Is co-location of services with HIV care associated with improved HIV care outcomes? A systematic review

Abstract Background It is known that ‘drop out’ from human immunodeficiency virus (HIV) treatment, the so called lost-to-follow-up (LTFU) occurs to persons enrolled in HIV care services. However, in sub-Saharan Africa (SSA), the risk factors for the LTFU are not well understood. Methods We performed a systematic review and meta-analysis of risk factors for LTFU among adults living with HIV in SSA. A systematic search of literature using identified keywords and index terms was conducted across five databases: MEDLINE, PubMed, CINAHL, Scopus, and Web of Science. We included quantitative studies published in English from 2002 to 2019. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for methodological validity assessment and data extraction. Mantel Haenszel method using Revman-5 software was used for meta-analysis. We demonstrated the meta-analytic measure of association using pooled odds ratio (OR), 95% confidence interval (CI) and heterogeneity using I2 tests. Results Thirty studies met the search criteria and were included in the meta-analysis. Predictors of LTFU were: demographic factors including being: (i) a male (OR = 1.2, 95% CI 1.1–1.3, I2 = 59%), (ii) between 15 and 35 years old (OR = 1.3, 95% CI 1.1–1.3, I2 = 0%), (iii) unmarried (OR = 1.2, 95% CI 1.2–1.3, I2 = 21%), (iv) a rural dweller (OR = 2.01, 95% CI 1.5–2.7, I2 = 40%), (v) unemployed (OR = 1.2, 95% CI 1.04–1.4, I2 = 58%); (vi) diagnosed with behavioral factors including illegal drug use(OR = 13.5, 95% CI 7.2–25.5, I2 = 60%), alcohol drinking (OR = 2.9, 95% CI 1.9–4.4, I2 = 39%), and tobacco smoking (OR = 2.6, 95% CI 1.6–4.3, I2 = 74%); and clinical diagnosis of mental illness (OR = 3.4, 95% CI 2.2–5.2, I2 = 1%), bed ridden or ambulatory functional status (OR = 2.2, 95% CI 1.5–3.1, I2 = 74%), low CD4 count in the last visit (OR = 1.4, 95% CI 1.1–1.9, I2 = 75%), tuberculosis co-infection (OR = 1.2, 95% CI 1.02–1.4, I2 = 66%) and a history of opportunistic infections (OR = 2.5, 95% CI 1.7–2.8, I2 = 75%). Conclusions The current review identifies demographic, behavioral and clinical factors to be determinants of LTFU. We recommend strengthening of HIV care services in SSA targeting the aforementioned group of patients. Trial registration Protocol: the PROSPERO Registration Number is CRD42018114418

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Re-Engagement into HIV Care: A Systematic Review

AIDS and Behavior ◽

10.1007/s10461-021-03365-y ◽

2021 ◽

Author(s):

Natalia Blanco ◽

Marie-Claude C. Lavoie ◽

Emily Koech ◽

David J. Riedel ◽

Caroline Ngeno ◽

...

Keyword(s):

Systematic Review ◽

Hiv Care

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A systematic review examining the clinical and health-care outcomes for congenital heart disease patients using home monitoring programmes

Journal of Telemedicine and Telecare ◽

10.1177/1357633x20984052 ◽

2021 ◽

pp. 1357633X2098405

Author(s):

Rachel Crawford ◽

Ciara Hughes ◽

Sonyia McFadden ◽

Jacqui Crawford

Keyword(s):

