Retention in HIV Care between Testing and Treatment in Sub-Saharan Africa A Systematic Review 英文参考文献.docVIP

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Retention in HIV Care between Testing and Treatment in Sub-Saharan Africa A Systematic Review 英文参考文献.doc

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Retention in HIV Care between Testing and Treatment in Sub-Saharan Africa A Systematic Review 英文参考文献

RetentioninHIVCarebetweenTestingandTreatmentin Sub-SaharanAfrica:ASystematicReview SydneyRosen1,2*,MatthewP.Fox1,2,3 1CenterforGlobalHealthandDevelopment,BostonUniversity,Boston,Massachusetts,UnitedStatesofAmerica,2HealthEconomicsandEpidemiologyResearchOffice, WitsHealthConsortium,FacultyofHealthSciences,UniversityoftheWitwatersrand,Johannesburg,SouthAfrica,3DepartmentofEpidemiology,BostonUniversitySchool ofPublicHealth,Boston,Massachusetts,UnitedStatesofAmerica Abstract Background: Improving the outcomes of HIV/AIDS treatment programs in resource-limited settings requires successful linkageofpatientstestingpositiveforHIVtopre–antiretroviraltherapy(ART)careandretentioninpre-ARTcareuntilART initiation.Weconductedasystematicreviewofpre-ARTretentionincareinAfrica. MethodsandFindings:WesearchedPubMed,ISIWebofKnowledge,conferenceabstracts,andreferencelistsforreports ontheproportionofadultpatientsretainedbetweenanytwopointsbetweentestingpositiveforHIVandinitiatingARTin sub-SaharanAfricanHIV/AIDScareprograms.ResultswerecategorizedasStage1(fromHIVtestingtoreceiptofCD4count resultsorclinicalstaging),Stage2(fromstagingtoARTeligibility),orStage3(fromARTeligibilitytoARTinitiation).Medians (ranges)werereportedfortheproportionsofpatientsretainedineachstage.Weidentified28eligiblestudies.Themedian proportionretainedinStage1was59%(35%–88%);Stage2,46%(31%–95%);andStage3,68%(14%–84%).Moststudies reportedononlyonestage;nonefollowedacohortofpatientsthroughallthreestages.Enrollmentcriteria,terminology, endpoints,follow-up,andoutcomesvariedwidelyandwereoftenpoorlydefined,makingaggregationofresultsdifficult. Synthesisoffindingsfrommultiplestudiessuggeststhatfewerthanone-thirdofpatientstestingpositiveforHIVandnot yet eligible for ART when diagnosed are retained continuously in care, though this estimate should be regarded with cautionbecauseofreviewlimitations. Conclusions:Studiesofretentioninpre-ARTcarereportsubstantiallossofpatientsateverystep,startingwithpatientswho donotreturnfortheir