Implementation of the Prevention of Mother to Child Transmission (PMTCT) of HIV Program: An Integrative Literature Review

Purpose: The burden of HIV/AIDS on women and children is very high. Worldwide, 60% of HIV infections occurred in women and children in 2007. In 2009, 370,000 children were born with HIV. With effective interventions, the rate of mother to child transmission of HIV can be reduced from 45% to 5%. Evidence on effectiveness is not sufficient, however, evidence on implementation also is needed to ensure that programs reach and retain women over time.The pupose of this review was to provide an integrative information on how PMTCT is being implemented across different heath care settings globally.

Methods: We searched the following databases: PubMed, CINAHL and Family & Society Studies Worldwide. The search was limited to studies published in English between 2007 and 2012.  Studies that evaluated PMTCT programs were included in the review.  A standardized template was applied to extract data on study design, study quality, sample, setting, and validity and reliability of the data collection measures. To identify factors associated with PMTCT program implementation, we extracted data on the profession of PMTCT service providers, program components, program congruence with World Health Organization guidelines for PMTCT, fidelity of implementation, and program reach to and retention of women at labor and delivery, 6 weeks, 6 months and ≥15months post-delivery periods.

Results: Twenty studies were included: 18 in Africa and 2 in Asia. Nurses were the major PMTCT service providers. The primary interventions they provided were HIV testing and counseling and providing Antiretroviral Therapy to pregnant women.  Most programs were congruent with the WHO’s PMTCT guidelines. Retention of women was low across all settings (Range: 23.5%- 99% at delivery, 9.6%-68% at 6 weeks, and 44% at 6 months [one study] and 10.5%-85% at ≥15 months ). Active involvement of community members in intervention design and implementation was the program component most strongly associated with higher retention rates.

Conclusion: The best approach to implementing PMTCT programs is still unknown. Exploring factors responsible for high attrition rates is an urgent need because women, who are retained in the program, will have access to HIV-related care and support which could help improve their health and reduce pediatric HIV infection