scholarly journals Differential yield of universal versus selective drug susceptibility testing of patients with tuberculosis in high-burden countries: a systematic review and meta-analysis

2020 ◽  
Vol 5 (10) ◽  
pp. e003438
Author(s):  
Anita Svadzian ◽  
Giorgia Sulis ◽  
Genevieve Gore ◽  
Madhukar Pai ◽  
Claudia M Denkinger
Keyword(s):  
Systematic Review ◽  
High Risk ◽  
Susceptibility Testing ◽  
Meta Analysis ◽  
Scale Up ◽  
Risk Groups ◽  
Drug Susceptibility ◽  
Drug Susceptibility Testing ◽  
Cochrane Library ◽  
Universal Testing

IntroductionAlthough universal drug susceptibility testing (DST) is a component of the End-TB Strategy, over 70% of drug-resistant tuberculosis (DR-TB) cases globally remain undetected. This detection gap reflects difficulties in DST scale-up and substantial heterogeneity in policies and implemented practices. We conducted a systematic review and meta-analysis to assess whether implementation of universal DST yields increased DR-TB detection compared with only selectively testing high-risk groups.MethodsPubMed, Embase, Global Health, Cochrane Library and Web of Science Core Collection were searched for publications reporting on the differential yield of universal versus selective DST implementation on the proportion of DR-TB, from January 2007 to June 2019. Random-effects meta-analyses were used to calculate respective pooled proportions of DR-TB cases detected; Higgins test and prediction intervals were used to assess between-study heterogeneity. We adapted an existing risk-of-bias assessment tool for prevalence studies.ResultsOf 18 736 unique citations, 101 studies were included in the qualitative synthesis. All studies used WHO-endorsed DST methods, and most (87.1%) involved both high-risk groups and the general population. We found only cross-sectional, observational, non-randomised studies that compared universal with selective DST strategies. Only four studies directly compared the testing approaches in the same study population, with the proportion of DR-TB cases detected ranging from 2.2% (95% CI: 1.4% to 3.2%) to 12.8% (95% CI: 11.4% to 14.3%) with selective testing, versus 4.4% (95% CI: 3.3% to 5.8%) to 9.8% (95% CI: 8.9% to 10.7%) with universal testing. Broad population studies were very heterogeneous. The vast majority (88/101; 87.1%) reported on the results of universal testing. However, while 37 (36.6%)/101 included all presumptive TB cases, an equal number of studies applied sputum-smear as a preselection criterion. A meaningful meta-analysis was not possible.ConclusionGiven the absence of randomised studies and the paucity of studies comparing strategies head to head, and selection bias in many studies that applied universal testing, our findings have limited generalisability. The lack of evidence reinforces the need for better data to inform policies.

scholarly journals Peer education for HIV prevention among high-risk groups: a systematic review and meta-analysis

2019 ◽  
Author(s):  
Jiayu He ◽  
Ying Wang ◽  
Zhicheng Du ◽  
Na He ◽  
Yuantao Hao
Keyword(s):  
Systematic Review ◽  
High Risk ◽  
Hiv Testing ◽  
Large Scale ◽  
Meta Analysis ◽  
Peer Education ◽  
Risk Groups ◽  
Unprotected Sex ◽  
Cochrane Library ◽  
Better Than

Abstract Background Peer education has become a strategy for health promotion among HIV groups at high-risk worldwide. However, the quantitative effect and its duration of peer education on preventing HIV is still unknown.Method A systematic review and meta-analysis was adopted to assess the effects and its duration of peer education, following the PRISMA guidelines. A thorough literature search of PubMed, Web of Science, Embase and Cochrane Library was performed, and studies about peer education on HIV high-risk groups were reviewed. Pooled effects were calculated and the heterogeneity source were explored using meta-regression and subgroup analysis.Results A total of 60 articles with 96484 subjects were identified, and peer education was associated with 36% decreased rates of HIV infection among high risk groups overall (OR: 0.64; 95%CI: 0.47-0.87). Peer education can promote HIV testing (OR=3.19; 95%CI:2.13,4.79) better than condom use (OR=2.66, 95% CI: 2.11-3.36) and can reduce equipment sharing (OR=0.50; 95%CI:0.33,0.75) better than unprotected sex (OR=0.82; 95%CI: 0.72-0.94). Time trend analysis showed a persistent effect of peer education and the different follow-up time was a source of heterogeneity.Conclusion Peer education is persistently effective for changing behaviors among high-risk groups worldwide, especially for the behaviors of HIV testing and equipment sharing. Low and middle income countries are encouraged to conduct peer education at a large scale.

