scholarly journals Economic and modeling evidence for tuberculosis preventive therapy among people living with HIV: A systematic review and meta-analysis

PLoS Medicine ◽  
2021 ◽  
Vol 18 (9) ◽  
pp. e1003712
Author(s):  
Aashna Uppal ◽  
Samiha Rahman ◽  
Jonathon R. Campbell ◽  
Olivia Oxlade ◽  
Dick Menzies
Keyword(s):  
Systematic Review ◽  
Cost Effectiveness ◽  
Meta Analysis ◽  
Cost Effective ◽  
The Body ◽  
World Health ◽  
Model Parameters ◽  
People Living With Hiv ◽  
Quantitative Analyses ◽  
Living With Hiv

Background Human immunodeficiency virus (HIV) is the strongest known risk factor for tuberculosis (TB) through its impairment of T-cell immunity. Tuberculosis preventive treatment (TPT) is recommended for people living with HIV (PLHIV) by the World Health Organization, as it significantly reduces the risk of developing TB disease. We conducted a systematic review and meta-analysis of modeling studies to summarize projected costs, risks, benefits, and impacts of TPT use among PLHIV on TB-related outcomes. Methods and findings We searched MEDLINE, Embase, and Web of Science from inception until December 31, 2020. Two reviewers independently screened titles, abstracts, and full texts; extracted data; and assessed quality. Extracted data were summarized using descriptive analysis. We performed quantile regression and random effects meta-analysis to describe trends in cost, effectiveness, and cost-effectiveness outcomes across studies and identified key determinants of these outcomes. Our search identified 6,615 titles; 61 full texts were included in the final review. Of the 61 included studies, 31 reported both cost and effectiveness outcomes. A total of 41 were set in low- and middle-income countries (LMICs), while 12 were set in high-income countries (HICs); 2 were set in both. Most studies considered isoniazid (INH)-based regimens 6 to 2 months long (n = 45), or longer than 12 months (n = 11). Model parameters and assumptions varied widely between studies. Despite this, all studies found that providing TPT to PLHIV was predicted to be effective at averting TB disease. No TPT regimen was substantially more effective at averting TB disease than any other. The cost of providing TPT and subsequent downstream costs (e.g. post-TPT health systems costs) were estimated to be less than $1,500 (2020 USD) per person in 85% of studies that reported cost outcomes (n = 36), regardless of study setting. All cost-effectiveness analyses concluded that providing TPT to PLHIV was potentially cost-effective compared to not providing TPT. In quantitative analyses, country income classification, consideration of antiretroviral therapy (ART) use, and TPT regimen use significantly impacted cost-effectiveness. Studies evaluating TPT in HICs suggested that TPT may be more effective at preventing TB disease than studies evaluating TPT in LMICs; pooled incremental net monetary benefit, given a willingness-to-pay threshold of country-level per capita gross domestic product (GDP), was $271 in LMICs (95% confidence interval [CI] −$81 to $622, p = 0.12) and was $2,568 in HICs (−$32,115 to $37,251, p = 0.52). Similarly, TPT appeared to be more effective at averting TB disease in HICs; pooled percent reduction in active TB incidence was 20% (13% to 27%, p < 0.001) in LMICs and 37% (−34% to 100%, p = 0.13) in HICs. Key limitations of this review included the heterogeneity of input parameters and assumptions from included studies, which limited pooling of effect estimates, inconsistent reporting of model parameters, which limited sample sizes of quantitative analyses, and database bias toward English publications. Conclusions The body of literature related to modeling TPT among PLHIV is large and heterogeneous, making comparisons across studies difficult. Despite this variability, all studies in all settings concluded that providing TPT to PLHIV is potentially effective and cost-effective for preventing TB disease.

scholarly journals Health economic analyses of latent tuberculosis infection screening and preventive treatment among people living with HIV in lower tuberculosis incidence settings: a systematic review

