A systematic review of health system barriers and enablers for antiretroviral therapy (ART) for HIV-infected pregnant and postpartum women

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dc.contributor.authorColvin, Christopher Jen_ZA
dc.contributor.authorKonopka, Sarahen_ZA
dc.contributor.authorChalker, John Cen_ZA
dc.contributor.authorJonas, Ednaen_ZA
dc.contributor.authorAlbertini, Jenniferen_ZA
dc.contributor.authorAmzel, Anouken_ZA
dc.contributor.authorFogg, Karenen_ZA
dc.date.accessioned2015-11-16T04:07:56Z
dc.date.available2015-11-16T04:07:56Z
dc.date.issued2014en_ZA
dc.description.abstractBACKGROUND: Despite global progress in the fight to reduce maternal mortality, HIV-related maternal deaths remain persistently high, particularly in much of Africa. Lifelong antiretroviral therapy (ART) appears to be the most effective way to prevent these deaths, but the rates of three key outcomes--ART initiation, retention in care, and long-term ART adherence--remain low. This systematic review synthesized evidence on health systems factors affecting these outcomes in pregnant and postpartum women living with HIV. METHODS: Searches were conducted for studies addressing the population of interest (HIV-infected pregnant and postpartum women), the intervention of interest (ART), and the outcomes of interest (initiation, adherence, and retention). Quantitative and qualitative studies published in English since January 2008 were included. A four-stage narrative synthesis design was used to analyze findings. Review findings from 42 included studies were categorized according to five themes: 1) models of care, 2) service delivery, 3) resource constraints and governance challenges, 4) patient-health system engagement, and 5) maternal ART interventions. RESULTS: Low prioritization of maternal ART and persistent dropout along the maternal ART cascade were key findings. Service delivery barriers included poor communication and coordination among health system actors, poor clinical practices, and gaps in provider training. The few studies that assessed maternal ART interventions demonstrated the importance of multi-pronged, multi-leveled interventions. CONCLUSIONS: There has been a lack of emphasis on the experiences, needs and vulnerabilities particular to HIV-infected pregnant and postpartum women. Supporting these women to successfully traverse the maternal ART cascade requires carefully designed and targeted interventions throughout the steps. Careful design of integrated service delivery models is of critical importance in this effort. Key knowledge gaps and research priorities were also identified, including definitions and indicators of adherence rates, and the importance of cumulative measures of dropout along the maternal ART cascade.en_ZA
dc.identifier.apacitationColvin, C. J., Konopka, S., Chalker, J. C., Jonas, E., Albertini, J., Amzel, A., & Fogg, K. (2014). A systematic review of health system barriers and enablers for antiretroviral therapy (ART) for HIV-infected pregnant and postpartum women. <i>PLoS One</i>, http://hdl.handle.net/11427/14981en_ZA
dc.identifier.chicagocitationColvin, Christopher J, Sarah Konopka, John C Chalker, Edna Jonas, Jennifer Albertini, Anouk Amzel, and Karen Fogg "A systematic review of health system barriers and enablers for antiretroviral therapy (ART) for HIV-infected pregnant and postpartum women." <i>PLoS One</i> (2014) http://hdl.handle.net/11427/14981en_ZA
dc.identifier.citationColvin, C. J., Konopka, S., Chalker, J. C., Jonas, E., Albertini, J., Amzel, A., & Fogg, K. (2014). A systematic review of health system barriers and enablers for antiretroviral therapy (ART) for HIV-infected pregnant and postpartum women.PloS one, 9(10), e108150-e108150. doi:10.1371/journal.pone.0108150en_ZA
dc.identifier.ris TY - Journal Article AU - Colvin, Christopher J AU - Konopka, Sarah AU - Chalker, John C AU - Jonas, Edna AU - Albertini, Jennifer AU - Amzel, Anouk AU - Fogg, Karen AB - BACKGROUND: Despite global progress in the fight to reduce maternal mortality, HIV-related maternal deaths remain persistently high, particularly in much of Africa. Lifelong antiretroviral therapy (ART) appears to be the most effective way to prevent these deaths, but the rates of three key outcomes--ART initiation, retention in care, and long-term ART adherence--remain low. This systematic review synthesized evidence on health systems factors affecting these outcomes in pregnant and postpartum women living with HIV. METHODS: Searches were conducted for studies addressing the population of interest (HIV-infected pregnant and postpartum women), the intervention of interest (ART), and the outcomes of interest (initiation, adherence, and retention). Quantitative and qualitative studies published in English since January 2008 were included. A four-stage narrative synthesis design was used to analyze findings. Review findings from 42 included studies were categorized according to five themes: 1) models of care, 2) service delivery, 3) resource constraints and governance challenges, 4) patient-health system engagement, and 5) maternal ART interventions. RESULTS: Low prioritization of maternal ART and persistent dropout along the maternal ART cascade were key findings. Service delivery barriers included poor communication and coordination among health system actors, poor clinical practices, and gaps in provider training. The few studies that assessed maternal ART interventions demonstrated the importance of multi-pronged, multi-leveled interventions. CONCLUSIONS: There has been a lack of emphasis on the experiences, needs and vulnerabilities particular to HIV-infected pregnant and postpartum women. Supporting these women to successfully traverse the maternal ART cascade requires carefully designed and targeted interventions throughout the steps. Careful design of integrated service delivery models is of critical importance in this effort. Key knowledge gaps and research priorities were also identified, including definitions and indicators of adherence rates, and the importance of cumulative measures of dropout along the maternal ART cascade. DA - 2014 DB - OpenUCT DO - 10.1371/journal.pone.0108150 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2014 T1 - A systematic review of health system barriers and enablers for antiretroviral therapy (ART) for HIV-infected pregnant and postpartum women TI - A systematic review of health system barriers and enablers for antiretroviral therapy (ART) for HIV-infected pregnant and postpartum women UR - http://hdl.handle.net/11427/14981 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14981
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0108150
dc.identifier.vancouvercitationColvin CJ, Konopka S, Chalker JC, Jonas E, Albertini J, Amzel A, et al. A systematic review of health system barriers and enablers for antiretroviral therapy (ART) for HIV-infected pregnant and postpartum women. PLoS One. 2014; http://hdl.handle.net/11427/14981.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherPregnancyen_ZA
dc.subject.otherHIVen_ZA
dc.subject.otherAntenatal careen_ZA
dc.subject.otherAntiretroviral therapyen_ZA
dc.subject.otherHealth systems strengtheningen_ZA
dc.subject.otherWomen's healthen_ZA
dc.titleA systematic review of health system barriers and enablers for antiretroviral therapy (ART) for HIV-infected pregnant and postpartum womenen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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