WHO/HIV/2013.74 © World Health Organization 2013

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WHO/HIV/2013.74 © World Health Organization 2013

This work was commissioned by the World Health Organization and carried out by The University of California, San Francisco (UCSF), Cochrane Review Group on HIV/AIDS

1 GRADE table: Should integrated HIV and maternal and child health services versus referral to HIV services be used for providing HIV care to pregnant women living with HIV and their infants?

Author(s): Alicen B. Spaulding, Deborah Bain-Brickley, Hana Azman Date: 2012-10-30

Question: Should integrated HIV and maternal and child health services versus referral to HIV services be used for providing HIV care to pregnant women living with HIV and their infants?

Settings: Rwanda, Kenya and Zambia

Bibliography: Killam 2010, Ong'ech 2012, SHAIP study 2012, Tsague 2010

Quality assessment No. of patients Effect

Quality Importance No. of

studies Design Risk of

bias Inconsistency Indirectness Imprecision Other considerations

Integrated HIV and maternal and

child health services

Referral to HIV services

Relative

(95% CI) Absolute

Maternal mortality (follow-up 12 months)

1 observational studies

no serious risk of bias

no serious inconsistency

no serious indirectness

serious¹ none 9/569

(1.6%)

8/603 (1.3%)

RR 1.19 (0.46 to 3.07)

3 more per 1000 (from 7

fewer to 27 more)

⊕ΟΟΟ VERY LOW

CRITICAL

Morbidity (follow-up 12 months)

1² observational studies

(18.2%)

21/121 (17.4%)

RR 1.05 (0.61 to 1.8)

fewer to 139 more)

⊕ΟΟΟ VERY LOW

CRITICAL

Immune response (follow-up 12 months)

3³ observational studies⁴

no serious imprecision

none 982/3921

(25%)

752/2881 (26.1%)

RR 0.92 (0.67 to 1.27)

21 fewer per 1000 (from 86

fewer to 70 more)

⊕⊕ΟΟ LOW

CRITICAL

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WHO/HIV/2013.74 © World Health Organization 2013

2

Retention (follow-up 12 and 24 months)

2⁵ observational studies⁴

none 356/457

(77.9%)

183/287 (63.8%)

RR 1.11 (0.76 to 1.62)

fewer to 395 more)

⊕⊕ΟΟ LOW

CRITICAL

ART initiation (follow-up 12 months)

3⁶ observational studies⁴

none 486/1204

(40.4%)

168/966 (17.4%)

RR 1.71 (0.79 to 3.72)

123 more per 1000 (from 37 fewer to 473

more)

⊕⊕ΟΟ LOW

IMPORTANT

Adherence to ART during pregnancy

(80%)

398/603 (66%)

RR 1.21 (1.13 to 1.3)

139 more per 1000 (from 86 more to 198

more)

⊕ΟΟΟ VERY LOW

IMPORTANT

Uptake of infant HIV testing at six months of life

(38.3%)

93/232 (40.1%)

RR 0.96 (0.76 to 1.21)

16 fewer per 1000 (from 96

fewer to 84 more)

⊕ΟΟΟ VERY LOW

IMPORTANT

Enrolment in care (follow-up 12 months)

2 observational studies⁴

No serious risk of bias

none 875/1309

(66.8%)

256/778 (32.9%)

RR 2.03 (1.82 to 2.26)

more to 415 more)

⊕⊕ΟΟ LOW

IMPORTANT

Satisfaction with care among women living with HIV (cross-sectional)

(79.3%)

14/26 (53.8%)

RR 1.47 (0.99 to 2.2)

253 more per 1000 (from 5 fewer to 646

more)

⊕ΟΟΟ VERY LOW

IMPORTANT

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3

1 Small number of events.

2 Defined as those who developed WHO stage 3 or 4 disease.

3 Defined in one study as CD4 <250 cells/mm³, one study as CD4 <350 and the final study as CD4 <200.

4 Three prospective observational cohort studies and one stepped-wedge evaluation study.

5 Defined in one study as 90-day retention among those who initiated ART and in the other study as still enrolled at 12 months.

6 Defined in one study as initiation of ART within 60 days before delivery or estimated due date, in another study as ART initiation among women with CD4 cell counts <350 cells/mm³ and in the final study as those initiating ART within one year of follow-up.