-positive pregnant women was continually increased, and the mean estimated ART rate increased from 47.1% (95% confidence interval [CI], 22.4-71.8) in 2006 to 95.0% (95% CI, 93.2-96.0) in 2013. In the meta-regression model, study year, study region, and income level were statistically significantly associated with ART rate estimates. During the last 10 years, the pooled ART adherence proportions for all studies yielded an estimate of 76.7% (95% CI, 61.0-92.5) of patients with adequate ART adherence (100%). Emergency cesarean delivery (57.9%; 95% CI, 9.9-100) and not knowing their HIV-infection status before starting (45.7%; 95% CI, 24.4-67.0) account for the dominant reasons for not initiating ART.
  
  
  CONCLUSIONS
  The geographic variation in ART rate of HIV-infected pregnant women was significant in China, and >25% of pregnant women did not achieved optimal ART adherence. It is crucial to investigate specific barriers for lower ART rates in the high-income regions and to develop interventions to maintain the adequate ART adherence.
authors.affiliation: The First Affiliated Hospital of Bengbu Medical College, Bengbu, China; Health Management Department, Bengbu Medical College, Bengbu, China.
authors.forename: Huan
authors.initials: H
authors.lastname: Zhou
authors.affiliation: Health Management Department, Bengbu Medical College, Bengbu, China.
authors.forename: Lu
authors.initials: L
authors.lastname: Liu
authors.affiliation: Health Management Department, Bengbu Medical College, Bengbu, China.
authors.forename: Min
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Health Management Department, Bengbu Medical College, Bengbu, China.
authors.forename: Xingzhi
authors.initials: X
authors.lastname: Chen
authors.affiliation: Anhui Provincial Family Planning Institute of Science and Technology, Hefei China. Electronic address: huangzh_cdc@163.com.
authors.forename: Zhaohui
authors.initials: Z
authors.lastname: Huang
mesh_terms: D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D002681:China; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D055118:Medication Adherence; D049590:Postpartum Period; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*
chemical_list: D044966:Anti-Retroviral Agents
keywords: China; HIV; Prevention of mother to child transmission; antiretroviral therapy; systematic review