SynthesisBMJ global health2025
Effect of same-day HIV treatment initiation (SDI) on 1-year outcomes in low- and middle-income countries: systematic review and meta-analysis of randomised trials.
Synthesis in BMJ global health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled 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.
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.
Who cites it
2 citing papers in PubMed, 1 synthesis or guideline pooled it.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
14 authors.
Funding
Abstract
introductionSame-day initiation (SDI) of antiretroviral therapy is recommended for people presenting with HIV who have no contraindications. We reviewed the evidence on SDI interventions in low- and middle-income countries (LMICs).
methodsWe conducted a systematic review and meta-analysis of randomised controlled trials of SDI in adults diagnosed with HIV in LMICs. We searched MEDLINE, Embase and the Cochrane Library up to December 2024. Primary outcomes were viral suppression and retention in care 6-12 months after enrolment. Based on a qualitative assessment of the complex trial interventions, we considered two subgroups: (1) interventions newly introducing SDI and (2) interventions improving SDI implementation in settings where it was already routinely available. We conducted random-effects meta-analysis, assessed risk of bias using the ROBUST instrument and used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty of evidence.
resultsWe identified 12 eligible trials, 7 introducing and 5 improving SDI. The trial interventions introducing SDI were sufficiently similar for meta-analysis. Introducing SDI likely has an important benefit for viral suppression (relative risk (RR) 1.18, 95% CI 1.06 to 1.30, moderate certainty) and retention in care (RR 1.12, 95% CI 1.00 to 1.25, low certainty) at 6-12 months The five trials improving SDI were too heterogeneous for meaningful meta-analysis. Individually, they showed either low to very low certainty for an important effect or, when implementing SDI in patients with tuberculosis (TB) symptoms, moderate to high certainty for little to no effect on viral suppression and retention in care.
conclusionNewly introducing SDI likely improves viral suppression and retention in care. However, the impact of interventions to improve SDI where already available is less clear. Two studies provided evidence against the concern that SDI may have adverse effects in participants with TB symptoms. PROSPERO REGISTRATION NUMBER: CRD42023482522.
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Registered trials
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