Loss to programme between HIV diagnosis and initiation of antiretroviral therapy in sub-Saharan Africa: systematic review and meta-analysis
Identifieur interne : 003A23 ( Main/Curation ); précédent : 003A22; suivant : 003A24Loss to programme between HIV diagnosis and initiation of antiretroviral therapy in sub-Saharan Africa: systematic review and meta-analysis
Auteurs : Catrina Mugglin [Suisse] ; Janne Estill [Suisse] ; Gilles Wandeler [Suisse] ; Nicole Bender [Suisse] ; Matthias Egger [Suisse, Afrique du Sud] ; Thomas Gsponer [Suisse] ; Olivia Keiser [Suisse]Source :
- TM & IH. Tropical medicine & international health [ 1360-2276 ] ; 2012.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Mortalité.
English descriptors
- KwdEn :
Abstract
OBJECTIVES To assess the proportion of patients lost to programme (died, lost to follow-up, transferred out) between HIV diagnosis and start of antiretroviral therapy (ART) in sub-Saharan Africa, and determine factors associated with loss to programme. METHODS Systematic review and meta-analysis. We searched PubMed and EMBASE databases for studies in adults. Outcomes were the percentage of patients dying before starting ART, the percentage lost to follow-up, the percentage with a CD4 cell count, the distribution of first CD4 counts and the percentage of eligible patients starting ART. Data were combined using random-effects meta-analysis. RESULTS Twenty-nine studies from sub-Saharan Africa including 148 912 patients were analysed. Six studies covered the whole period from HIV diagnosis to ART start. Meta-analysis of these studies showed that of the 100 patients with a positive HIV test, 72 (95% CI 60-84) had a CD4 cell count measured, 40 (95% CI 26-55) were eligible for ART and 25 (95% CI 13-37) started ART. There was substantial heterogeneity between studies (P < 0.0001). Median CD4 cell count at presentation ranged from 154 to 274 cells/μl. Patients eligible for ART were less likely to become lost to programme (25% vs. 54%, P < 0.0001), but eligible patients were more likely to die (11% vs. 5%, P < 0.0001) than ineligible patients. Loss to programme was higher in men, in patients with low CD4 cell counts and low socio-economic status and in recent time periods. CONCLUSIONS Monitoring and care in the pre-ART time period need improvement, with greater emphasis on patients not yet eligible for ART.
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Preventive Medicine (ISPM), University of Bern</s1><s2>Bern</s2><s3>CHE</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Suisse</country><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region><settlement type="city">Berne</settlement></placeName><orgName type="university">Université de Berne</orgName></affiliation></author><author><name sortKey="Estill, Janne" sort="Estill, Janne" uniqKey="Estill J" first="Janne" last="Estill">Janne Estill</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern</s1><s2>Bern</s2><s3>CHE</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Suisse</country><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region><settlement type="city">Berne</settlement></placeName><orgName type="university">Université de Berne</orgName></affiliation></author><author><name sortKey="Wandeler, Gilles" sort="Wandeler, Gilles" uniqKey="Wandeler G" first="Gilles" last="Wandeler">Gilles Wandeler</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern</s1><s2>Bern</s2><s3>CHE</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Suisse</country><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region><settlement type="city">Berne</settlement></placeName><orgName type="university">Université de Berne</orgName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Department of Infectious Diseases, University Hospital Bern</s1><s2>Bern</s2><s3>CHE</s3><sZ>3 aut.</sZ></inist:fA14><country>Suisse</country><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region></placeName></affiliation></author><author><name sortKey="Bender, Nicole" sort="Bender, Nicole" uniqKey="Bender N" first="Nicole" last="Bender">Nicole Bender</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern</s1><s2>Bern</s2><s3>CHE</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Suisse</country><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region><settlement type="city">Berne</settlement></placeName><orgName type="university">Université de Berne</orgName></affiliation></author><author><name sortKey="Egger, Matthias" sort="Egger, Matthias" uniqKey="Egger M" first="Matthias" last="Egger">Matthias Egger</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern</s1><s2>Bern</s2><s3>CHE</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Suisse</country><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region><settlement type="city">Berne</settlement></placeName><orgName type="university">Université de Berne</orgName></affiliation><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>School of Public Health and Family Medicine, University of Cape Town</s1><s2>Cape Town</s2><s3>ZAF</s3><sZ>5 aut.