scholarly journals Does undernutrition increase the risk of lost to follow-up in adults living with HIV in sub-Saharan Africa? Protocol for a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e048022
Author(s):  
Animut Alebel ◽  
Daniel Demant ◽  
Pammla Petrucka ◽  
David Sibbritt
Keyword(s):  
Systematic Review ◽  
Effect Size ◽  
Grey Literature ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Significance Level ◽  
Sub Saharan ◽  
Living With Hiv ◽  
Lost To Follow Up

IntroductionUndernutrition is considered a marker for poor prognosis among people living with HIV (PLHIV), particularly in sub-Saharan Africa (SSA), where undernutrition and HIV are both highly prevalent. Evidence suggests that undernutrition (body mass index <18.5 kg/m2) is one of the main factors that significantly increases the risk of lost to follow-up (LTFU) in PLHIV. However, primary studies in SSA have reported inconsistent findings on the relationship between undernutrition and LTFU among adults living with HIV. To the best of our knowledge, no systematic review which aimed to summarise the available evidence. Hence, this review aims to determine the pooled effect of undernutrition on LTFU among adults living with HIV in SSA.Methods and analysisPubMed, EMBASE, Web of Science, Scopus, and, for grey literature, Google Scholar will be systematically searched to include relevant articles published since 2005. Studies reporting the effect of undernutrition on LTFU in adults living with HIV in SSA will be included. The Newcastle-Ottawa Scale will be used for quality assessment. Data from eligible studies will be extracted using a standardised data extraction tool. Heterogeneity between included studies will be assessed using Cochrane Q-test and I2 statistics. The Egger’s and Begg’s tests at a 5% significance level will be used to evaluate publication bias. As heterogeneity is anticipated, the pooled effect size will be estimated using a random-effects model. The final effect size will be reported using the adjusted HR with a 95% CI.Ethics and disseminationEthical approval is not required for a protocol for a systematic review. The results of this systematic review will be published in a peer-reviewed journal and will be publicly available.PROSPERO registration numberCRD42021277741.

scholarly journals Predictors of lost to follow up from antiretroviral therapy among adults in sub-Saharan Africa: a systematic review and meta-analysis

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Hafte Kahsay Kebede ◽  
Lillian Mwanri ◽  
Paul Ward ◽  
Hailay Abrha Gesesew
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Meta Analysis ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Care Services ◽  
Validity Assessment ◽  
Sub Saharan ◽  
Lost To Follow Up

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

scholarly journals Characteristics and impacts ofSystematic review nutritional programmes to address undernutrition of adults living with HIV in sub-Saharan Africa: a systematic review of evidence

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e047205
Author(s):  
Fisaha Haile Tesfay ◽  
Sara Javanparast ◽  
Hailay Gesesew ◽  
Lillian Mwanri ◽  
Anna Ziersch
Keyword(s):  
Systematic Review ◽  
Data Extraction ◽  
Health Facilities ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Nutritional Recovery ◽  
Sub Saharan ◽  
Living With Hiv ◽  
Nutritional Outcomes

ObjectivesAlthough some studies have identified various challenges affecting nutritional programmes to effectively tackle undernutrition among people living with HIV, evidence about the characteristics and impacts of these programmes on weight-related nutritional outcomes varies based on country contexts, specific programme goals and the implementation processes. This systematic review sought to synthesise evidence on the characteristics and impact of nutritional programmes on weight-related nutritional outcomes of people living with HIV in sub-Saharan Africa.DesignSystematic review.Data sourcesWe searched for primary studies published in the following databases: Web of Science, Medline, Scopus, ScienceDirect, ProQuest and Google Scholar, supplemented by checking reference lists of included papers.Eligibility criteriaStudies published from 2005 to 10 July 2020 and reporting on the weight-related nutritional outcomes of undernourished people enrolled in nutritional programmes in HIV care in sub-Saharan Africa were included.Data extraction and synthesisData were extracted using a data extraction proforma. Weight-related nutritional outcomes of people living with HIV before and after enrolment in a nutritional programme were compared and narratively synthesised.ResultsSixteen studies assessing the impact of nutritional programmes in HIV care on weight-related nutritional outcomes were included. Of these, 13 examined nutritional programmes implemented in health facilities and the remaining three were delivered outside of health facilities. Nutritional recovery (defined differently in the studies) ranged from 13.1% to 67.9%. Overall programme failure rate, which included default after enrolment in a nutritional programme or non-response, ranged from 37.6% to 48.0%. More specifically, non-response to a nutritional programme ranged from 21.0% to 67.4% and default from the programme ranged from 19.0% to 70.6%. Key sociodemographic, clinical and nutritional characteristics that affect nutritional recovery, non-response and default were also identified.Conclusions and recommendationsNutritional programmes in HIV care have led to some improvements in weight-related nutritional outcomes among people living with HIV. However, the programmes were characterised by a high magnitude of default and non-response. To improve desired weight-related nutritional outcomes of people living with HIV, a holistic approach that addresses longer-term determinants of undernutrition is needed.PROSPERO registration numberCRD42020196827.

