Prevention of mother-to-child HIV transmission cascade in China: A systematic review and meta-analysis

Zeng Huan, Eric P F Chow, Yong Zhao, Wang Yang, Tang Maozhi, Leyu Li, Tang Xue, Liu Xi, Zhong Yi, Wang Ailing, Ying Ru Lo, Lei Zhang

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23 Citations (Scopus)

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 2003â€"2011, among 25 312 (23 995â€" 26 644) infants born to HIV-positive mothers who received ARV prophylaxis, 975 (564â€"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 2003â€"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.

Original languageEnglish
Pages (from-to)116-123
Number of pages8
JournalSexually Transmitted Infections
Volume92
Issue number2
DOIs
Publication statusPublished - 1 Mar 2016

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