</sZ></inist:fA14><country>Afrique du Sud</country><wicri:noRegion>Cape Town</wicri:noRegion></affiliation></author><author><name sortKey="Gsponer, Thomas" sort="Gsponer, Thomas" uniqKey="Gsponer T" first="Thomas" last="Gsponer">Thomas Gsponer</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern</s1><s2>Bern</s2><s3>CHE</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Suisse</country><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region><settlement type="city">Berne</settlement></placeName><orgName type="university">Université de Berne</orgName></affiliation></author><author><name sortKey="Keiser, Olivia" sort="Keiser, Olivia" uniqKey="Keiser O" first="Olivia" last="Keiser">Olivia Keiser</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern</s1><s2>Bern</s2><s3>CHE</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Suisse</country><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region><settlement type="city">Berne</settlement></placeName><orgName type="university">Université de Berne</orgName></affiliation></author></analytic><series><title level="j" type="main">TM & IH. Tropical medicine & international health</title><title level="j" type="abbreviated">TM IH, Trop. med. int. health</title><idno type="ISSN">1360-2276</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">TM & IH. Tropical medicine & international health</title><title level="j" type="abbreviated">TM IH, Trop. med. int. health</title><idno type="ISSN">1360-2276</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>AIDS</term><term>Antiretroviral agent</term><term>Antiviral</term><term>Bibliographic review</term><term>Chemotherapy</term><term>Diagnosis</term><term>Genetic linkage</term><term>Human immunodeficiency virus</term><term>Mortality</term><term>Prognosis</term><term>Sub-Saharan Africa</term><term>Tropical medicine</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>SIDA</term><term>Antiviral</term><term>Chimiothérapie</term><term>Diagnostic</term><term>Antirétroviral</term><term>Virus immunodéficience humaine</term><term>Afrique subsaharienne</term><term>Revue bibliographique</term><term>Liaison génétique</term><term>Mortalité</term><term>Médecine tropicale</term><term>Pronostic</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Mortalité</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">OBJECTIVES To assess the proportion of patients lost to programme (died, lost to follow-up, transferred out) between HIV diagnosis and start of antiretroviral therapy (ART) in sub-Saharan Africa, and determine factors associated with loss to programme. METHODS Systematic review and meta-analysis. We searched PubMed and EMBASE databases for studies in adults. Outcomes were the percentage of patients dying before starting ART, the percentage lost to follow-up, the percentage with a CD4 cell count, the distribution of first CD4 counts and the percentage of eligible patients starting ART. Data were combined using random-effects meta-analysis. RESULTS Twenty-nine studies from sub-Saharan Africa including 148 912 patients were analysed. Six studies covered the whole period from HIV diagnosis to ART start. Meta-analysis of these studies showed that of the 100 patients with a positive HIV test, 72 (95% CI 60-84) had a CD4 cell count measured, 40 (95% CI 26-55) were eligible for ART and 25 (95% CI 13-37) started ART. There was substantial heterogeneity between studies (P < 0.0001). Median CD4 cell count at presentation ranged from 154 to 274 cells/μl. Patients eligible for ART were less likely to become lost to programme (25% vs. 54%, P < 0.0001), but eligible patients were more likely to die (11% vs. 5%, P < 0.0001) than ineligible patients. Loss to programme was higher in men, in patients with low CD4 cell counts and low socio-economic status and in recent time periods. CONCLUSIONS Monitoring and care in the pre-ART time period need improvement, with greater emphasis on patients not yet eligible for ART.</div></front></TEI><double idat="1360-2276:2012:Mugglin C:loss:to:programme"><INIST><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en" level="a">Loss to programme between HIV diagnosis and initiation of antiretroviral therapy in sub-Saharan Africa: systematic review and meta-analysis</title><author><name sortKey="Mugglin, Catrina" sort="Mugglin, Catrina" uniqKey="Mugglin C" first="Catrina" last="Mugglin">Catrina Mugglin</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern</s1><s2>Bern</s2><s3>CHE</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Suisse</country><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region><settlement type="city">Berne</settlement></placeName><orgName type="university">Université de Berne</orgName></affiliation></author><author><name sortKey="Estill, Janne" sort="Estill, Janne" uniqKey="Estill J" first="Janne" last="Estill">Janne Estill</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern</s1><s2>Bern</s2><s3>CHE</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Suisse</country><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region><settlement type="city">Berne</settlement></placeName><orgName type="university">Université de Berne</orgName></affiliation></author><author><name sortKey="Wandeler, Gilles" sort="Wandeler, Gilles" uniqKey="Wandeler G" first="Gilles" last="Wandeler">Gilles Wandeler</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern</s1><s2>Bern</s2><s3>CHE</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Suisse</country><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region><settlement type="city">Berne</settlement></placeName><orgName type="university">Université de Berne</orgName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Department of Infectious Diseases, University Hospital Bern</s1><s2>Bern</s2><s3>CHE</s3><sZ>3 aut.