scholarly journals Assessment of neurocognitive deficits in people living with HIV in Sub Saharan Africa: A systematic review

2019 ◽  
Vol 33 (sup1) ◽  
pp. 1-26 ◽  
Author(s):  
Primrose Nyamayaro ◽  
Dixon Chibanda ◽  
Reuben N. Robbins ◽  
James Hakim ◽  
Hetta Gouse
Keyword(s):  
Systematic Review ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Neurocognitive Deficits ◽  
Sub Saharan ◽  
Living With Hiv

scholarly journals Mental health and well-being of older adults living with HIV in sub-Saharan Africa: a systematic review

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e052810
Author(s):  
Patrick Nzivo Mwangala ◽  
Adam Mabrouk ◽  
Ryan Wagner ◽  
Charles R J C Newton ◽  
Amina A Abubakar
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Cognitive Impairment ◽  
Well Being ◽  
Sub Saharan Africa ◽  
Current Evidence ◽  
People Living With Hiv ◽  
Sub Saharan ◽  
Living With Hiv

ObjectiveIn this systematic review, we aimed to summarise the empirical evidence on common mental disorders (CMDs), cognitive impairment, frailty and health-related quality of life (HRQoL) among people living with HIV aged ≥50 years (PLWH50 +) residing in sub-Saharan Africa (SSA). Specifically, we document the prevalence and correlates of these outcomes.Design, data sources and eligibility criteriaThe following online databases were systematically searched: PubMed, CINAHL, PsycINFO, Embase and Scopus up to January 2021. English-language publications on depression, anxiety, cognitive function, frailty and quality of life among PLWH50+ residing in SSA were included.Data extraction and synthesisWe extracted information, including study characteristics and main findings. These were tabulated, and a narrative synthesis approach was adopted, given the substantial heterogeneity among included studies.ResultsA total of 50 studies from fifteen SSA countries met the inclusion criteria. About two-thirds of these studies emanated from Ethiopia, Uganda and South Africa. Studies regarding depression predominated (n=26), followed by cognitive impairment (n=13). Overall, PLWH50+ exhibited varying prevalence of depression (6%–59%), cognitive impairments (4%–61%) and frailty (3%–15%). The correlates of CMDs, cognitive impairment, frailty and HRQoL were rarely investigated, but those reported were sociodemographic variables, many of which were inconsistent.ConclusionsThis review documented an increasing number of published studies on HIV and ageing from SSA. However, the current evidence on the mental and well-being outcomes in PLWH50+ is inadequate to characterise the public health dimension of these impairments in SSA, because of heterogeneous findings, few well-designed studies and substantial methodological limitations in many of the available studies. Future work should have sufficiently large samples of PLWH50+, engage appropriate comparison groups, harmonise the measurement of these outcomes using a standardised methodology to generate more robust prevalence estimates and confirm predictors.PROSPERO registration numberCRD42020145791.

scholarly journals Epidemiology of multimorbidity among people living with HIV in sub-Saharan Africa: a systematic review protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e036988
Author(s):  
Kelechi Elizabeth Oladimeji ◽  
Armstrong Dzomba ◽  
Olatunji Adetokunboh ◽  
Lindiwe Zungu ◽  
Sanni Yaya ◽  
...  
Keyword(s):  
Systematic Review ◽  
Quality Assessment ◽  
Observational Studies ◽  
Sub Saharan Africa ◽  
Current Status ◽  
Cochrane Library ◽  
Forest Plot ◽  
People Living With Hiv ◽  
Sub Saharan ◽  
Living With Hiv

