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Home >> Publications >> Loss to programme between HIV diagnosis and initiation of antiretroviral therapy in sub-Saharan Africa: systematic review and meta-analysis.

Publication

Author(s):

Mugglin C, Estill J, Wandeler G, Bender N, Egger M, Gsponer T, Keiser O; for IeDEA Southern Africa Collaboration.

Pub Title:

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

Pub Date:

Dec 31 2012

Pub Region(s):

Southern Africa

Journal Issue:

Epub

Page Number:
Epub

Journal:

Title: 
Tropical Medicine and International Health
Link: 
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-3156.2012.03089.x/abstract

PubMed: 22994151
Pub PDF: PDF icon 22994151.pdf

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.

© 2012 Blackwell Publishing Ltd.

PMID: 22994151 [PubMed - as supplied by publisher]

 

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Citation:

Mugglin C, Estill J, Wandeler G, Bender N, Egger M, Gsponer T, Keiser O; for IeDEA Southern Africa. Loss to programme between HIV diagnosis and initiation of antiretroviral therapy in sub-Saharan Africa: systematic review and meta-analysis. Trop Med Int Health. 2012 Sep 20. doi: 10.1111/j.1365-3156.2012.03089.x. [Epub ahead of print] PubMed PMID: 22994151.