</sZ></inist:fA14><country>Suisse</country><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region></placeName></affiliation></author><author><name sortKey="Bender, Nicole" sort="Bender, Nicole" uniqKey="Bender N" first="Nicole" last="Bender">Nicole Bender</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern</s1><s2>Bern</s2><s3>CHE</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Suisse</country><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region><settlement type="city">Berne</settlement></placeName><orgName type="university">Université de Berne</orgName></affiliation></author><author><name sortKey="Egger, Matthias" sort="Egger, Matthias" uniqKey="Egger M" first="Matthias" last="Egger">Matthias Egger</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern</s1><s2>Bern</s2><s3>CHE</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Suisse</country><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region><settlement type="city">Berne</settlement></placeName><orgName type="university">Université de Berne</orgName></affiliation><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>School of Public Health and Family Medicine, University of Cape Town</s1><s2>Cape Town</s2><s3>ZAF</s3><sZ>5 aut.</sZ></inist:fA14><country>Afrique du Sud</country><wicri:noRegion>Cape Town</wicri:noRegion></affiliation></author><author><name sortKey="Gsponer, Thomas" sort="Gsponer, Thomas" uniqKey="Gsponer T" first="Thomas" last="Gsponer">Thomas Gsponer</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern</s1><s2>Bern</s2><s3>CHE</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Suisse</country><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region><settlement type="city">Berne</settlement></placeName><orgName type="university">Université de Berne</orgName></affiliation></author><author><name sortKey="Keiser, Olivia" sort="Keiser, Olivia" uniqKey="Keiser O" first="Olivia" last="Keiser">Olivia Keiser</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern</s1><s2>Bern</s2><s3>CHE</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Suisse</country><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region><settlement type="city">Berne</settlement></placeName><orgName type="university">Université de Berne</orgName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">13-0002885</idno><date when="2012">2012</date><idno type="stanalyst">PASCAL 13-0002885 INIST</idno><idno type="RBID">Pascal:13-0002885</idno><idno type="wicri:Area/PascalFrancis/Corpus">000125</idno><idno type="wicri:Area/PascalFrancis/Curation">000769</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">000148</idno><idno type="wicri:explorRef" wicri:stream="PascalFrancis" wicri:step="Checkpoint">000148</idno><idno type="wicri:doubleKey">1360-2276:2012:Mugglin C:loss:to:programme</idno><idno type="wicri:Area/Main/Merge">003A49</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Loss to programme between HIV diagnosis and initiation of antiretroviral therapy in sub-Saharan Africa: systematic review and meta-analysis</title><author><name sortKey="Mugglin, Catrina" sort="Mugglin, Catrina" uniqKey="Mugglin C" first="Catrina" last="Mugglin">Catrina Mugglin</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern</s1><s2>Bern</s2><s3>CHE</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Suisse</country><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region><settlement type="city">Berne</settlement></placeName><orgName type="university">Université de Berne</orgName></affiliation></author><author><name sortKey="Estill, Janne" sort="Estill, Janne" uniqKey="Estill J" first="Janne" last="Estill">Janne Estill</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern</s1><s2>Bern</s2><s3>CHE</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Suisse</country><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region><settlement type="city">Berne</settlement></placeName><orgName type="university">Université de Berne</orgName></affiliation></author><author><name sortKey="Wandeler, Gilles" sort="Wandeler, Gilles" uniqKey="Wandeler G" first="Gilles" last="Wandeler">Gilles Wandeler</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern</s1><s2>Bern</s2><s3>CHE</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Suisse</country><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region><settlement type="city">Berne</settlement></placeName><orgName type="university">Université de Berne</orgName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Department of Infectious Diseases, University Hospital Bern</s1><s2>Bern</s2><s3>CHE</s3><sZ>3 aut.