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Table 2 Characteristics of included articles

From: The impact of programs for prevention of mother-to-child transmission of HIV on health care services and systems in sub-Saharan Africa - A review

No. Autors, year and country of study Study types or designs Focus interface with PMTCT Brief topic of investigation Main results
1. Bancheno WM et al. 2010/ Swaziland [45] Mixed Maternal and child health (MCH) Reporting the outcomes and challenges of a comprehensive service to PMTCT Provision of a complete package of PMTCT services in resource limited setting is possible but challenged by staff shortage, socio-economic and service-related factors
2. Barker PM et al. 2011/ RSA [46] Quantitative Health systems The impact of health systems’ performance on MTCT It’s necessary to support PMTCT interventions at scale to achieve gains in maternal and child survival
3. Barker PM; Mate K. 2012/ Multicountry [47] Quantitative MCH Eliminating mother-to-child HIV transmission will require major improvements in maternal and child health services Access to maternal and child health services along with prevention measures and HIV treatment before pregnancy need to dramatically be improved
4. Barry OM et al. 2012/ RSA [48] Quantitative Antenatal care (ANC) The patient-provider relationship (PPR) in antenatal care and its importance in PMTCT PPR scale is useful and context-appropriate instrument that could have an important role in future research focusing on improved PMTCT and decreasing the risk of paediatric HIV
5. Behets F et al. 2009/ RDC [49] Quantitative ANC, maternal health Reducing vertical HIV transmission Initiating vertical HIV transmission prevention embedded in improved antenatal services in a fragile, fragmented, severely resource-deprived health care system was possible and improved over time
6. Both JMC et al. 2010/ Multicountry [14] Systematic review Maternal health The impact of Prevention of PMTCT programs on maternal health care (MHC) Integrated PMTCT programs can lead to more positive effects despite its current positive and negative impact on MHC
7. Chi BH et al. 2013/ Multicountry [50] Review Health facilities, health policy Antiretroviral drug regimens to prevent mother-to-child transmission of HIV Global campaigns to “virtually eliminate” paediatric HIV and dramatically reduce HIV-related maternal mortality have mobilised new resources and renewed political will
8. Cotton MF et al. 2008/ RSA [51] Quantitative Tuberculosis (TB) Tuberculosis exposure in HIV-exposed infants in a high-prevalence setting Programs to prevent MTCT offer an important opportunity to screen for TB. In-depth assessment is required for evaluating TB exposure.
9. DeGennaro V; Zeitz P. 2009/ Multicountry [52] Review Family, paediatric AIDS Family-centred response to the HIV/AIDS epidemic for the elimination of paediatric AIDS Governments must embrace family-centred and implement paediatric-friendly infrastructure, and train healthcare workers to treat children care in order to eliminate paediatric HIV/AIDS
10. Desclaux A et al. 2012/ Senegal [75] Qualitative Social issues Social stakes to eliminate MTCT by 2015 Integration of HIV testing and treatment in RH services is not fully established and health services organisation hinders family approach of prevention
11. Druce N; Nolan A. 2007/ Multicountry [44] Review Maternal health linking HIV and maternity care services Experience in some countries has shown that progress can be made whenever nationals are committed to resources increase to meet HIV maternal and newborn needs
12. Du Plessis E et al. 2014/ Kenya [53] Quantitative ANC Challenges to PMTCT implementation Guideline implementation in low resource settings continues to be confronted with challenges related to late presentation, less than four ANC visits, low screening rates for opportunistic infections and limited contraception counselling
13. Ekouevi DK et al. 2012/ Multicountry [54] Mixed Health facilities Health facility characteristics associated with effective PMTCT There is a positive relationship between an antenatal quality score and PMTCT coverage but variables to predict PMTCT coverage were not identified
14. Evjen-Olsen B et al. 2009/ Tanzania [76] Descriptive* MCH Integrating PMTCT on healthcare services Horizontal and comprehensive services should be strengthened and supported at all levels towards a sustainable MCH impact
15. Ferguson L et al. 2012/ Multicountry [77] Systematic review Maternal health, ANC and post-natal care (PNC) Linking women who test HIV-positive in pregnancy-related services to long-term HIV care and treatment services Providing ‘family-focused care’, integrating CD4 testing and providing HAART into PMTCT services are promising for increasing women’s uptake of HIV related services
16. Gibbs A et al. 2012/ Multicountry [55] Analytical** MCH Inclusion of women, girls and gender equality in National Strategic Plans for HIV and AIDS There is poor inclusion, except the accessible post-exposure prophylaxis in the case of sexual violence and vertical transmission services
17. Govender T; Coovadia H. 2014/ Multicountry [56] Review ANC, MCH Eliminating mother to child transmission of HIV-1 and keeping mothers alive Family planning messages and provision of contraception methods to avoid unplanned pregnancies are more effective than HIV counselling and testing, and single dose Nevirapine in averting transmission of perinatal HIV infection.
18. Gunn JK et al. 2016/ Multicountry [98] Quantitative ANC Relationship between ANC and PMTCT in SSA. Analysis of data from four countries. Integration of HIV testing into routine ANC service is needed to increase opportunities for PMTCT programs to reach HIV-positive pregnant women.
