SidaSubSaharaV1, Pmc, Corpus, bibRecord, 001F12

Loss to programme between HIV diagnosis and initiation of antiretroviral therapy in sub-Saharan Africa: Systematic review and meta-analysis

Identifieur interne : 001F12 ( Pmc/Corpus ); précédent : 001F11; suivant : 001F13

Loss to programme between HIV diagnosis and initiation of antiretroviral therapy in sub-Saharan Africa: Systematic review and meta-analysis

Auteurs : Catrina Mugglin ; Janne Estill ; Gilles Wandeler ; Nicole Bender ; Matthias Egger ; Thomas Gsponer ; Olivia Keiser

Source :

Tropical medicine & international health : TM & IH [ 1360-2276 ] ; 2012.

RBID : PMC:3895621

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

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.

Conclusions

Monitoring and care in the pre-ART time period needs improvement, with greater emphasis on patients not yet eligible for ART.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3895621

DOI: 10.1111/j.1365-3156.2012.03089.x
PubMed: 22994151
PubMed Central: 3895621

Links to Exploration step

PMC:3895621

Le document en format XML

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<author><name sortKey="Mugglin, Catrina" sort="Mugglin, Catrina" uniqKey="Mugglin C" first="Catrina" last="Mugglin">Catrina Mugglin</name>
<affiliation><nlm:aff id="A1">Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland</nlm:aff>
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<author><name sortKey="Estill, Janne" sort="Estill, Janne" uniqKey="Estill J" first="Janne" last="Estill">Janne Estill</name>
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<author><name sortKey="Wandeler, Gilles" sort="Wandeler, Gilles" uniqKey="Wandeler G" first="Gilles" last="Wandeler">Gilles Wandeler</name>
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<affiliation><nlm:aff id="A2">Infectious Diseases Clinic, University Hospital Bern, Bern, Switzerland</nlm:aff>
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<author><name sortKey="Bender, Nicole" sort="Bender, Nicole" uniqKey="Bender N" first="Nicole" last="Bender">Nicole Bender</name>
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<author><name sortKey="Egger, Matthias" sort="Egger, Matthias" uniqKey="Egger M" first="Matthias" last="Egger">Matthias Egger</name>
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<affiliation><nlm:aff id="A3">School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa</nlm:aff>
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<author><name sortKey="Gsponer, Thomas" sort="Gsponer, Thomas" uniqKey="Gsponer T" first="Thomas" last="Gsponer">Thomas Gsponer</name>
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<author><name sortKey="Keiser, Olivia" sort="Keiser, Olivia" uniqKey="Keiser O" first="Olivia" last="Keiser">Olivia Keiser</name>
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<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><nlm:aff id="A1">Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland</nlm:aff>
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<author><name sortKey="Estill, Janne" sort="Estill, Janne" uniqKey="Estill J" first="Janne" last="Estill">Janne Estill</name>
<affiliation><nlm:aff id="A1">Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Wandeler, Gilles" sort="Wandeler, Gilles" uniqKey="Wandeler G" first="Gilles" last="Wandeler">Gilles Wandeler</name>
<affiliation><nlm:aff id="A1">Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A2">Infectious Diseases Clinic, University Hospital Bern, Bern, Switzerland</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Bender, Nicole" sort="Bender, Nicole" uniqKey="Bender N" first="Nicole" last="Bender">Nicole Bender</name>
<affiliation><nlm:aff id="A1">Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Egger, Matthias" sort="Egger, Matthias" uniqKey="Egger M" first="Matthias" last="Egger">Matthias Egger</name>
<affiliation><nlm:aff id="A1">Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A3">School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Gsponer, Thomas" sort="Gsponer, Thomas" uniqKey="Gsponer T" first="Thomas" last="Gsponer">Thomas Gsponer</name>
<affiliation><nlm:aff id="A1">Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Keiser, Olivia" sort="Keiser, Olivia" uniqKey="Keiser O" first="Olivia" last="Keiser">Olivia Keiser</name>
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<series><title level="j">Tropical medicine & international health : TM & IH</title>
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<imprint><date when="2012">2012</date>
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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>
</TEI>
<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
  <pmc-dir>properties manuscript</pmc-dir>
  <front><journal-meta><journal-id journal-id-type="nlm-journal-id">9610576</journal-id>
<journal-id journal-id-type="pubmed-jr-id">20323</journal-id>
<journal-id journal-id-type="nlm-ta">Trop Med Int Health</journal-id>
<journal-id journal-id-type="iso-abbrev">Trop. Med. Int. Health</journal-id>
<journal-title-group><journal-title>Tropical medicine & international health : TM & IH</journal-title>
</journal-title-group>
<issn pub-type="ppub">1360-2276</issn>
<issn pub-type="epub">1365-3156</issn>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">22994151</article-id>
<article-id pub-id-type="pmc">3895621</article-id>
<article-id pub-id-type="doi">10.1111/j.1365-3156.2012.03089.x</article-id>
<article-id pub-id-type="manuscript">NIHMS494474</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
</subj-group>
</article-categories>
<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>
<award-id>U01 AI069924 || AI</award-id>
</award-group>
</funding-group>
</article-meta>
</front>
</pmc>
</record>

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	Le SIDA en Afrique subsaharienne (serveur d'exploration)
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Le SIDA en Afrique subsaharienne (serveur d'exploration)

Loss to programme between HIV diagnosis and initiation of antiretroviral therapy in sub-Saharan Africa: Systematic review and meta-analysis

Loss to programme between HIV diagnosis and initiation of antiretroviral therapy in sub-Saharan Africa: Systematic review and meta-analysis

Source :

Abstract

Links to Exploration step

Le document en format XML

Pour manipuler ce document sous Unix (Dilib)

Pour mettre un lien sur cette page dans le réseau Wicri

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