# Prevention of mother-to-child transmission of HIV in the MENA region: A systematic review with comparative evidence from Sub-Saharan Africa

## TL;DR

This paper reviews strategies to prevent mother-to-child HIV transmission in the MENA region, drawing insights from Sub-Saharan Africa.

## Contribution

The study provides a systematic review of PMTCT in the MENA region, using comparative evidence from Sub-Saharan Africa due to limited local data.

## Key findings

- Antiretroviral therapy during pregnancy significantly reduces mother-to-child HIV transmission.
- Longer zidovudine prophylaxis and optimized feeding strategies improve PMTCT outcomes.
- Maternal genetics and non-ART factors also influence transmission dynamics.

## Abstract

•PMTCT remains a critical priority in the MENA region.•Antiretroviral therapy during pregnancy reduces MTCT rates.•Longer zidovudine prophylaxis lowers placental HIV expression.•Feeding strategies impact MTCT depending on maternal ART.•Maternal genetics and non-ART factors influence transmission.

PMTCT remains a critical priority in the MENA region.

Antiretroviral therapy during pregnancy reduces MTCT rates.

Longer zidovudine prophylaxis lowers placental HIV expression.

Feeding strategies impact MTCT depending on maternal ART.

Maternal genetics and non-ART factors influence transmission.

The Middle East and North Africa (MENA) region faces distinct challenges in addressing the HIV epidemic, including social stigma, limited surveillance data, and insufficient coverage of prevention services. Prevention of mother-to-child transmission (PMTCT) of HIV remains a critical public health priority, particularly in regions with rising HIV incidence and constrained health systems. We conducted a systematic review to assess the status of PMTCT in the MENA region, identify gaps in effective implementation, and summarize successful interventions and responses. Due to the scarcity of PMTCT studies originating from the MENA region, high-quality studies from Sub-Saharan Africa were also included to provide comparative and contextual evidence relevant to similar resource-limited settings. Electronic databases (PubMed, Web of Science, and Scopus) were searched for articles published up to March 2024, with no restrictions on study design. Methodological quality and risk of bias were assessed using validated tools. A total of 51 studies were included, comprising data from 32,180 HIV-infected mothers and 171,142 infants. The majority of evidence originated from Sub-Saharan Africa, with limited data available from the MENA region. Antiretroviral therapy during pregnancy, particularly highly active antiretroviral therapy (HAART) and lifelong antiretroviral therapy (Option B +), was consistently associated with substantial reductions in mother-to-child transmission (MTCT) rates. Longer duration of antenatal antiretroviral prophylaxis, appropriate infant antiretroviral regimens, and optimized infant-feeding strategies further contributed to improved outcomes. Non-antiretroviral interventions and maternal genetic factors also influenced transmission dynamics. Despite limited region-specific evidence, this review highlights effective PMTCT strategies that are potentially applicable to the MENA region when informed by comparative evidence from Sub-Saharan Africa. Strengthening access to comprehensive and context-adapted PMTCT services, simplifying treatment pathways, and addressing socio-cultural barriers are essential to reducing vertical HIV transmission in the MENA region.

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