</sZ></inist:fA14><country>Suisse</country><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region></placeName></affiliation></author><author><name sortKey="Bender, Nicole" sort="Bender, Nicole" uniqKey="Bender N" first="Nicole" last="Bender">Nicole Bender</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern</s1><s2>Bern</s2><s3>CHE</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Suisse</country><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region><settlement type="city">Berne</settlement></placeName><orgName type="university">Université de Berne</orgName></affiliation></author><author><name sortKey="Egger, Matthias" sort="Egger, Matthias" uniqKey="Egger M" first="Matthias" last="Egger">Matthias Egger</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern</s1><s2>Bern</s2><s3>CHE</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Suisse</country><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region><settlement type="city">Berne</settlement></placeName><orgName type="university">Université de Berne</orgName></affiliation><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>School of Public Health and Family Medicine, University of Cape Town</s1><s2>Cape Town</s2><s3>ZAF</s3><sZ>5 aut.</sZ></inist:fA14><country>Afrique du Sud</country><wicri:noRegion>Cape Town</wicri:noRegion></affiliation></author><author><name sortKey="Gsponer, Thomas" sort="Gsponer, Thomas" uniqKey="Gsponer T" first="Thomas" last="Gsponer">Thomas Gsponer</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern</s1><s2>Bern</s2><s3>CHE</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Suisse</country><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region><settlement type="city">Berne</settlement></placeName><orgName type="university">Université de Berne</orgName></affiliation></author><author><name sortKey="Keiser, Olivia" sort="Keiser, Olivia" uniqKey="Keiser O" first="Olivia" last="Keiser">Olivia Keiser</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern</s1><s2>Bern</s2><s3>CHE</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Suisse</country><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region><settlement type="city">Berne</settlement></placeName><orgName type="university">Université de Berne</orgName></affiliation></author></analytic><series><title level="j" type="main">TM & IH. Tropical medicine & international health</title><title level="j" type="abbreviated">TM IH, Trop. med. int. health</title><idno type="ISSN">1360-2276</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">TM & IH. Tropical medicine & international health</title><title level="j" type="abbreviated">TM IH, Trop. med. int. health</title><idno type="ISSN">1360-2276</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>AIDS</term><term>Antiretroviral agent</term><term>Antiviral</term><term>Bibliographic review</term><term>Chemotherapy</term><term>Diagnosis</term><term>Genetic linkage</term><term>Human immunodeficiency virus</term><term>Mortality</term><term>Prognosis</term><term>Sub-Saharan Africa</term><term>Tropical medicine</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>SIDA</term><term>Antiviral</term><term>Chimiothérapie</term><term>Diagnostic</term><term>Antirétroviral</term><term>Virus immunodéficience humaine</term><term>Afrique subsaharienne</term><term>Revue bibliographique</term><term>Liaison génétique</term><term>Mortalité</term><term>Médecine tropicale</term><term>Pronostic</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Mortalité</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">OBJECTIVES To assess the proportion of patients lost to programme (died, lost to follow-up, transferred out) between HIV diagnosis and start of antiretroviral therapy (ART) in sub-Saharan Africa, and determine factors associated with loss to programme. METHODS Systematic review and meta-analysis. We searched PubMed and EMBASE databases for studies in adults. Outcomes were the percentage of patients dying before starting ART, the percentage lost to follow-up, the percentage with a CD4 cell count, the distribution of first CD4 counts and the percentage of eligible patients starting ART. Data were combined using random-effects meta-analysis. RESULTS Twenty-nine studies from sub-Saharan Africa including 148 912 patients were analysed. Six studies covered the whole period from HIV diagnosis to ART start. Meta-analysis of these studies showed that of the 100 patients with a positive HIV test, 72 (95% CI 60-84) had a CD4 cell count measured, 40 (95% CI 26-55) were eligible for ART and 25 (95% CI 13-37) started ART. There was substantial heterogeneity between studies (P < 0.0001). Median CD4 cell count at presentation ranged from 154 to 274 cells/μl. Patients eligible for ART were less likely to become lost to programme (25% vs. 54%, P < 0.0001), but eligible patients were more likely to die (11% vs. 5%, P < 0.0001) than ineligible patients. Loss to programme was higher in men, in patients with low CD4 cell counts and low socio-economic status and in recent time periods. CONCLUSIONS Monitoring and care in the pre-ART time period need improvement, with greater emphasis on patients not yet eligible for ART.