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Background: To assess the adherence to option B + antiretroviral therapy (ART) and associated factors in pregnant and breastfeeding women in Sub-Saharan Africa (SSA). Methods: We conducted a comprehensive search from 01st January 2012 to 03rd October 2022, across four databases: PubMed, Scopus, Proquest Central, and Index Medicus Africain, to identify studies focused on pregnant and/or breastfeeding women living with HIV and receiving option B+ ART in SSA. Studies reporting adherence data were included in the meta-analysis. Were excluded studies published before 01st January 2012, grey literature, systematic reviews, and meta-analysis studies. Articles selection and data extraction were performed independently by two reviewers. We evaluated pooled adherence and pooled association between various factors and adherence using a random-effects model. Results: Overall, 42 studies involving 15,158 participants across 15 countries contributed to the meta-analysis. The overall pooled adherence was 72.3% (95% CI: 68.2–76.1%). Having high education level (pooled odds ratio (OR): 2.25; 95% CI: 1.57–3.21), living in urban area (pooled OR: 1.75; 95% CI: 1.10–2.81), disclosing status to a family/partner (pooled OR: 1.74; 95% CI: 1.27–2.40), having a support system (pooled OR: 3.19; 95% CI: 1.89–5.36), receiving counseling (pooled OR: 3.97; 95% CI: 2.96–5.34), initiating ART at early clinical HIV stage (pooled OR: 2.22; 95% CI: 1.08–4.56), and having good knowledge on PMTCT/HIV (pooled OR: 2.71; 95% CI: 1.40–5.25) were factors significantly associated with adherence to option B + ART. Conclusions: Despite the implementation of option B+ ART, the level of adherence among pregnant and breastfeeding women in SSA falls short of meeting the critical thresholds for viral load suppression as outlined in the 95-95-95 objectives set for 2025. These objectives are integral for achieving HIV elimination, and in turn, preventing HIV mother-to-child transmission. To bridge this gap, urgent tailored interventions based on individual and structural factors are essential to enhance adherence within these subgroups of women. This targeted approach is crucial in striving towards the HIV elimination target in SSA. [ABSTRACT FROM AUTHOR]

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The Millennium Development Goals (MDGs) were defined in 2001, making poverty the central focus of the global political agenda. In response to MDG targets for health, new funding instruments called Global Health Initiatives were set up to target specific diseases, with an emphasis on "quick win" interventions, in order to show improvements by 2015. In 2005 the UN Millennium Project defined quick wins as simple, proven interventions with "very high potential short-term impact that can be immediately implemented", in contrast to "other interventions which are more complicated and will take a decade of effort or have delayed benefits". Although the terminology has evolved from "quick wins" to "quick impact initiatives" and then to "high impact interventions", the short-termism of the approach remains. This paper examines the merits and limitations of MDG indicators for assessing progress and their relationship to quick impact interventions. It then assesses specific health interventions through both the lens of time and their integration into health care services, and examines the role of health systems strengthening in support of the MDGs. We argue that fast-track interventions promoted by donors and Global Health Initiatives need to be complemented by mid- and long-term strategies, cutting across specific health problems. Implementing the MDGs is more than a process of "money changing hands". Combating poverty needs a radical overhaul of the partnership between rich and poor countries and between rich and poor people within countries. Les objectifs du Millénaire pour le développement (OMD), définis en 2001, ont placé la pauvreté au centre des préoccupations politiques mondiales. En réponse aux OMD de la santé, de nouveaux instruments de financement, appelés initiatives de santé mondiale, ont été créés pour cibler des maladies spécifiques avec des interventions à « gains rapides », afin d'obtenir des améliorations d'ici 2015. En 2005, le Projet Objectifs du Millénaire des Nations Unies a décrit les gains rapides comme des interventions simples et éprouvées avec « un impact potentiel très élevé à court terme et pouvant être appliquées immédiatement », contrairement à « d'autres interventions plus compliquées, qui demanderont dix ans d'efforts ou auront des bienfaits différés ». La terminologie a évolué de « gains rapides » à « initiatives à impact rapide », puis « interventions à fort impact », mais la nature à court terme de l'approche demeure. Cet article examine les mérites et les limites des indicateurs des OMD pour évaluer les progrès et leur lien avec les interventions à impact rapide. Il évalue ensuite des interventions de santé dans la perspective des délais et de leur intégration dans les services de santé, et analyse le rôle du renforcement des systèmes de santé à l'appui des OMD. Nous estimons qu'il faut compléter les interventions à court terme prônées par les donateurs et les initiatives de santé mondiale avec des stratégies à moyen et long terme qui dépasseront les problèmes spécifiques de santé. La réalisation des OMD est davantage qu'un « transfert de fonds ». La lutte contre la pauvreté requiert une refonte radicale du partenariat entre pays riches et pauvres, et entre riches et pauvres à l'intérieur des pays. Los Objetivos de Desarrollo del Milenio (ODM) definidos en 2001, centraron la agenda política mundial en la pobreza. En respuesta a los ODM en salud, se establecieron nuevos mecanismos de financiamiento, llamados Iniciativas Sanitarias Mundiales dirigidas a enfermedades específicas, con énfasis en intervenciones que produzcan resultados positivos rápidos, a fin de mostrar mejoras para el 2015. En 2005 el Proyecto del Milenio de las Naciones Unidas definió resultados positivos rápidos como intervenciones sencillas comprobadas con "un potencial muy alto de impacto a corto plazo que se puede implementar inmediatamente", a diferencia de "otras intervenciones que son más complicadas y requerirán una década de esfuerzos o tendrán beneficios atrasados". Aunque la terminología ha evolucionado de "resultados positivos rápidos" a "iniciativas de rápido impacto" y luego a "intervenciones de gran impacto", aún continúa siendo un enfoque de corto plazo. En este artículo se examinan los méritos y las limitaciones de los indicadores de los ODM para evaluar los avances y su relación con las intervenciones de rápido impacto. Se evalúan determinadas intervenciones en salud a lo largo del tiempo y su integración en los servicios de salud; además, se examina el rol de fortalecer los sistemas de salud para apoyar los ODM. Se arguye que las intervenciones que están en la "vía rápida", promovidas por donantes, y las Iniciativas Sanitarias Mundiales deben ser complementadas por estrategias de medio y largo plazo, que abarquen diversos problemas de salud. Realizar los ODM es más que una "transferencia de fondos". La lucha contra la pobreza requiere una revisión radical de las alianzas entre los países ricos y los pobres y entre ricos y pobres en esos países. [ABSTRACT FROM AUTHOR]