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Meta-Analysis
. 2020 Apr 1;34(5):761-776.
doi: 10.1097/QAD.0000000000002487.

Incident HIV among pregnant and breast-feeding women in sub-Saharan Africa: a systematic review and meta-analysis

Lauren A Graybill  1 , Margaret Kasaro  2 , Kellie Freeborn  3 , Jennifer S Walker  4 , Charles Poole  1 , Kimberly A Powers  1 , Katie R Mollan  1   5 , Nora E Rosenberg  6 , Sten H Vermund  7 , Wilbroad Mutale  8 , Benjamin H Chi  3
Affiliations
Meta-Analysis

Incident HIV among pregnant and breast-feeding women in sub-Saharan Africa: a systematic review and meta-analysis

Lauren A Graybill et al. AIDS. .

Abstract

Objectives: A previous meta-analysis reported high HIV incidence among pregnant and breast-feeding women in sub-Saharan Africa (SSA), but limited evidence of elevated risk of HIV acquisition during pregnancy or breast-feeding when compared with nonpregnant periods. The rapidly evolving HIV prevention and treatment landscape since publication of this review may have important implications for maternal HIV incidence.

Design: Systematic review and meta-analysis.

Methods: We searched four databases and abstracts from relevant conferences through 1 December 2018, for literature on maternal HIV incidence in SSA. We used random-effects meta-analysis to summarize incidence rates and ratios, and to estimate 95% prediction intervals. We evaluated potential sources of heterogeneity with random-effects meta-regression.

Results: Thirty-seven publications contributed 100 758 person-years of follow-up. The estimated average HIV incidence rate among pregnant and breast-feeding women was 3.6 per 100 person-years (95% prediction interval: 1.2--11.1), while the estimated average associations between pregnancy and risk of HIV acquisition, and breast-feeding and risk of HIV acquisition, were close to the null. Wide 95% prediction intervals around summary estimates highlighted the variability of HIV incidence across populations of pregnant and breast-feeding women in SSA. Average HIV incidence appeared associated with age, partner HIV status, and calendar time. Average incidence was highest among studies conducted pre-2010 (4.1/100 person-years, 95% prediction interval: 1.1--12.2) and lowest among studies conducted post-2014 (2.1/100 person-years, 95% prediction interval: 0.7--6.5).

Conclusion: Substantial HIV incidence among pregnant and breast-feeding women in SSA, even in the current era of combination HIV prevention and treatment, underscores the need for prevention tailored to high-risk pregnant and breast-feeding women.

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Conflict of interest statement

Conflict of Interest Statement: We declare no competing interests.

Figures

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Figure 1.
Study Selection Flowchart
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