scholarly journals Comparative Efficacy and Acceptability of Non-pharmacological Interventions for Depression Among People Living With HIV: Protocol for a Systematic Review and Network-meta Analysis

2021 ◽  
Author(s):  
Ting Zhao ◽  
Chulei Tang ◽  
Huang Yan ◽  
Honghong Wang
Keyword(s):  
Systematic Review ◽  
Low Income ◽  
Meta Analysis ◽  
Global Network ◽  
Controlled Trials ◽  
Pharmacological Treatments ◽  
Comparative Efficacy ◽  
Pharmacological Interventions ◽  
Middle Income ◽  
Middle Income Countries

Abstract Background: Improving depression is critical to successful HIV treatment. Due to the adverse reactions of pharmacotherapy, treatment for depression in PLWH has increasingly turned to non-pharmacological treatments. However, the comparative efficacy and acceptability of non-pharmacological treatments for depression among PLWH in different resource contexts remain inconclusive. This protocol for a systematic review and network meta-analysis aims at evaluating the efficacy and acceptability of non-pharmacological treatments for depression among PLWH to guide future research and practice for all research settings and for low-income and middle-income countries (LMIC) only. Methods: We will include all randomized controlled trials of any non-pharmacological interventions to reduce depression in PLWH. The primary outcomes will be the efficacy (the overall mean change scores in depression) and acceptability (the proportion of participants who withdrew for any reason). We will systematically search Published studies through the related databases (PubMed, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, and CINAHL) and the bibliographies. There is no restriction by language and publication year. At least two investigators will independently conduct all study selection, quality evaluation, and data extraction. We will employ a network meta-analysis to synthesize all available evidence for each outcome and obtain a comprehensive ranking of all interventions for the global network and for low-income and middle-income countries (LMICs) network only. We will employ validated local and global approaches to assess inconsistency. We will use OpenBUGS (version 3.2.3) to fit our model into the Bayesian framework. We will evaluate the strength of evidence with the GRADE system. Discussion: We will synthesize all available evidence and identify the most efficacious and acceptable non-pharmacological interventions for depression among PLWH for global network and for LMIC network only. The results of this study will be used to guide decision-making better in different resource settings.Systematic review registration: PROSPERO CRD42021244230.

scholarly journals Effects of integrated models of care for diabetes and hypertension in low-income and middle-income countries: a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e043705
Author(s):  
Anke Rohwer ◽  
Jeannine Uwimana Nicol ◽  
Ingrid Toews ◽  
Taryn Young ◽  
Charlotte M Bavuma ◽  
...  
Keyword(s):  
Systematic Review ◽  
Usual Care ◽  
Integrated Care ◽  
Low Income ◽  
Meta Analysis ◽  
Models Of Care ◽  
Controlled Trials ◽  
Integrated Models ◽  
Middle Income ◽  
Middle Income Countries

ObjectivesTo assess the effects of integrated models of care for people with multimorbidity including at least diabetes or hypertension in low-income and middle-income countries (LMICs) on health and process outcomes.DesignSystematic review.Data sourcesWe searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, LILACS, Africa-Wide, CINAHL and Web of Science up to 12 December 2019.Eligibility criteriaWe included randomised controlled trials (RCTs), non-RCTs, controlled before-and-after studies and interrupted time series (ITS) studies of people with diabetes and/or hypertension plus any other disease, in LMICs; assessing the effects of integrated care.Data extraction and synthesisTwo authors independently screened retrieved records; extracted data and assessed risk of bias. We conducted meta-analysis where possible and assessed certainty of evidence using Grading of Recommendations Assessment, Development and Evaluation.ResultsOf 7568 records, we included five studies—two ITS studies and three cluster RCTs. Studies were conducted in South Africa (n=3), Uganda/Kenya (n=1) and India (n=1). Integrated models of care compared with usual care may make little or no difference to mortality (very low certainty), the number of people achieving blood pressure (BP) or diabetes control (very low certainty) and access to care (very low certainty); may increase the number of people who achieve both HIV and BP/diabetes control (very low certainty); and may have a very small effect on achieving HIV control (very low certainty). Interventions to promote integrated delivery of care compared with usual care may make little or no difference to mortality (very low certainty), depression (very low certainty) and quality of life (very low certainty); and may have little or no effect on glycated haemoglobin (low certainty), systolic BP (low certainty) and total cholesterol levels (low certainty).ConclusionsCurrent evidence on the effects of integrated care on health outcomes is very uncertain. Programmes and policies on integrated care must consider context-specific factors related to health systems and populations.PROSPERO registration numberCRD42018099314.

scholarly journals Clinical characteristics, treatment and outcomes of paediatric COVID-19: a systematic review and meta-analysis

