Loss to programme between HIV diagnosis and initiation of antiretroviral therapy in sub-Saharan Africa: Systematic review and meta-analysis
Identifieur interne : 001948 ( Ncbi/Merge ); précédent : 001947; suivant : 001949Loss 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 :
- Tropical medicine & international health : TM & IH [ 1360-2276 ] ; 2012.
Abstract
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.
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.
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.
Monitoring and care in the pre-ART time period needs improvement, with greater emphasis on patients not yet eligible for ART.
Url:
DOI: 10.1111/j.1365-3156.2012.03089.x
PubMed: 22994151
PubMed Central: 3895621
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<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>
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<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
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<title-group><article-title>Loss to programme between HIV diagnosis and initiation of antiretroviral therapy in sub-Saharan Africa: Systematic review and meta-analysis</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Mugglin</surname>
<given-names>Catrina</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Estill</surname>
<given-names>Janne</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Wandeler</surname>
<given-names>Gilles</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
<xref ref-type="aff" rid="A2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Bender</surname>
<given-names>Nicole</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Egger</surname>
<given-names>Matthias</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
<xref ref-type="aff" rid="A3">3</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Gsponer</surname>
<given-names>Thomas</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Keiser</surname>
<given-names>Olivia</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<on-behalf-of>for IeDEA Southern Africa</on-behalf-of>
</contrib-group>
<aff id="A1"><label>1</label>
Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland</aff>
<aff id="A2"><label>2</label>
Infectious Diseases Clinic, University Hospital Bern, Bern, Switzerland</aff>
<aff id="A3"><label>3</label>
School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa</aff>
<author-notes><corresp id="FN1">Corresponding authors: Olivia Keiser and Catrina Mugglin, Institute of Social and Preventive Medicine (ISPM), University of Bern, Finkenhubelweg 11, CH-3012 Bern, Switzerland. Phone +41 31 631 35 15; Fax +41 31 631 35 20; <email>okeiser@ispm.unibe.ch</email>
, <email>catrina.mugglin@gmail.com</email>
</corresp>
</author-notes>
<pub-date pub-type="nihms-submitted"><day>16</day>
<month>11</month>
<year>2013</year>
</pub-date>
<pub-date pub-type="epub"><day>20</day>
<month>9</month>
<year>2012</year>
</pub-date>
<pub-date pub-type="ppub"><month>12</month>
<year>2012</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>20</day>
<month>1</month>
<year>2014</year>
</pub-date>
<volume>17</volume>
<issue>12</issue>
<fpage>1509</fpage>
<lpage>1520</lpage>
<pmc-comment>elocation-id from pubmed: 10.1111/j.1365-3156.2012.03089.x</pmc-comment>
<abstract><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>
</abstract>
<kwd-group><kwd>pre-ART</kwd>
<kwd>linkage to care</kwd>
<kwd>sub-Saharan Africa</kwd>
<kwd>mortality</kwd>
<kwd>loss to follow-up</kwd>
</kwd-group>
<funding-group><award-group><funding-source country="United States">National Institute of Allergy and Infectious Diseases Extramural Activities : NIAID</funding-source>
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<affiliations><list><country><li>Afrique du Sud</li>
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<name sortKey="Bender, Nicole" sort="Bender, Nicole" uniqKey="Bender N" first="Nicole" last="Bender">Nicole Bender</name>
<name sortKey="Egger, Matthias" sort="Egger, Matthias" uniqKey="Egger M" first="Matthias" last="Egger">Matthias Egger</name>
<name sortKey="Estill, Janne" sort="Estill, Janne" uniqKey="Estill J" first="Janne" last="Estill">Janne Estill</name>
<name sortKey="Gsponer, Thomas" sort="Gsponer, Thomas" uniqKey="Gsponer T" first="Thomas" last="Gsponer">Thomas Gsponer</name>
<name sortKey="Keiser, Olivia" sort="Keiser, Olivia" uniqKey="Keiser O" first="Olivia" last="Keiser">Olivia Keiser</name>
<name sortKey="Wandeler, Gilles" sort="Wandeler, Gilles" uniqKey="Wandeler G" first="Gilles" last="Wandeler">Gilles Wandeler</name>
<name sortKey="Wandeler, Gilles" sort="Wandeler, Gilles" uniqKey="Wandeler G" first="Gilles" last="Wandeler">Gilles Wandeler</name>
</country>
<country name="Afrique du Sud"><noRegion><name sortKey="Egger, Matthias" sort="Egger, Matthias" uniqKey="Egger M" first="Matthias" last="Egger">Matthias Egger</name>
</noRegion>
</country>
</tree>
</affiliations>
</record>
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