Retention in care and viral suppression in differentiated service delivery models for HIV treatment delivery in sub-Saharan Africa: a rapid systematic review.
Retention in care and viral suppression in differentiated service delivery models for HIV treatment delivery in sub-Saharan Africa: a rapid systematic review.
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DOI：
10.1002/jia2.25640
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发表时间：
2020-11
影响因子：
6
通讯作者：
Rosen S
中科院分区：
文献类型：
--
作者：
Long L;Kuchukhidze S;Pascoe S;Nichols BE;Fox MP;Cele R;Govathson C;Huber AN;Flynn D;Rosen S
目前正在扩大艾滋病毒抗逆转录病毒治疗的差别化服务提供模式，以期更好地满足患者的需要，提高治疗提供的质量和效率，降低成本，同时至少保持同等的临床结果。我们回顾了最近关于DSD模型的文献，以描述已知的临床结局。我们对PubMed、Embase和Web of Science上的同行评议出版物以及主要国际会议摘要进行了快速系统性综述，这些出版物报告了2016年1月1日至2019年9月12日在撒哈拉以南非洲提供ART的DSD模型的结果。对报告标准临床HIV治疗指标（主要是保留护理和病毒载量抑制）的来源进行了审查，并通过DSD模型进行了分类，并对来源质量进行了评估。描述37个DSD模型并报告52个离散结局的29篇论文和摘要符合检索纳入标准。在37个模型中，7个（19%）是基于机构的个人模型，12个（32%）是基于机构外的个人模型，5个（14%）是客户主导的小组，13个（35%）是医护人员主导的小组。29个模型（78%）报告了滞留，22个模型（59%）报告了病毒抑制。在提供与传统护理的比较的情况下，大多数DSD模型中的保留率在传统护理的5%以内;在没有提供比较的情况下，保留率通常超过80%（范围为47%至100%）。对于病毒抑制，与传统治疗相比，所有患者均报告在DSD模型中抑制率略有增加;在11/21个模型中报告的抑制率超过90%（范围77%至98%）。分析受到研究设计、结局、模型和人群广泛异质性的限制。大多数来源没有提供与传统护理的比较，评估结果的指标差异很大，在许多情况下定义不清。关于DSD模式在撒哈拉以南非洲治疗艾滋病毒的临床结果的现有证据在数量和质量上都是有限的，但表明护理和病毒抑制的保留与传统护理模式大致相当。
Differentiated service delivery (DSD) models for antiretroviral treatment (ART) for HIV are being scaled up in the expectation that they will better meet the needs of patients, improve the quality and efficiency of treatment delivery and reduce costs while maintaining at least equivalent clinical outcomes. We reviewed the recent literature on DSD models to describe what is known about clinical outcomes. We conducted a rapid systematic review of peer‐reviewed publications in PubMed, Embase and the Web of Science and major international conference abstracts that reported outcomes of DSD models for the provision of ART in sub‐Saharan Africa from January 1, 2016 to September 12, 2019. Sources reporting standard clinical HIV treatment metrics, primarily retention in care and viral load suppression, were reviewed and categorized by DSD model and source quality assessed. Twenty‐nine papers and abstracts describing 37 DSD models and reporting 52 discrete outcomes met search inclusion criteria. Of the 37 models, 7 (19%) were facility‐based individual models, 12 (32%) out‐of‐facility‐based individual models, 5 (14%) client‐led groups and 13 (35%) healthcare worker‐led groups. Retention was reported for 29 (78%) of the models and viral suppression for 22 (59%). Where a comparison with conventional care was provided, retention in most DSD models was within 5% of that for conventional care; where no comparison was provided, retention generally exceeded 80% (range 47% to 100%). For viral suppression, all those with a comparison to conventional care reported a small increase in suppression in the DSD model; reported suppression exceeded 90% (range 77% to 98%) in 11/21 models. Analysis was limited by the extensive heterogeneity of study designs, outcomes, models and populations. Most sources did not provide comparisons with conventional care, and metrics for assessing outcomes varied widely and were in many cases poorly defined. Existing evidence on the clinical outcomes of DSD models for HIV treatment in sub‐Saharan Africa is limited in both quantity and quality but suggests that retention in care and viral suppression are roughly equivalent to those in conventional models of care.
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DOI：
10.1111/tmi.12460
发表时间：
2015-04
期刊：
Tropical medicine & international health : TM & IH
影响因子：
--
作者：
Duncombe C;Rosenblum S;Hellmann N;Holmes C;Wilkinson L;Biot M;Bygrave H;Hoos D;Garnett G
通讯作者：
Garnett G
影响因子：
15.8
作者：
Geldsetzer, Pascal;Francis, Joel M.;Baernighausen, Till
通讯作者：
Baernighausen, Till
DOI：
10.1080/09540121.2018.1500995
发表时间：
2018-01-01
影响因子：
1.7
作者：
Hagey, Jill M.;Li, Xuan;Cohen, Craig R.
通讯作者：
Cohen, Craig R.
影响因子：
3.7
作者：
Avong, Yohanna Kambai;Aliyu, Gambo Gumel;Dakum, Patrick
通讯作者：
Dakum, Patrick
影响因子：
15.8
作者：
Fox, Matthew P.;Pascoe, Sophie;Fraser-Hurt, Nicole
通讯作者：
Fraser-Hurt, Nicole