Interventions to increase early infant diagnosis of HIV infection: A systematic review and meta-analysis

Objectives Early infant diagnosis (EID) of HIV infection increases antiretroviral therapy initiation, which reduces pediatric HIV-related morbidity and mortality. This review aims to critically appraise the effects of interventions to increase uptake of early infant diagnosis. Design This is a systematic review and meta-analysis of interventions to increase the EID of HIV infection. We searched PubMed, EMBASE, CINAHL, and PsycINFO to identify eligible studies from inception of these databases to June 18, 2020. EID Uptake at 4-8 weeks of age was primary outcome assessed by the review. We conducted meta-analysis, using data from reports of included studies. The measure of the effect of dichotomous data was odds ratios (OR), with a 95% confidence interval. The grading of recommendations assessment, development, and evaluation (GRADE) approach was used to assess quality of evidence. Settings The review was not limited by time of publication or setting in which the studies conducted. Participants HIV-exposed infants were participants. Results Database search and review of reference lists yielded 923 unique titles, out of which 16 studies involving 13,822 HIV exposed infants (HEI) were eligible for inclusion in the review. Included studies were published between 2014 and 2019 from Kenya, Nigeria, Uganda, South Africa, Zambia, and India. Of the 16 included studies, nine (experimental) and seven (observational) studies included had low to moderate risk of bias. The studies evaluated eHealth services (n = 6), service improvement (n = 4), service integration (n = 2), behavioral interventions (n = 3), and male partner involvement (n = 1). Overall, there was no evidence that any of the evaluated interventions, including eHealth, health systems improvements, integration of EID, conditional cash transfer, mother-to-mother support, or partner (male) involvement, was effective in increasing uptake of EID at 4-8 weeks of age. There was also no evidence that any intervention was effective in increasing HIV-infected infants' identification at 4-8 weeks of age. Conclusions There is limited evidence to support the hypothesis that interventions implemented to increase uptake of EID were effective at 4-8 weeks of life. Further research is required to identify effective interventions that increase early infant diagnosis of HIV at 4-8 weeks of age.