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Prevention of mother-to-child HIV transmission cascade in China: a systematic review and meta-analysis
  1. Huan Zeng1,2,3,4,
  2. Eric P F Chow5,6,7,
  3. Yong Zhao1,2,3,4,
  4. Yang Wang1,2,3,4,
  5. Maozhi Tang8,
  6. Leyu Li8,
  7. Xue Tang8,
  8. Xi Liu8,
  9. Yi Zhong8,
  10. Ailing Wang9,
  11. Ying-Ru Lo10,
  12. Lei Zhang6,7,11
  1. 1School of Public Health and Management, Chongqing Medical University, Chongqing, China
  2. 2China Effective Health Care Network, Chongqing, China
  3. 3Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
  4. 4The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
  5. 5The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
  6. 6Faculty of Medicine, Nursing and Health Sciences, Central Clinical School, Monash University, Melbourne, Australia
  7. 7Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
  8. 8School of Pediatrics, Chongqing Medical University, Chongqing, China
  9. 9Women's Health Department, National Center for Women's and Children's Health, China CDC, Beijing, China
  10. 10Department of HIV&STI, WHO Regional Office for the Western Pacific, Manila, The Philippines
  11. 11School of Medicine, Research Center for Public Health, Tsinghua University, Beijing, China
  1. Correspondence to Huan Zeng, School of Public Health and Management, Chongqing Medical University, Chongqing, China, 400016; zenghuan586@aliyun.com and Ailing Wang, Women's Health department, National center for women's and children's health, China CDC, 100050; ailing@chinawch.org.cn and Lei Zhang, The Kirby Institute, University of New South Wales, Sydney, NSW 2010, Australia; lzhang@kirby.unsw.edu.au

Abstract

Introduction 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.

  • HIV
  • WOMEN
  • ANTIRETROVIRAL THERAPY
  • AIDS

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