Effect of Point-of-Care Diagnostics on Maternal Outcomes in Human Immunodeficiency Virus–Infected Women: Systematic Review and Meta-analysis

Abstract

Introduction The World Health Organization advocates for increased accessibility of human immunodeficiency virus (HIV)–related point-of-care (POC) diagnostics in settings that lack laboratory infrastructure. The aim of this study was to assess the effect of POC diagnostics on maternal health outcomes in HIV-infected women. Methods A systematic literature review used the following multiple data sources: Cochrane Infectious Disease Group Specialized Register, Cochrane Central Register of Control Trials, published in The Cochrane Library, PubMed, Elton B. Stephens Co Host, and Latin American and Caribbean Health Sciences Literature from January 2000 to October 2015. References of included studies were hand-searched. Randomized controlled trials and observational studies examining health outcomes of HIV-infected women were eligible for inclusion in this review. The Cochrane Risk of Bias tool was used for bias assessment of the included studies. Preferred reporting items for systematic reviews and meta-analyses guidelines were used for reporting. Results Of 695 studies identified, 6 retrievable studies (5 cross-sectional studies and 1 case-control study) met the inclusion criteria and were included in this study. These studies examined a total of 167 HIV-infected women in different study settings. No studies reported evidence of CD4 count, viral load, and tuberculosis, and the syphilis POC test effect on HIV-infected women was not found by this study. Included studies reported the effect of various HIV rapid tests across the following 5 maternal outcomes: timely receipt of results with a pooled effect size (ES) of 1.00 (95% confidence interval [CI], 0.98–1.02); enabling partner testing with an ES of 0.95 (95% CI, 0.85–1.04); prevention of mother-to-child transmission of HIV with an ES of 0.86 (95% CI, 0.79–0.93); linkage to antiretroviral treatment with an ES of 0.76 (95 CI, 0.69–0.84); and linkage to HIV care with an ES of 0.50 (95% CI, 0.18–0.82). No studies reported evidence of the effect of POC testing on maternal mortality or maternal and child morbidity of HIV-infected women. Conclusions The review provides an international overview of the effect of HIV POC diagnostics on maternal outcomes in HIV-infected women, showing the evidence that the HIV POC test is significantly associated with decreased mother-to-child transmission of HIV and increased linkage to antiretroviral treatment and HIV care for HIV-infected women. It also revealed a gap in the literature aimed at assessing the effect of POC diagnostics on maternal morbidity and mortality in HIV-infected women. PROSPERO registration number: CRD42014015439