scholarly journals Effect of syphilis infection on HIV acquisition: a systematic review and meta-analysis

2020 ◽  
pp. sextrans-2020-054706
Author(s):  
Meng Yin Wu ◽  
Hui Zi Gong ◽  
Kui Ru Hu ◽  
He-yi Zheng ◽  
Xia Wan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Relative Risk ◽  
High Risk ◽  
Meta Analysis ◽  
Risk Groups ◽  
Hiv Incidence ◽  
Syphilis Infection ◽  
High Risk Populations ◽  
Hiv Acquisition ◽  
Risk Of Hiv Acquisition

ObjectivesCo-infection of syphilis and HIV remains hard to manage and its morbidity shows a rising tendency. Syphilis has been associated with increased risk of HIV acquisition in high-risk groups, especially in men who have sex with men (MSM). This systematic review and meta-analysis estimates the effect of syphilis infection on subsequent HIV acquisition, and assesses its difference between MSM and other high-risk populations.MethodsFive electronic databases were searched for literature published to 21 September 2019 without language restrictions. Longitudinal studies that enrolled key populations to compare the incidence of HIV with and without syphilis exposure were included. We used a random-effects model to estimate the effect of syphilis infection on HIV acquisition among high-risk populations, which include MSM, sex workers, serodiscordant couples, people who inject drugs and attendees of STD clinics.ResultsA total of 17 cohorts and 5 case-control studies involving 65 232 participants were included. HIV incidence showed a two-time increase after syphilis exposure, compared with a control group (relative risk (RR) 2.67 (95% CI 2.05 to 3.47); p<0.05 for prevalence; RR 3.21 (95% CI 2.26 to 4.57); p=0.419 for incidence). No significant differences were observed between MSM and other high-risk groups in syphilis infection prevalence (RR 2.60 (95% CI 1.78 to 3.80); p<0.05 vs RR, 2.98 (95% CI 2.15 to 4.14); p<0.05; ratio of relative risk 0.76 (95% CI 0.49 to 1.17)).ConclusionsSyphilis infection increases the risk of HIV acquisition in high-risk populations. There is no evidence to suggest MSM are at greater risk than other high-risk populations. Prompt diagnosis, timely treatment, preventive interventions against syphilis infection would be a worthwhile investment for reducing HIV incidence. Strategies to combat stigma and discrimination targeted at MSM are pragmatically needed.

scholarly journals Peer education for HIV prevention among high-risk groups: a systematic review and meta-analysis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jiayu He ◽  
Ying Wang ◽  
Zhicheng Du ◽  
Jing Liao ◽  
Na He ◽  
...  
Keyword(s):  
Systematic Review ◽  
High Risk ◽  
Hiv Prevention ◽  
Meta Analysis ◽  
Peer Education ◽  
Risk Groups

scholarly journals HIV and Hepatitis B and C incidence rates in US correctional populations and high risk groups: a systematic review and meta-analysis

2010 ◽  
Vol 10 (1) ◽  
Author(s):  
Ethan Gough ◽  
Mirjam C Kempf ◽  
Laura Graham ◽  
Marvin Manzanero ◽  
Edward W Hook ◽  
...  
Keyword(s):  
Systematic Review ◽  
High Risk ◽  
Hepatitis B ◽  
Meta Analysis ◽  
Risk Groups ◽  
Incidence Rates

scholarly journals Prognostic value of miR-21 for prostate cancer: a systematic review and meta-analysis

2021 ◽  
Author(s):  
MY Cynthia Stafford ◽  
Colin E Willoughby ◽  
Colum P Walsh ◽  
Declan J McKenna
Keyword(s):  
Prostate Cancer ◽  
Systematic Review ◽  
Disease Progression ◽  
Poor Prognosis ◽  
Meta Analysis ◽  
Risk Groups ◽  
Cochrane Library ◽  
Clinical Biomarker ◽  
Meta Analyses ◽  
The Relationship