2021 ◽  
Vol 6 ◽  
pp. 51
Author(s):  
Rebecca F. Baggaley ◽  
Carolin Vegvari ◽  
Christian A. Dimala ◽  
Marc Lipman ◽  
Robert F. Miller ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Economic ◽  
Cost Effectiveness ◽  
Preventive Treatment ◽  
Cost Effective ◽  
People Living With Hiv ◽  
Study Quality ◽  
Ltbi Screening ◽  
Screening Cost ◽  
Living With Hiv

Introduction: In lower tuberculosis (TB) incidence countries (<100 cases/100,000/year), screening and preventive treatment (PT) for latent TB infection (LTBI) among people living with HIV (PLWH) is often recommended, yet guidelines advising which groups to prioritise for screening can be contradictory and implementation patchy. Evidence of LTBI screening cost-effectiveness may improve uptake and health outcomes at reasonable cost. Methods: Our systematic review assessed cost-effectiveness estimates of LTBI screening/PT strategies among PLWH in lower TB incidence countries to identify model-driving inputs and methodological differences. Databases were searched 1980-2020. Studies including health economic evaluation of LTBI screening of PLWH in lower TB incidence countries (<100 cases/100,000/year) were included. Study quality was assessed using the CHEERS checklist. Results: Of 2,644 articles screened, nine studies were included. Cost-effectiveness estimates of LTBI screening/PT for PLWH varied widely, with universal screening/PT found highly cost-effective by some studies, while only targeting to high-risk groups (such as those from mid/high TB incidence countries) deemed cost-effective by others. Cost-effectiveness of strategies screening all PLWH from studies published in the past five years varied from US$2828 to US$144,929/quality-adjusted life-year gained (2018 prices). Study quality varied, with inconsistent reporting of methods and results limiting comparability of studies. Cost-effectiveness varied markedly by screening guideline, with British HIV Association guidelines more cost-effective than NICE guidelines in the UK. Discussion: Cost-effectiveness studies of LTBI screening/PT for PLWH in lower TB incidence settings are scarce, with large variations in methods and assumptions used, target populations and screening/PT strategies evaluated. The limited evidence suggests LTBI screening/PT may be cost-effective for some PLWH groups but further research is required, particularly on strategies targeting screening/PT to PLWH at higher risk. Standardisation of model descriptions and results reporting could facilitate reliable comparisons between studies, particularly to identify those factors driving the wide disparity between cost-effectiveness estimates. Registration: PROSPERO CRD42020166338 (18/03/2020).

scholarly journals Incidence of Herpes Zoster in HIV-Infected Patients Undergoing Antiretroviral Therapy: A Systematic Review and Meta-analysis

2021 ◽  
Vol 10 (11) ◽  
pp. 2300
Author(s):  
Han-Chang Ku ◽  
Yi-Tseng Tsai ◽  
Sriyani-Padmalatha Konara-Mudiyanselage ◽  
Yi-Lin Wu ◽  
Tsung Yu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Herpes Zoster ◽  
Antiretroviral Therapy ◽  
Random Effects ◽  
Meta Analysis ◽  
People Living With Hiv ◽  
Funnel Plots ◽  
Sex With Men ◽  
Treat All ◽  
Living With Hiv

The incidence of herpes zoster (HZ) in patients infected with HIV is higher than that of the general population. However, the incidence of HZ in HIV patients receiving antiretroviral therapy (ART) remains unclear. This meta-analysis aimed to estimate the pooled incidence rate and risk factors for HZ in the post-ART era. We identified studies assessing the incidence of HZ in the post-ART era between 1 January 2000 and 28 February 2021, from four databases. Pooled risk ratios were calculated from 11 articles using a random-effects model. The heterogeneity of the included trials was evaluated by visually inspecting funnel plots, performing random-effects meta-regression and using I2 statistics. Of the 2111 studies screened, we identified 11 studies that were eligible for final inclusion in the systematic review and 8 studies that were eligible for a meta-analysis. The pooled incidence of HZ in the post-ART era (after the introduction of ART in 1997) was 2.30 (95% confidence interval (CI): 1.56–3.05) per 100 person years (PYs). The risks of incidence of HZ among people living with HIV included male sex (AOR: 4.35 (95% CI: 054–2.41)), men who have sex with men (AOR: 1.21 (95% CI: −0.76–1.13)), CD4 count < 200 cells/μL (AOR: 11.59 (95% CI: 0.53–4.38)) and not receiving ART (AOR: 2.89 (95% CI: −0.44–2.56)). The incidence of HZ is substantially lower among HIV infected patients receiving ART than those not receiving ART. Initiating ART immediately after diagnosis to treat all HIV-positive individuals is crucial to minimize the disease burden of HZ.

