OBJECTIVES:To 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. METHODS:Systematic 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. RESULTS:Twenty-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. CONCLUSIONS:Monitoring and care in the pre-ART time period need improvement, with greater emphasis on patients not yet eligible for ART.

译文

目的:评估在撒哈拉以南非洲艾滋病毒诊断与开始抗逆转录病毒治疗(ART)之间因计划而流失(死亡,失去随访,转出)的患者比例,并确定与计划流失相关的因素。
方法:系统评价和荟萃分析。我们在PubMed和EMBASE数据库中进行了成人研究。结果是开始接受抗逆转录病毒治疗之前死亡的患者百分比,随访损失的百分比,具有CD4细胞计数的百分比,首次CD4计数的分布以及符合条件的开始抗逆转录病毒治疗的患者的百分比。使用随机效应荟萃分析合并数据。
结果:分析了来自撒哈拉以南非洲地区的29项研究,包括148,912名患者。六项研究涵盖了从艾滋病毒诊断到抗病毒治疗的整个过程。对这些研究的荟萃分析显示,在100例HIV检测呈阳性的患者中,有72例(95%CI 60-84)的CD4细胞计数被测量,40例(95%CI 26-55)符合ART的条件,而25例(95%CI 26-55)符合条件。 95%CI 13-37)开始接受抗逆转录病毒治疗。研究之间存在很大的异质性(P <0.0001)。呈现时CD4细胞的中位数范围为154至274细胞/μl。有资格接受抗逆转录病毒治疗的患者不太可能失去程序(25%vs. 54%,P <0.0001),但与不符合资格的患者相比,有资格死亡的患者更有可能死亡(11%vs. 5%,P <0.0001)。男性,CD4细胞计数低,社会经济地位低的患者以及最近一段时间的程序丢失率更高。
结论:在ART治疗之前的时期内的监测和护理需要改善,重点更多的是尚未获得ART治疗资格的患者。

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