</div></front></TEI></INIST><PMC><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Loss to programme between HIV diagnosis and initiation of antiretroviral therapy in sub-Saharan Africa: Systematic review and meta-analysis</title><author><name sortKey="Mugglin, Catrina" sort="Mugglin, Catrina" uniqKey="Mugglin C" first="Catrina" last="Mugglin">Catrina Mugglin</name><affiliation wicri:level="4"><nlm:aff id="A1">Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern</wicri:regionArea><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region><settlement type="city">Berne</settlement></placeName><orgName type="university">Université de Berne</orgName></affiliation></author><author><name sortKey="Estill, Janne" sort="Estill, Janne" uniqKey="Estill J" first="Janne" last="Estill">Janne Estill</name><affiliation wicri:level="4"><nlm:aff id="A1">Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern</wicri:regionArea><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region><settlement type="city">Berne</settlement></placeName><orgName type="university">Université de Berne</orgName></affiliation></author><author><name sortKey="Wandeler, Gilles" sort="Wandeler, Gilles" uniqKey="Wandeler G" first="Gilles" last="Wandeler">Gilles Wandeler</name><affiliation wicri:level="4"><nlm:aff id="A1">Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern</wicri:regionArea><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region><settlement type="city">Berne</settlement></placeName><orgName type="university">Université de Berne</orgName></affiliation><affiliation wicri:level="3"><nlm:aff id="A2">Infectious Diseases Clinic, University Hospital Bern, Bern, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Infectious Diseases Clinic, University Hospital Bern, Bern</wicri:regionArea><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region></placeName></affiliation></author><author><name sortKey="Bender, Nicole" sort="Bender, Nicole" uniqKey="Bender N" first="Nicole" last="Bender">Nicole Bender</name><affiliation wicri:level="4"><nlm:aff id="A1">Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern</wicri:regionArea><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region><settlement type="city">Berne</settlement></placeName><orgName type="university">Université de Berne</orgName></affiliation></author><author><name sortKey="Egger, Matthias" sort="Egger, Matthias" uniqKey="Egger M" first="Matthias" last="Egger">Matthias Egger</name><affiliation wicri:level="4"><nlm:aff id="A1">Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern</wicri:regionArea><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region><settlement type="city">Berne</settlement></placeName><orgName type="university">Université de Berne</orgName></affiliation><affiliation wicri:level="1"><nlm:aff id="A3">School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa</nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>School of Public Health and Family Medicine, University of Cape Town, Cape Town</wicri:regionArea><wicri:noRegion>Cape Town</wicri:noRegion></affiliation></author><author><name sortKey="Gsponer, Thomas" sort="Gsponer, Thomas" uniqKey="Gsponer T" first="Thomas" last="Gsponer">Thomas Gsponer</name><affiliation wicri:level="4"><nlm:aff id="A1">Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern</wicri:regionArea><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region><settlement type="city">Berne</settlement></placeName><orgName type="university">Université de Berne</orgName></affiliation></author><author><name sortKey="Keiser, Olivia" sort="Keiser, Olivia" uniqKey="Keiser O" first="Olivia" last="Keiser">Olivia Keiser</name><affiliation wicri:level="4"><nlm:aff id="A1">Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern</wicri:regionArea><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region><settlement type="city">Berne</settlement></placeName><orgName type="university">Université de Berne</orgName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">22994151</idno><idno type="pmc">3895621</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3895621</idno><idno type="RBID">PMC:3895621</idno><idno type="doi">10.1111/j.1365-3156.2012.03089.x</idno><date when="2012">2012</date><idno type="wicri:Area/Pmc/Corpus">001F12</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001F12</idno><idno type="wicri:Area/Pmc/Curation">001F11</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">001F11</idno><idno type="wicri:Area/Pmc/Checkpoint">001D71</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">001D71</idno><idno type="wicri:Area/Ncbi/Merge">001948</idno><idno type="wicri:Area/Ncbi/Curation">001948</idno><idno type="wicri:Area/Ncbi/Checkpoint">001948</idno><idno type="wicri:doubleKey">1360-2276:2012:Mugglin C:loss:to:programme</idno><idno type="wicri:Area/Main/Merge">003316</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Loss to programme between HIV diagnosis and initiation of antiretroviral therapy in sub-Saharan Africa: Systematic review and meta-analysis</title><author><name sortKey="Mugglin, Catrina" sort="Mugglin, Catrina" uniqKey="Mugglin C" first="Catrina" last="Mugglin">Catrina Mugglin</name><affiliation wicri:level="4"><nlm:aff id="A1">Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern</wicri:regionArea><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region><settlement type="city">Berne</settlement></placeName><orgName type="university">Université de Berne</orgName></affiliation></author><author><name sortKey="Estill, Janne" sort="Estill, Janne" uniqKey="Estill J" first="Janne" last="Estill">Janne Estill</name><affiliation wicri:level="4"><nlm:aff