2021 ◽  
pp. archdischild-2020-321385
Author(s):  
Omar Irfan ◽  
Fiona Muttalib ◽  
Kun Tang ◽  
Li Jiang ◽  
Zohra S Lassi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Disease Severity ◽  
World Bank ◽  
Low Income ◽  
Meta Analysis ◽  
Severe Disease ◽  
Income Level ◽  
Clinical Findings ◽  
Middle Income ◽  
Middle Income Countries

ObjectiveCompare paediatric COVID-19 disease characteristics, management and outcomes according to World Bank country income level and disease severity.DesignSystematic review and meta-analysis.SettingBetween 1 December 2019 and 8 January 2021, 3350 articles were identified. Two reviewers conducted study screening, data abstraction and quality assessment independently and in duplicate. Observational studies describing laboratory-confirmed paediatric (0–19 years old) COVID-19 were considered for inclusion.Main outcomes and measuresThe pooled proportions of clinical findings, treatment and outcomes were compared according to World Bank country income level and reported disease severity.Results129 studies were included from 31 countries comprising 10 251 children of which 57.4% were hospitalised. Mean age was 7.0 years (SD 3.6), and 27.1% had a comorbidity. Fever (63.3%) and cough (33.7%) were common. Of 3670 cases, 44.1% had radiographic abnormalities. The majority of cases recovered (88.9%); however, 96 hospitalised children died. Compared with high-income countries, in low-income and middle-income countries, a lower proportion of cases were admitted to intensive care units (ICUs) (9.9% vs 26.0%) yet pooled proportion of deaths among hospitalised children was higher (relative risk 2.14, 95% CI 1.43 to 3.20). Children with severe disease received antimicrobials, inotropes and anti-inflammatory agents more frequently than those with non-severe disease. Subgroup analyses showed that a higher proportion of children with multisystem inflammatory syndrome (MIS-C) were admitted to ICU (47.1% vs 22.9%) and a higher proportion of hospitalised children with MIS-C died (4.8% vs 3.6%) compared with the overall sample.ConclusionPaediatric COVID-19 has a favourable prognosis. Further severe disease characterisation in children is needed globally.

scholarly journals Efficacy of zinc as adjunctive pneumonia treatment in children aged 2 to 60 months in low-income and middle-income countries: a systematic review and meta-analysis

2020 ◽  
Vol 4 (1) ◽  
pp. e000662 ◽  
Author(s):  
Nick Brown ◽  
Antti Juhani Kukka ◽  
Andreas Mårtensson
Keyword(s):  
Systematic Review ◽  
Treatment Failure ◽  
Low Income ◽  
Meta Analysis ◽  
Severe Pneumonia ◽  
Risk Of Bias ◽  
Sensitivity Analyses ◽  
Cochrane Library ◽  
Middle Income ◽  
Middle Income Countries

BackgroundDespite advances in vaccination and case management, pneumonia remains the single largest contributor to early child mortality worldwide. Zinc has immune-enhancing properties, but its role in adjunctive treatment of pneumonia in low-income and middle-income countries (LMICs) is controversial and research still active.MethodsSystematic review and meta-analysis of randomised controlled trials of zinc and placebo in pneumonia in children aged 2 to 60 months in LMICs. Databases included MEDLINE, the Cochrane Library, EMBASE, LILACS, SciELO, the WHO portal, Scopus, Google Scholar and ClinicalTrials.gov. Inclusion criteria included accepted signs of pneumonia and clear measure of outcome. Risk of bias was independently assessed by two authors. ORs with 95% CI were used for calculating the pooled estimate of dichotomous outcomes including treatment failure and mortality. Time to recovery was expressed as HRs. Sensitivity analyses considering risk of bias and subgroup analyses for pneumonia severity were performed.ResultsWe identified 11 trials published between 2004 and 2019 fulfilling the a priori defined criteria, 7 from South Asia and 3 from Africa and 1 from South America. Proportional treatment failure was comparable in both zinc and placebo groups when analysed for all patients (OR 0.95 (95% CI 0.80 to 1.14)) and only for those with severe pneumonia (OR 0.93 (95% CI 0.75 to 1.14)). No difference was seen in mortality between zinc and placebo groups (OR 0.64 (95% CI 0.31 to 1.31)). Time to recovery from severe pneumonia did not differ between the treatment and control groups for patients with severe pneumonia (HR 1.01 (95% CI 0.89 to 1.14)). Removal of four studies with high risk of bias made no difference to the conclusions.ConclusionThere is no evidence that adjunctive zinc treatment improves recovery from pneumonia in children in LMICs.Trial registration numberCRD42019141602.

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