PEOPLE LIVING WITH HIV, LEAN MASS, AND SARCOPENIA: A SYSTEMATIC REVIEW AND META-ANALYSIS

2021 ◽  
Author(s):  
Nathalia Sernizon Guimarães ◽  
Mariana Amaral Raposo ◽  
Dirceu Greco ◽  
Unaí Tupinambás ◽  
Melissa Orlandin Premaor
Keyword(s):  
Systematic Review ◽  
Lean Mass ◽  
Meta Analysis ◽  
People Living With Hiv ◽  
Living With Hiv

scholarly journals Incremental Net Monetary Benefit of Bariatric Surgery: Systematic Review and Meta-Analysis of Cost-Effectiveness Evidences

2021 ◽  
Author(s):  
Prapaporn Noparatayaporn ◽  
Montarat Thavorncharoensap ◽  
Usa Chaikledkaew ◽  
Bhavani Shankara Bagepally ◽  
Ammarin Thakkinstian
Keyword(s):  
Systematic Review ◽  
Bariatric Surgery ◽  
Cost Effectiveness ◽  
Evaluation Studies ◽  
Meta Analysis ◽  
Cost Effective ◽  
Diabetes Group ◽  
Lifetime Horizon ◽  
Middle Income ◽  
Full Economic Evaluation

AbstractThis systematic review aimed to comprehensively synthesize cost-effectiveness evidences of bariatric surgery by pooling incremental net monetary benefits (INB). Twenty-eight full economic evaluation studies comparing bariatric surgery with usual care were identified from five databases. In high-income countries (HICs), bariatric surgery was cost-effective among mixed obesity group (i.e., obesity with/without diabetes) over a 10-year time horizon (pooled INB = $53,063.69; 95% CI $42,647.96, $63,479.43) and lifetime horizon (pooled INB = $101,897.96; 95% CI $79,390.93, $124,404.99). All studies conducted among obese with diabetes reported that bariatric surgery was cost-effective. Also, the pooled INB for obesity with diabetes group over lifetime horizon in HICs was $80,826.28 (95% CI $32,500.75, $129,151.81). Nevertheless, no evidence is available in low- and middle-income countries. Graphical abstract

scholarly journals Rates and risk factors for suicidal ideation, suicide attempts and suicide deaths in persons with HIV: a systematic review and meta-analysis

2021 ◽  
Vol 34 (2) ◽  
pp. e100247
Author(s):  
Matt Pelton ◽  
Matt Ciarletta ◽  
Holly Wisnousky ◽  
Nicholas Lazzara ◽  
Monica Manglani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Suicidal Ideation ◽  
General Population ◽  
Suicide Attempts ◽  
Advanced Disease ◽  
Meta Analysis ◽  
People Living With Hiv ◽  
Meta Regression ◽  
Living With Hiv