Elevated levels of miR-21 expression are associated with many cancers, suggesting it may be a promising clinical biomarker. In prostate cancer (PCa), however, there is still no consensus about the usefulness of miR-21 as an indicator of disease progression. This systematic review and meta-analysis was conducted to investigate the value of miR-21 expression as a prognostic measurement in PCa patients. Medline (Ovid), EMBASE, Web of Science, Scopus and Cochrane Library databases were systematically searched for relevant publications between 2010 to 2021. Studies exploring the relationship between miR-21 expression, PCa prognosis and clinicopathological factors were selected for review. Those reporting hazard ratio (HR) and 95% confidence intervals (CIs) were subject to meta-analyses. Fixed-effect models were employed to calculated pooled HRs and 95% CIs. Risk of bias in each study was assessed using QUIPS tool. Certainty of evidence in each meta-analysis was assessed using GRADE guidelines. A total of 64 studies were included in the systematic review. Of these, 11 were eligible for inclusion in meta-analysis. Meta-analyses revealed that high miR-21 expression was associated with poor prognosis: HR=1.58 (95% CI=1.19-2.09) for biochemical recurrence, MODERATE certainty; HR=1.46 (95% CI=1.06-2.01) for death, VERY LOW certainty; and HR=1.26 (95% CI=0.70-2.27) for disease progression, VERY LOW certainty. Qualitative summary revealed elevated miR-21 expression was significantly positively associated with PCa stage, Gleason score and risk groups. This systematic review and meta-analysis suggests that elevated levels of miR-21 are associated with poor prognosis in PCa patients. miR-21 expression may therefore be a useful prognostic biomarker in this disease.

P0625CONTINUOUS RENAL REPLACEMENT THERAPY WITHOUT ANTICOAGULATION IN CRITICALLY ILL PATIENTS AT HIGH RISK OF BLEEDING-A SYSTEMATIC REVIEW AND META-ANALYSIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Shiren Sun ◽  
Wei Zhang ◽  
Ming Bai ◽  
Lijuan Zhao ◽  
Xiaolan Chen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Renal Replacement Therapy ◽  
High Risk ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Bleeding Risk ◽  
Cochrane Library ◽  
Risk Of Bleeding

Abstract Background and Aims Continuous renal replacement therapy (CRRT) has been widely used in the critical care setting and anticoagulation is usually necessitated. However, critically ill patients are commonly at incremental risk of bleeding, which contributed to the hesitation of anticoagulant use for CRRT in clinical practice. The current guideline recommended CRRT proceed without anticoagulation in patients with contraindication to citrate and increased bleeding risk. Nevertheless, the efficacy of anticoagulation-free CRRT remains inconsistent. Therefore, the purpose of our present systematic review is to evaluate the efficacy and safety of anticoagulant-free CRRT based on the current literatures. Method We conducted a comprehensive search of PubMed (US National Library of Medicine, Bethesda, MD, USA), Cochrane Library databases and EMBASE from database inception to January 12, 2019 for potential candidate studies. Studies included adult critically ill (age &gt; 18 years) patients with increased bleeding risk, and underwent CRRT without anticoagulation were considered for the inclusion. Results Finally, 17 observational studies and 3 randomized controlled trials with 1615 patients were included in our present meta-analysis. There was no significant difference in filter lifespan between the anticoagulation-free and systemic heparin group. The filter lifespan was significantly prolonged in the citrate (WMD -23.01, 95%CI [-28.62, -17.39], P &lt; 0.001; I2 = 0%, P = 0.53) and nafamostat (WMD -8.4, 95%CI [-9.9, -6.9], P &lt; 0.001; I2 = 33.7%, P = 0.21) groups, compared with anticoagulation-free group. The averaged filter lifespan of the anticoagulation-free CRRT ranged from 10.2 to 52.5 hours. Conclusion The filter lifespan in anticoagulation-free patients with increased bleeding risk was comparable to that in patients without increased bleeding risk underwent systemic heparin anticoagulation CRRT. Nafamostat was not recommended for CRRT anticoagulation due to its drawbacks. Currently, the optimal choice of anticoagulation strategy for critically ill patients without citrate contraindications at high risk of bleeding should be regional citrate anticoagulation. Further studies should focus on the special cut-off value of activated partial thromboplastin time (APTT), international normalized ratio (INR) and platelet (PLT) count, at which the anticoagulation-free CRRT would be beneficial.

Sign in / Sign up

Export Citation Format

Share Document