id="A1">Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern</wicri:regionArea><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region><settlement type="city">Berne</settlement></placeName><orgName type="university">Université de Berne</orgName></affiliation></author><author><name sortKey="Wandeler, Gilles" sort="Wandeler, Gilles" uniqKey="Wandeler G" first="Gilles" last="Wandeler">Gilles Wandeler</name><affiliation wicri:level="4"><nlm:aff id="A1">Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern</wicri:regionArea><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region><settlement type="city">Berne</settlement></placeName><orgName type="university">Université de Berne</orgName></affiliation><affiliation wicri:level="3"><nlm:aff id="A2">Infectious Diseases Clinic, University Hospital Bern, Bern, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Infectious Diseases Clinic, University Hospital Bern, Bern</wicri:regionArea><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region></placeName></affiliation></author><author><name sortKey="Bender, Nicole" sort="Bender, Nicole" uniqKey="Bender N" first="Nicole" last="Bender">Nicole Bender</name><affiliation wicri:level="4"><nlm:aff id="A1">Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern</wicri:regionArea><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region><settlement type="city">Berne</settlement></placeName><orgName type="university">Université de Berne</orgName></affiliation></author><author><name sortKey="Egger, Matthias" sort="Egger, Matthias" uniqKey="Egger M" first="Matthias" last="Egger">Matthias Egger</name><affiliation wicri:level="4"><nlm:aff id="A1">Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern</wicri:regionArea><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region><settlement type="city">Berne</settlement></placeName><orgName type="university">Université de Berne</orgName></affiliation><affiliation wicri:level="1"><nlm:aff id="A3">School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa</nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>School of Public Health and Family Medicine, University of Cape Town, Cape Town</wicri:regionArea><wicri:noRegion>Cape Town</wicri:noRegion></affiliation></author><author><name sortKey="Gsponer, Thomas" sort="Gsponer, Thomas" uniqKey="Gsponer T" first="Thomas" last="Gsponer">Thomas Gsponer</name><affiliation wicri:level="4"><nlm:aff id="A1">Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern</wicri:regionArea><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region><settlement type="city">Berne</settlement></placeName><orgName type="university">Université de Berne</orgName></affiliation></author><author><name sortKey="Keiser, Olivia" sort="Keiser, Olivia" uniqKey="Keiser O" first="Olivia" last="Keiser">Olivia Keiser</name><affiliation wicri:level="4"><nlm:aff id="A1">Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern</wicri:regionArea><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region><settlement type="city">Berne</settlement></placeName><orgName type="university">Université de Berne</orgName></affiliation></author></analytic><series><title level="j">Tropical medicine & international health : TM & IH</title><idno type="ISSN">1360-2276</idno><idno type="eISSN">1365-3156</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Objectives</title><p id="P1">To assess the proportion of patients lost to programme (died, lost to follow-up, transferred-out) between HIV diagnosis and start of antiretroviral therapy (ART) in sub-Saharan Africa, and determine factors associated with loss to programme.</p></sec><sec id="S2"><title>Methods</title><p id="P2">Systematic review and meta-analysis. We searched PubMed and EMBASE databases for studies in adults. Outcomes were the percentage of patients dying before starting ART, the percentage lost to follow-up, the percentage with a CD4 cell count, the distribution of first CD4 counts and the percentage of eligible patients starting ART. Data were combined using random-effects meta-analysis.</p></sec><sec id="S3"><title>Results</title><p id="P3">29 studies from sub-Saharan Africa including 148,912 patients were analysed. 6 studies covered the whole period from HIV diagnosis to ART start. Meta-analysis of these studies showed that of 100 patients with a positive HIV test, 72 (95% CI 60–84) had a CD4 cell count measured, 40 (95% CI 26–55) were eligible for ART and 25 (95% CI 13–37) started ART. There was substantial heterogeneity between studies (p<0.0001). Median CD4 cell count at presentation ranged from 154 cells/μl to 274 cells/μl. Patients eligible for ART were less likely to become lost to programme (25% versus 54%, p<0.0001) but eligible patients were more likely to die (11% versus 5%, p<0.0001) than ineligible patients. Loss to programme was higher in men, in patients with low CD4 cell counts and low socio-economic status, and in recent time periods.</p></sec><sec id="S4"><title>Conclusions</title><p id="P4">Monitoring and care in the pre-ART time period needs improvement, with greater emphasis on patients not yet eligible for ART.</p></sec></div></front></TEI></PMC></double></record>Pour manipuler ce document sous Unix (Dilib)
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