Systematic Review ◽

Health Care ◽

Congenital Heart Disease ◽

Heart Disease ◽

Congenital Heart ◽

Case Series ◽

Home Monitoring ◽

Risk Of Bias ◽

Health Care Outcomes ◽

Care Outcomes

Objectives This review aimed to present the clinical and health-care outcomes for patients with congenital heart disease (CHD) who use home monitoring technologies. Methods Five databases were systematically searched from inception to November 2020 for quantitative studies in this area. Data were extracted using a pre-formatted data-collection table which included information on participants, interventions, outcome measures and results. Risk of bias was determined using the Cochrane Risk of Bias 2 tool for randomised controlled trials (RCTs), the Newcastle–Ottawa Quality Assessment Scale for cohort studies and the Institute of Health Economics quality appraisal checklist for case-series studies. Data synthesis: Twenty-two studies were included in this systematic review, which included four RCTs, 12 cohort studies and six case-series studies. Seventeen studies reported on mortality rates, with 59% reporting that home monitoring programmes were associated with either a significant reduction or trend for lower mortality and 12% reporting that mortality trended higher. Fourteen studies reported on unplanned readmissions/health-care resource use, with 29% of studies reporting that this outcome was significantly decreased or trended lower with home monitoring and 21% reported an increase. Impact on treatment was reported in 15 studies, with 67% of studies finding that either treatment was undertaken significantly earlier or significantly more interventions were undertaken in the home monitoring groups. Conclusion The use of home monitoring programmes may be beneficial in reducing mortality, enabling earlier and more timely detection and treatment of CHD complication. However, currently, this evidence is limited due to weakness in study designs.

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An Exploratory Study of Resilience, HIV-Related Stigma, and HIV Care Outcomes Among Men who have Sex with Men (MSM) Living with HIV in Louisiana

AIDS and Behavior ◽

10.1007/s10461-020-02778-5 ◽

2020 ◽

Vol 24 (7) ◽

pp. 2119-2129 ◽

Cited By ~ 4

Author(s):

Russell Brewer ◽

Kristina B. Hood ◽

Mary Moore ◽

Andrew Spieldenner ◽

Chris Daunis ◽

...

Keyword(s):

Exploratory Study ◽

Hiv Care ◽

Related Stigma ◽

Care Outcomes ◽

Sex With Men ◽

Living With Hiv

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A Systematic Review and Meta-regression of Temporal Trends in Adult CD4+ Cell Count at Presentation to HIV Care, 1992-2011

Clinical Infectious Diseases ◽

10.1093/cid/cit421 ◽

2013 ◽

Vol 57 (7) ◽

pp. 1027-1037 ◽

Cited By ~ 60

Author(s):

C. R. Lesko ◽

S. R. Cole ◽

A. Zinski ◽

C. Poole ◽

M. J. Mugavero

Keyword(s):

Systematic Review ◽

Cell Count ◽

Temporal Trends ◽

Hiv Care ◽

Cd4 Cell Count ◽

Meta Regression ◽

Cd4 Cell

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Mental health and retention in HIV care: A systematic review and meta-analysis.

Health Psychology ◽

10.1037/hea0000606 ◽

2018 ◽

Vol 37 (6) ◽

pp. 574-585 ◽

Cited By ~ 19

Author(s):

Cherie R. Rooks-Peck ◽

◽

Adebukola H. Adegbite ◽

Megan E. Wichser ◽

Rebecca Ramshaw ◽

...

Keyword(s):

Mental Health ◽

Systematic Review ◽

Meta Analysis ◽

Hiv Care ◽

Retention In Hiv Care

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Influence of Material Deprivation on Clinical Outcomes Among People Living with HIV in High-Income Countries: A Systematic Review and Meta-analysis

AIDS and Behavior ◽

10.1007/s10461-021-03551-y ◽

2021 ◽

Author(s):

Vasiliki Papageorgiou ◽

Bethan Davies ◽

Emily Cooper ◽

Ariana Singer ◽

Helen Ward

Keyword(s):

Systematic Review ◽

Social Determinants ◽

Meta Analysis ◽

Hiv Treatment ◽

Material Deprivation ◽

Hiv Care ◽

People Living With Hiv ◽

Hiv Care Continuum ◽

Care Continuum ◽

Living With Hiv

AbstractDespite developments in HIV treatment and care, disparities persist with some not fully benefiting from improvements in the HIV care continuum. We conducted a systematic review to explore associations between social determinants and HIV treatment outcomes (viral suppression and treatment adherence) in high-income countries. A random effects meta-analysis was performed where there were consistent measurements of exposures. We identified 83 observational studies eligible for inclusion. Social determinants linked to material deprivation were identified as education, employment, food security, housing, income, poverty/deprivation, socioeconomic status/position, and social class; however, their measurement and definition varied across studies. Our review suggests a social gradient of health persists in the HIV care continuum; people living with HIV who reported material deprivation were less likely to be virologically suppressed or adherent to antiretrovirals. Future research should use an ecosocial approach to explore these interactions across the lifecourse to help propose a causal pathway.

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