IntroductionSub-Saharan Africa remains the epicentre of the HIV pandemic, yet enormous knowledge gaps still exist to elicit a comprehensive portrait of multimorbidity and HIV linkage. This study aims to conduct a systematic meta-analysis of peer-reviewed literature to investigate the current status of multimorbidity epidemiology among people living with HIV (PLHIV) in sub-Saharan Africa.Methods and analysisOur review will assess observational studies (ie, cohort, case–control and cross-sectional) on multimorbidity associated with HIV/AIDS between 1 January 2005 and 31 October 2020 from sub-Saharan Africa. Databases to be searched include PubMed/MEDLINE, Scopus, Web of Science, Cochrane library, African Index Medicus and African Journals Online. We will also search the WHO clinical trial registry and databases for systematic reviews. The search strategy will involve the use of medical subject headings and key terms to obtain studies on the phenomena of HIV and multimorbidity at high precision. Quality assessment of eligible studies will be ascertained using a validated quality assessment tool for observational studies and risk of bias through sensitivity analysis to identify publication bias. Further, data on characteristics of the study population, multimorbid conditions, epidemiological rates and spatial distribution of multimorbid conditions in PLHIV will be extracted. Heterogeneity of individual studies will be evaluated using the I2 statistic from combined effect size estimates. The statistical analysis will be performed using STATA statistical software V.15 and results will be graphically represented on a forest plot.Ethics and disseminationEthical approval is not applicable in this study as it is a systematic review of published literature. The review findings may also be presented at conferences or before other relevant stakeholders.PROSPERO registration numberCRD42020148668.

scholarly journals Effects of undernutrition on mortality and morbidity among adults living with HIV in sub-Saharan Africa: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Animut Alebel ◽  
Daniel Demant ◽  
Pammla Petrucka ◽  
David Sibbritt
Keyword(s):  
Cohort Studies ◽  
Meta Analysis ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Analysis Model ◽  
Significance Level ◽  
Mortality And Morbidity ◽  
Risk Of Death ◽  
Sub Saharan ◽  
Living With Hiv

Abstract Background Undernutrition is one of the most common problems among people living with HIV, contributing to premature death and the development of comorbidities within this population. In Sub-Saharan Africa (SSA), the impacts of these often inter-related conditions appear in a series of fragmented and inconclusive studies. Thus, this review examines the pooled effects of undernutrition on mortality and morbidities among adults living with HIV in SSA. Methods A systematic literature search was conducted from PubMed, EMBASE, CINAHL, and Scopus databases. All observational studies reporting the effects of undernutrition on mortality and morbidity among adults living with HIV in SSA were included. Heterogeneity between the included studies was assessed using the Cochrane Q-test and I2 statistics. Publication bias was assessed using Egger’s and Begg’s tests at a 5% significance level. Finally, a random-effects meta-analysis model was employed to estimate the overall adjusted hazard ratio. Results Of 4309 identified studies, 53 articles met the inclusion criteria and were included in this review. Of these, 40 studies were available for the meta-analysis. A meta-analysis of 23 cohort studies indicated that undernutrition significantly (AHR: 2.1, 95% CI: 1.8, 2.4) increased the risk of mortality among adults living with HIV, while severely undernourished adults living with HIV were at higher risk of death (AHR: 2.3, 95% CI: 1.9, 2.8) as compared to mildly undernourished adults living with HIV. Furthermore, the pooled estimates of ten cohort studies revealed that undernutrition significantly increased the risk of developing tuberculosis (AHR: 2.1, 95% CI: 1.6, 2.7) among adults living with HIV. Conclusion This review found that undernutrition has significant effects on mortality and morbidity among adults living with HIV. As the degree of undernutrition became more severe, mortality rate also increased. Therefore, findings from this review may be used to update the nutritional guidelines used for the management of PLHIV by different stakeholders, especially in limited-resource settings.

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