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Externalities of Prevention of Mother-to-Child Transmission Programs: A Systematic Review

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Abstract

There has been considerable debate about the effects of targeted global health assistance in low- and middle-income countries on health systems, specifically HIV/AIDS funding. Recently, a handful of studies have emerged that describe the implementation of PMTCT programs, which have many theoretical links to maternal and child health. Through a systematic review of research published between January 2000 and March 2011, this paper synthesizes evidence evaluating the impact of these programs. We assessed 5,855 papers, reviewed 154, and included 21 articles. They offer evidence of beneficial synergies between PMTCT programs and both STI prevention and early childhood immunization. Other data, including information about antenatal and delivery care, family planning, and nutrition supplementation varied considerably across studies demonstrating both positive and negative effects of PMTCT. More research is needed to allow countries and funders to make informed decisions regarding allocation of limited funds to targeted versus broad categories of health care.

Resumen

Hay considerable debate acerca de los efectos de asistencia específica de la salud públicamundial aplicados a los sistemas de salud en países de bajos y medianos ingresos, en particular para financiacion de VIH/SIDA. Recientemente, varios estudios han surgido describiendo la aplicación de los programas de PTMI, que poseen muchos vínculos teóricos con la salud materna e infantil. A través de una revisión sistemática de estudios publicados entre 2000 y marzo de 2011, este documento sintetiza la evidencia que evalua el impacto de estos programas. Nosotros estudiamos 5855 publicaciones, revisamos 154, e incluimos 21 artículos. En conjunto, este material ofrece evidencia de sinergias beneficiosas entre los programas de PTMI, la prevención de ITS y la inmunización en la infancia temprana. Otros datos, incluyendo información sobre el cuidado prenatal y parto, planificación familiar y suplementacion de la nutrición varian considerablemente entre los estudios que demuestran un impacto positivo y negativo de la PTMI. Se necesita más investigación para que los países y los financiadores puedan tomar decisiones informadas con respecto a la asignación de fondos limitados para categorías específicas en comparacion con categorías amplias de salud.

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Notes

  1. While we screened articles through March 2011 and included articles published through that date, no study discussed goes beyond 2009, likely due to the lag between the end of a study and publication of an article.

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Acknowledgments

We would like to thank Nicoli Nattrass for her insightful comments, the reviewers for their helpful suggestions, and Giselle Crosa.

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Authors and Affiliations

  1. College of Arts and Sciences, Yale University, New Haven, CT, USA

    Sarah Nutman

  2. Department of Economics, Economic Growth Center, Yale University, New Haven, CT, USA

    Douglas McKee

  3. Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, PO Box 208034, 60 College Street, New Haven, CT, 06520-8034, USA

    Kaveh Khoshnood

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Nutman, S., McKee, D. & Khoshnood, K. Externalities of Prevention of Mother-to-Child Transmission Programs: A Systematic Review. AIDS Behav 17, 445–460 (2013). https://doi.org/10.1007/s10461-012-0228-8

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