Retention of Adult Patients on Antiretroviral Therapy in Low- and Middle-Income Countries: Systematic Review and Meta-analysis 2008-2013.
Retention of Adult Patients on Antiretroviral Therapy in Low- and Middle-Income Countries: Systematic Review and Meta-analysis 2008-2013.
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DOI：
10.1097/qai.0000000000000553
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发表时间：
2015-05-01
期刊：
影响因子：
--
通讯作者：
Rosen S
中科院分区：
文献类型：
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作者：
Fox MP;Rosen S
我们之前发表了关于撒哈拉以南非洲一般成年人群开始抗逆转录病毒治疗后保留护理的系统评价。我们估计 2007 年至 2010 年出版物的 36 个月保留率为 73%。本报告将审查范围扩大到2008-2013年，并将其范围扩大到所有低收入和中等收入国家。我们检索了 2008 年 1 月 1 日至 2013 年 12 月 31 日期间的 PubMed、Embase、Cochrane Register 和 ISI Web of Science，以及 2008 年至 2013 年期间 AIDS 和 IAS 的摘要。我们使用简单平均值估算了各群组的保留率，并根据上次报告的时间插值了缺失时间。我们估计了低收入和中等收入国家在常规环境中接受一线 ART 治疗的患者的全因流失（死亡、失访）。我们发现了 123 篇论文和摘要，报告了 42 个国家 154 个患者队列和 1,554,773 名患者的保留情况。总体而言，已知未保留的所有患者中有 43% 已死亡。治疗开始后 12、24 和 36 个月时报告的未加权平均保留率分别为 78%、71% 和 69%。我们估计非洲的 36 个月保留率为 65%，亚洲为 80%，拉丁美洲和加勒比地区为 64%。根据寿命分析，我们估计 12、24、36、48 和 60 个月的保留率分别为 83%、74%、68%、64% 和 60%。 36 个月时的治疗保留率平均为 65-70%。证据基础存在几个重要的空白，可以通过进一步的研究来填补，特别是在地理覆盖范围和随访持续时间方面。
We previously published systematic reviews of retention in care after antiretroviral therapy initiation among general adult populations in sub-Saharan Africa. We estimated 36-month retention at 73% for publications from 2007–2010. This report extends the review to cover 2008–2013 and expands it to all low- and middle-income countries. We searched PubMed, Embase, Cochrane Register, and ISI Web of Science from January 1, 2008 to December 31, 2013 and abstracts from AIDS and IAS from 2008–2013. We estimated retention across cohorts using simple averages and interpolated missing times through the last time reported. We estimated all-cause attrition (death, loss to follow-up) for patients receiving first-line ART in routine settings in low- and middle-income countries. We found 123 papers and abstracts reporting retention for 154 patient cohorts and 1,554,773 patients in 42 countries. Overall, 43% of all patients not retained were known to have died. Unweighted averages of reported retention was 78%, 71% and 69% at 12, 24, and 36 months after treatment initiation, respectively. We estimated 36-month retention at 65% in Africa, 80% in Asia, and 64% in Latin America and the Caribbean. From lifetable analysis, we estimated retention at 12, 24, 36, 48 and 60 months at 83%, 74%, 68%, 64% and 60%, respectively. Retention at 36 months on treatment averages 65–70%. There are several important gaps in the evidence-base, which could be filled by further research, especially in terms of geographic coverage and duration of follow-up.