A Systematic Review to Explore the Factors Related to Parent to Child Transmission of HIV, Survival and Treatment Provision of Children with HIV in India

Introduction: There are a multitude of factors that impact the transmission of HIV from parent to child and the subsequent survival of infected children. Changing dynamics in HIV transmission have led to an increase in the number of children living with HIV in India. This review synthesizes the evidence related to transmission of HIV to children, survival and treatment provision among children living with HIV. Methods: A systematic search was conducted in MEDLINE, IndMed, Web of Science, Google Scholar and major journals related to HIV/AIDS to identify relevant studies published between 1992 and 2015. Inclusion criteria included studies related to parent to child transmission of HIV, treatment of children living with HIV and survival of children living with HIV. One of the authors reviewed the studies and extracted the data in a pre-coded extraction sheet. Results: Thirty-three studies were included in the review. HIV transmission rate from parent to Child who received nevirapine prophylaxis ranged from 2.1% to 27.3%. Extended dose regimen of nevirapine prophylaxis was found to be more effective than the single dose regimen. Adherence to ART ranged from 65% to 95%. Adherence varied depending upon the level of health care facility. Both social and medical factors were associated with non-adherence. CD 4 count at the time of diagnosis and delayed age at HIV diagnosis were important predictors of survival. Conclusion: Shift in policy to provide option B regimen is yielding better results. If the age at diagnosis could be reduced further, it would increase the survival of children living with HIV. The program needs to increase access to the health care facilities.