19. Harrington EK et al. 2012/ Kenya [78] Quantitative Family planning (FP) Fertility intentions and interest in integrated FP services among women living with HIV Integration of FP and HIV services is acceptable and should be supported for preventing the unintended pregnancies through increased access to contraceptive methods and confidential services that take into account women’s varied reproductive intentions
20. Hatcher AM et al. 2014/ RSA [57] Qualitative Partners of PMTCT women Links between HIV and intimate partner violence in pregnancy HIV diagnosis during pregnancy and subsequent partner disclosure are common trigger of IPV
21. Hoke T et al. 2014/ RSA [79] Mixed FP Contraceptive options for PMTCT clients Consistent access to high quality FP services that are effectively linked to HIV services, attention must also be focused on resolving underlying health system constraints weakening health service delivery more generally.
22. Horwood C et al. 2010/ RSA [80] Mixed MCH Evaluating PMTCT implementation and integration into routine maternal, child and women’s health services Poor integration of PMTCT services into routine care, lack of clarity about health worker roles and poor record keeping constitute barriers to services accessibility in post-partum
23. Jashi M. et al. 2013/ Multicountry [81] Review Paediatric HIV care PMTCT - paediatric HIV joint technical missions Joint technical missions bring together stakeholders for common action towards informed PMTCT and paediatric HIV policies
24. Kaida A et al. 2010/ RSA [82] Quantitative Contraceptives Investigating the contraceptive use and method preferences by HIV status and receipt of HAART among women Integrated HIV and sexual and reproductive health services have potential to positively impact maternal, partner, and child health.
25. Karl Peltzer et al. 2009/ Multicountry [58] Randomised control trial (RCT) FP Family Planning - effects of PMTCT HIV prevention and FP should consider the reproductive desires of HIV positive women and men
26. Kerber KJ et al. 2013/ RSA [83] Systematic review Child deaths Meeting Millennium Development Goal 4 through HIV services Failing to address other aspects of care like the integration of high-quality maternal and neonatal care leads to low decline in child mortality
27. Kerouedan D. 2010/ Multicountry [59] Evaluative*** Global Fund- health policy and systems Evaluating policy issues Health systems’ weaknesses at district level, such as human resources, laboratory commodities, and medicine shortages are major constraints to further expansion of services and impact of funds
28. Ladur AN et al. 2015/ RSA [60] Qualitative Male involvement Perceptions on Male Involvement in PMTCT HIV testing, disclosure and direct health worker engagement with men increases male involvement in PMTCT.
29. Lassi ZS et al. 2014/Multicountry [61] Review Neonatal health Essential pre-pregnancy and pregnancy interventions Proper implementation of a set of essential interventions leads to both improved and sustained maternal, neonatal and child health outcomes
30. Levy JM. 2009/ Malawi [62] Qualitative ANC, MCH Examining women’s decisions about HIV testing and their experience of PMTCT and HIV-related care Women’s own health was particularly marginalised within the PMTCT programs but good models exist for comprehensive care for women, infants and their families
31. Lyons C et al. 2012/ Multicountry [84] Commentary & supplement article MCH Ending paediatric AIDS and achieving a generation born HIV-free Scale-up of PMTCT has provided a foundation for HIV prevention and care and treatment programs that are integrated within maternal and child health services
32. Nassali M et al. 2009/ Uganda [63] Qualitative MCH, PNC Adherence to the postnatal PMTCT program Strategies to increase mothers’ adherence to PN-PMTCT interventions leads to increased HIV/AIDS care access for mothers and children in SSA are recommended
33. Nutman S et al. 2013/ Multicountry [16] Systematic review STIs and child immunisation Assessment of PMTCT impact in all low and middle income countries There are beneficial synergies between PMTCT programs and both STI prevention and early childhood immunisation.
34. O’Reilly KR et al. 2013/ Multicountry [85] Systematic review FP and counselling FP counselling for women living with HIV There is a need for strengthened efforts to integrate family planning counselling and access to services into HIV prevention, and for greater consistency of effort over time.
35. Peltzer K et al. 2010/ RSA [86] Mixed Health systems Assessment of the PMTCT implementation across health facilities A well-functioning health system empowers PMTCT clients through strong leadership, coordination and collaboration between partners.
36. Pirkle CM et al. 2014/ Multicountry [64] Quantitative Nutrition Training and nutritional components of PMTCT programs Health professionals’ training in maternal healthcare and PMTCT could be combined to improve the quality of obstetric care in the region.
37. Potter D. et al. 2008/ Zambia [65] Quasi-experimental MCH, Primary health care Improve overall care for pregnant women Broader primary care impact and full PMTCT integration should be targeted.
