Evidence map›Paper›PMID 22994151›Full record

SynthesisTropical medicine & international health : TM & IH2012

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

Catrina Mugglin, Janne Estill, Gilles Wandeler, Nicole Bender, Matthias Egger, Thomas Gsponer, Olivia Keiser, IeDEA Southern Africa

Abstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Tropical medicine & international health : TM & IH, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 168 papers, 17 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
168citing papers in PubMed, 17 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

168 citing papers in PubMed, 17 syntheses or guidelines pooled it.

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  18. HIV Care Cascade Among Adolescents in a "Test and Treat" Community-Based Intervention: HPTN 071 (PopART) for Youth Study.The Journal of adolescent health : official publication of the Society for Adolescent Medicine · 2021
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108 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Catrina MugglinDivision of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland  Department of Infectious Diseases, University Hospital Bern, Bern, Switzerland  School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Janne Estill
Gilles Wandeler
Nicole Bender
Matthias Egger
Thomas Gsponer
Olivia Keiser
IeDEA Southern Africa

Funding

Observational Antiretroviral Studies In Southern Africa (OASIS) CollaborationU01AI069924 · NIAID · UNIVERSITAT BERN · PI Cleophas Chimbetete, Mary-Ann Davies · 2006 to 2026
$55.9M
NIAID NIH HHS U01 AI069924
6 · The paper itself

Abstract

objectivesTo 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.

methodsSystematic 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.

resultsTwenty-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.

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

Indexed as

Health Services Needs and DemandLost to Follow-UpAdultAfrica South of the SaharaAIDS SerodiagnosisAnti-HIV AgentsCD4 Lymphocyte CountFemaleHIV InfectionsHumansMaleSex DistributionAnti-HIV AgentsÁfrica subsaharianaAfrique subsaharienneliens avec les soinslinkage to careloss to follow‐upmortalidadmortalitémortalitynexo con atención médicapérdida durante el seguimientoperte au suivipre‐ARTpré‐ARTpre‐TARsub‐Saharan Africa

Identifiers

PMID22994151
PMCPMC3895621

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.