Table 3.

Meta-analytic results for infant HIV infection, comparing modes of delivery across study types and subpopulations.

	ECS versus vaginal delivery					ECS versus all other modes of delivery
	No. of articles	No. of effect sizes	No. of participants	OR (95% CI)	I2	No. of articles	No. of effect sizes	No. of participants	OR (95% CI)	I2
RCTs	1 [42]	1	385	0.2 (0.0–0.5)	N/Ac	–	–		–	–
Observational studies	13 [15–18,27,31,33,35,37,43,44,46,47]	24	16204	0.43 (0.30–0.63)	40.67	9 [15–17,27,31,33,44,46,47]	19	17638	0.47 (0.33–0.67)	31.26
Studies during the cART eraa	9 [17,18,20,26,32,35,36,41,45]	19	13719	0.45 (0.30–0.67)	21.89	5 [17,26,32,35,45]	15	15724	0.59 (0.37–0.93)	34.82
cART patients only	4 [17,18,33,47]	13	8823	0.82 (0.47–1.43)	0	3 [17,18,33]	12	12708	0.94 (0.59–1.51)	0
cART patients delivering at term only	1 [17]	5	3269	0.26 (0.62–1.45)	0	1 [17]	5	5242	0.72 (0.35–1.46)	0
Women with CD4+ cell count > 200 or VL < 400 only	2 [16,17]	5	4022	0.36 (0.17–0.79)	10.08	2 [16,17]	5	6314	0.46 (0.24–0.88)	0
Women with CD4+ cell count > 200 or VL < 400 delivering at term only	1 [17]	2	2782	0.59 (0.21–1.63)	0	1 [17]	2	4644	0.73 (0.29–1.80)	0
LMICs onlyb	5 [18,27,37,43,44]	6	2925	0.27 (0.16–0.45)	18.56	2 [27,44]	3	3016	0.34 (0.15–0.78)	67.32

cART, combination antiretroviral therapy; CI, confidence interval; ECS, elective c-section; LMIC, low-income/middle-income countries; OR, odds ratio; RCT, randomized controlled trial; VL, viral load.

^acART era was considered after 1996 or ART use in country.

^bCountries classified as lower income, lower-middle, or upper-middle income by the World Bank.

^cNot applicable, as meta-analysis was not conducted on the single RCT.