38. Rollins N et al. 2007/ RSA [87] Quantitative Immunisation Surveillance of MTCT prevention programs at immunisation clinics Anonymous HIV prevalence screening of all infants at immunisation clinics is feasible and could help to monitor the impact of PMTCT programs in peripartum infection, in identifying the infected children early for referral into care and treatment
39. Roxby AC et al. 2014/ Multicountry [66] Review MCH A lifecycle approach to HIV prevention in African women and children The potential for synergistic and additive benefits of lifecycle interventions should be considered when scaling up HIV prevention efforts in SSA
40. Ruton H. et al. 2012/ Rwanda [67] Mixed Child health, community PMTCT - community-based household survey National PMTCT programs in SSA should assess the effectiveness of their interventions to achieve the MTCT elimination goals
41. Rutta E. et al. 2008/ Tanzania [88] RCT MCH PMTCT in a refugee camp setting in Tanzania Integrated PMTCT (into existing ANC) is more successful and acceptable
42. Sarnquist CC et al. 2013/ Multicountry [89] Review SRH and FP Sexual and reproductive health and family planning needs among HIV-infected women in Sub-Saharan Africa Integrated services that help prevent unintended pregnancy and optimise maternal and infant health before, during and after pregnancy are also useful for both resources maximisation and improvement of reproductive outcomes
43. Shetty AK. 2013/ Multicountry [68] Review MCH, PNC Epidemiology of HIV infection in women and children: a global perspective Rapidly implemented combination of HIV prevention packages provides quality PMTC services and improves maternal and infant survival.
44. Spangler SA et al. 2014/ Kenya [69] Quantitative Maternal care HIV-positive status disclosure as factor for the use of PMTCT and maternal care Interventions to promote HIV disclosure must recognise the impact of HIV-related stigma on disclosure decisions and protect women’s rights, autonomy, and safety.
45. Sprague C et al. 2011/ RSA [70] Qualitative MCH Women’s experiences on continuum of maternal and child care There are missed opportunities for HIV testing in antenatal care due to huge operational weaknesses in HIV services.
46. Sinunu MA et al. 2014/ Malawi [71] Quantitative Immunisation Immunisation clinic-based surveillance of PMTCT and evaluation of PMTCT impact Successfully implemented PMTCT program averts HIV transmission and can be evaluated over time for impact through immunisation settings.
47. Tomlinson M et al. 2014/ RSA [90] RCT Health systems, community and MCH Evaluate an integrated, scalable package of pregnancy and post-natal home visits Implementation of a pro-poor integrated PMTCT and maternal, neonatal and child health home visiting model is feasible and effective.
48. Towle M; Lende DH. 2008/ Lesotho [72] Qualitative Community Social groups and contextual determinants impacting PMTCT Biomedical system, women, children and the community have to be considered as valuable partners in achieving positive health outcomes.
49. Uwimana J et al. 2012/ RSA [26] Mixed NGOs, Community care Workers (CCWs) and TB/HIV Engagement of NGOs and community care workers in collaborative TB/HIV activities including PMTCT Efforts to engage the NGO/CCWs for implementing collaborative TB/HIV/PMTCT activities are beneficial but sub-optimal in practice.
50. Uwimana J et al. 2012/ RSA [91] Qualitative TB/HIV Health system barriers to implementation of collaborative TB and HIV activities including PMTCT Accelerated implementation of collaborative TB/HIV activities including PMTCT requires political will and leadership to address these health systems barriers.
51. Uwimana J et al. 2012/ RSA [92] RCT TB/HIV Training community care workers to provide comprehensive TB/HIV/PMTCT integrated care Up-skilling CCWs could be one avenue to enhance TB/HIV case finding, TB contact tracing and linkages to care.
52. Uwimana J; Jackson D. 2013/ RSA [93] Qualitative TB Assessing the integration of TB services into the PMTCT The inadequate integration of TB prevention and care into the PMTCT programme will require a strong leadership that addresses training and supervision barriers.
53. Uwimana J et al. 2013/ RSA [94] RCT TB-HIV Impact assessment of an intervention to enhance the provision of community-based integrated services for TB, HIV and PMTCT The effective intervention in enhancing the provision of community-based TB-HIV and PMTCT services requires more attention to other primary health care services to ensure that all key services are provided.
54. Vermund SH; Hayes RJ. 2013/ Multicountry [95] Review MCH, PNC Combination prevention to stop HIV Combination approaches are complex and costly. They require substantial global commitments.
55. Wettstein C et al. 2012/ RSA [96] Systematic review MCH Determining the magnitude and reasons of loss to program and poor antiretroviral prophylaxis coverage in PMTCT Uptake of PMTCT interventions and early infant diagnosis is unsatisfactory. An integrated family-centred approach seems to improve retention.
56. Wiysonge CS et al. 2011/ Multicountry [73] Review ANC, PNC, Vitamin A Vitamin A supplementation for reducing the risk of MTCT vitamin A supplementation probably has little or no effect on MTCT in antenatal care or in postpartum.
57. Woldesenbet S et al. 2015/ RSA [97] Mixed MCH, Communities and health facilities Risk factors for low PMTCT service uptake Strengthened linkages of referral-system and between communities and health facilities can address factors to low PMTCT service uptake.
  1. *The paper described a health program in presentation form
  2. **National strategic plans in 20 countries were assessed in this study
  3. ***The paper evaluated policy issues and commented on them