- Title
- A systematic review and document analysis on the prevention of mother-to-child programmes to prevent vertical transmission of human immuno-deficiency virus
- Creator
- Sobetwa, Nwabisa Nokuzola
- Subject
- AIDS (Disease) in pregnancy
- Subject
- Maternal health services
- Subject
- HIV infections -- Children -- Transmission -- Prevention
- Date
- 2017
- Type
- Thesis
- Type
- Masters
- Type
- MSoc
- Identifier
- http://hdl.handle.net/10353/7957
- Identifier
- vital:31282
- Description
- Background: The National Strategic Plan 2012-2016 is advocating for zero new infections due to vertical transmission. This goal has not yet been achieved. This study evaluated whether the prevention of mother-to-child vertical transmission (PMTCT) of Human Immuno-deficiency Virus (HIV) programmes in South Africa are based on evidence. Aim: The aim of this study was to conduct a systematic review of the available literature comparing PMTCT antiretroviral regimens published between the years 2000 to 2015 and to do a document analysis of the current implemented PMTCT programme to evaluate if it is based on best evidence. Rational: The rational of the systematic review and the document analysis were to assess whether the latest PMTCT policy was based on evidence and to critically analyse published articles that addressed aspects related to efficacy and efficiency of PMTCT programmes to reduce transmission of HIV from mothers to their infants. Methods: Overall 25 randomised controlled trials and primary studies that assessed efficacy of ARV regimens to prevent mother-to-child transmission of the HIV during pregnancy, labour and the postnatal periods were systematically reviewed. In 1997 the first trial began and the last one ended in 2012. Twelve guidelines referring to PMTCT were sampled and they were published by WHO and Department of Health South Africa from 2001 to 2015. The document analysis was only based on National consolidated guidelines for the prevention of mother-to-child transmission of HIV (PMTCT) and the management of HIV in children, adolescents and adults April, 2015. Findings: The systematic review illustrated that significantly fewer infants tested HIV-positive when exposed to a longer ARV regime although there was no significant difference once the infants reached six months of age. Different ARVs have a similar Preamble effect on maternal deaths; however, a double or triple combination of ARVs is superior to monotherapy to decrease infant deaths. Common maternal adverse reactions to ARVs include anaemia, bronchopneumonia, and maculopapular rash. Infant adverse events included septicaemia, pneumonia, gastroenteritis, fever and maculopapular rash. The document analysis has shown that the PMTCT policy is mainly based on evidence from randomised controlled trials and systematic reviews. Occasionally some statements are still based on lower categories of evidence such as non-experimental descriptive studies. Conclusion: The systematic review showed that double and triple ARV therapy is superior to monotherapy and that the longer the mother and her infant are exposed to ARV therapy the better the results are to prevent MTCT. Adverse events are always posing a challenge and as with any other medication, caregivers must be aware of potential adverse reactions. The National consolidated guidelines for the prevention of mother-to-child transmission of HIV (PMTCT) and the management of HIV in children, adolescents and adults April 2015 is based on evidence, but the policy itself does not include any reference to evidence.
- Format
- 228 leaves
- Format
- Publisher
- University of Fort Hare
- Publisher
- Faculty of Social Sciences and Humanities
- Language
- English
- Rights
- University of Fort Hare
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UFH Department of Psychology
| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | SOURCE1 | Final dissertation for printing 19 April 2017 CN.pdf | 2 MB | Adobe Acrobat PDF | View Details Download |