BackgroundPeople living with HIV/AIDS (PLWHA) must contend with a significant burden of disease. However, current studies of this demographic have yielded wide variations in the incidence of suicidality (defined as suicidal ideation, suicide attempt and suicide deaths).AimsThis systematic review and meta-analysis aimed to assess the lifetime incidence and prevalence of suicidality in PLWHA.MethodsPublications were identified from PubMed (MEDLINE), SCOPUS, OVID (MEDLINE), Joanna Briggs Institute EBP and Cochrane Library databases (from inception to before 1 February 2020). The search strategy included a combination of Medical Subject Headings associated with suicide and HIV. Researchers independently screened records, extracted outcome measures and assessed study quality. Data were pooled using a random-effects model. Subgroup and meta-regression analyses were conducted to explore the associated risk factors and to identify the sources of heterogeneity. Main outcomes were lifetime incidence of suicide completion and lifetime incidence and prevalence of suicidal ideation and suicide attempt.ResultsA total of 185 199 PLWHA were identified from 40 studies (12 cohorts, 27 cross-sectional and 1 nested case-control). The overall incidence of suicide completion in PLWHA was 10.2/1000 persons (95%CI: 4.5 to 23.1), translating to 100-fold higher suicide deaths than the global general population rate of 0.11/1000 persons. The lifetime prevalence of suicide attempts was 158.3/1000 persons (95%CI: 106.9 to 228.2) and of suicidal ideation was 228.3/1000 persons (95%CI: 150.8 to 330.1). Meta-regression revealed that for every 10-percentage point increase in the proportion of people living with HIV with advanced disease (AIDS), the risk of suicide completion increased by 34 per 1000 persons. The quality of evidence by Grading of Recommendations, Assessment, Development and Evaluations for the suicide deaths was graded as ‘moderate’ quality.ConclusionsThe risk of suicide death is 100-fold higher in people living with HIV than in the general population. Lifetime incidence of suicidal ideation and attempts are substantially high. Suicide risk assessments should be a priority in PLWHA, especially for those with more advanced disease.

scholarly journals Adherence to Highly Active Antiretroviral Therapy and Its Association with Serostatus Disclosure among People Living with HIV in Ethiopia:  A Systematic Review and Meta-Analysis.

2020 ◽  
Author(s):  
Abere Woretaw Azagew ◽  
Chilot Kassa Mekonnen ◽  
Abebaw Jember Ferede ◽  
Kassahun Gebeyehu Yazew ◽  
Zewdu Baye Tezera
Keyword(s):  
Systematic Review ◽  
Antiretroviral Therapy ◽  
Highly Active Antiretroviral Therapy ◽  
Assessment Tool ◽  
Meta Analysis ◽  
People Living With Hiv ◽  
Serostatus Disclosure ◽  
Highly Active ◽  
Pooled Prevalence ◽  
Living With Hiv

Abstract Background: Adherence to highly active antiretroviral therapy (HAART) is a public health challenge worldwide. Non-adherence to HAART leads to treatment, immunologic, and virological failure. Despite different interventions made, adherence to HAART among adult people living with HIV (PLWHIV) is still inconsistent across studies, and the effect of serostatus disclosure on adherence to HAART was not studied in Ethiopia. Therefore, the study is aimed to determine the pooled prevalence of adherence to HAART and its relationship with serostatus disclosure among adult PLWHIV in Ethiopia.Methods: We searched 3247 original articles, both published and unpublished on Ethiopia dated from January 2016 to November 2019 by using different search engines. Data were extracted using Microsoft excel. New Castle Ottawa Scale quality assessment tool was used. STATA software version 11 was used for analysis. A random-effects model for meta-analysis was computed. Cochran Q statistics and I2 were used to estimate heterogeneity. Egger’s and Begg’s test was used to assess the publication bias.Results: A total of fifteen articles for systematic review and four articles for meta-analysis were used. The pooled prevalence of adherence to HAART is found to be 81.19% (80.1, 82.3). In the subgroup analysis, the pooled prevalence of adherence to HAART was 79.82% (73.19, 86.45) in the Oromia region, 82.51 %( 73.14, 91.87) in the Amhara region, and 72.7% (63.78, 81.61) in the Southern Nations Nationalities and Peoples’ Region (SNNPR). The serostatus disclosure improves adherence to HAART by nearly three times compared to non-serostatus disclosed PLWHIV (AOR=2.99, 95 %CI: 1.88, 4.77).Conclusions: The pooled prevalence of adherence to HAART among adult PLWHIV in Ethiopia was found to be low compared to WHO antiretroviral treatment recommendations. Having serostatus disclosure improved adherence to HAART.

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

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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