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Retention of Adult Patients on Antiretroviral Therapy in Low- and Middle-Income Countries: Systematic Review and Meta-analysis 2008-2013

Journal of acquired immune deficiency syndromes (1999), 2015-05, Vol.69 (1), p.98-108 [Peer Reviewed Journal]

Copyright Lippincott Williams & Wilkins May 1, 2015 ;ISSN: 1525-4135 ;EISSN: 1944-7884 ;DOI: 10.1097/QAI.0000000000000553 ;PMID: 25942461 ;CODEN: JDSRET

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  • Title:
    Retention of Adult Patients on Antiretroviral Therapy in Low- and Middle-Income Countries: Systematic Review and Meta-analysis 2008-2013
  • Author: Fox, Matthew P ; Rosen, Sydney
  • Subjects: Adolescent ; Adult ; Africa ; AIDS/HIV ; Anti-Retroviral Agents - therapeutic use ; Antiretroviral drugs ; Antiretroviral Therapy, Highly Active - methods ; Asia ; Caribbean Region ; Developing Countries ; Drug therapy ; Female ; HIV Infections - drug therapy ; Humans ; Latin America ; LDCs ; Male ; Medication Adherence ; Meta-analysis ; Middle Aged ; Systematic review ; Young Adult
  • Is Part Of: Journal of acquired immune deficiency syndromes (1999), 2015-05, Vol.69 (1), p.98-108
  • Description: 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 to 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 antiretroviral therapy in routine settings in low- and middle-income countries. We found 123 articles 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 were 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.
  • Publisher: United States: Lippincott Williams & Wilkins Ovid Technologies
  • Language: English
  • Identifier: ISSN: 1525-4135
    EISSN: 1944-7884
    DOI: 10.1097/QAI.0000000000000553
    PMID: 25942461
    CODEN: JDSRET
  • Source: Freely Accessible Journals
    MEDLINE
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