Persistent difficulties in switching to second-line ART in sub-saharan Africa--a systematic review and meta-analysis.
<h4>Objectives</h4>Switching to second-line antiretroviral therapy (ART) largely depends on careful clinical assessment and access to biological measurements. We performed a systematic review and meta-analysis to estimate the incidence of switching to second-line ART in sub-Saharan Afric...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2013-01-01
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| Series: | PLoS ONE |
| Online Access: | https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24376570/pdf/?tool=EBI |
| _version_ | 1818459700975370240 |
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| author | Yoann Madec Sandrine Leroy Marie-Anne Rey-Cuille Florence Huber Alexandra Calmy |
| author_facet | Yoann Madec Sandrine Leroy Marie-Anne Rey-Cuille Florence Huber Alexandra Calmy |
| author_sort | Yoann Madec |
| collection | DOAJ |
| description | <h4>Objectives</h4>Switching to second-line antiretroviral therapy (ART) largely depends on careful clinical assessment and access to biological measurements. We performed a systematic review and meta-analysis to estimate the incidence of switching to second-line ART in sub-Saharan Africa and its main programmatic determinants.<h4>Methods</h4>We searched 2 databases for studies reporting the incidence rate of switching to second-line ART in adults living in sub-Saharan Africa. Data on the incidence rate of switching were pooled, and random-effect models were used to evaluate the effect of factors measured at the programme level on this incidence rate.<h4>Results</h4>Nine studies (157,340 patients) in 21 countries were included in the meta-analysis. All studies considered patients under first-line ART and conditions to initiate ART were similar across studies. Overall, 3,736 (2.4%) patients switched to second-line ART. Incidence rate of switch was in mean 2.65 per 100 person-years (PY) (95% confidence interval: 2.01-3.30); it ranged from 0.42 to 4.88 per 100 PY and from 0 to 4.80 per 100 PY in programmes with and without viral load monitoring, respectively. No factors measured at the programme level were associated with the incidence rate of switching to second-line ART.<h4>Conclusion</h4>The low incidence rate of switching to second-line ART suggests that the monitoring of patients under ART is challenging and that access to second-line ART is ineffective; efforts should be made to increase access to second-line ART to those in need by providing monitoring tools, education and training, as well as a more convenient regimen. |
| first_indexed | 2024-12-14T23:18:32Z |
| format | Article |
| id | doaj.art-9457753a9c64446cb24202c1d3651821 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-14T23:18:32Z |
| publishDate | 2013-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-9457753a9c64446cb24202c1d36518212022-12-21T22:44:02ZengPublic Library of Science (PLoS)PLoS ONE1932-62032013-01-01812e8272410.1371/journal.pone.0082724Persistent difficulties in switching to second-line ART in sub-saharan Africa--a systematic review and meta-analysis.Yoann MadecSandrine LeroyMarie-Anne Rey-CuilleFlorence HuberAlexandra Calmy<h4>Objectives</h4>Switching to second-line antiretroviral therapy (ART) largely depends on careful clinical assessment and access to biological measurements. We performed a systematic review and meta-analysis to estimate the incidence of switching to second-line ART in sub-Saharan Africa and its main programmatic determinants.<h4>Methods</h4>We searched 2 databases for studies reporting the incidence rate of switching to second-line ART in adults living in sub-Saharan Africa. Data on the incidence rate of switching were pooled, and random-effect models were used to evaluate the effect of factors measured at the programme level on this incidence rate.<h4>Results</h4>Nine studies (157,340 patients) in 21 countries were included in the meta-analysis. All studies considered patients under first-line ART and conditions to initiate ART were similar across studies. Overall, 3,736 (2.4%) patients switched to second-line ART. Incidence rate of switch was in mean 2.65 per 100 person-years (PY) (95% confidence interval: 2.01-3.30); it ranged from 0.42 to 4.88 per 100 PY and from 0 to 4.80 per 100 PY in programmes with and without viral load monitoring, respectively. No factors measured at the programme level were associated with the incidence rate of switching to second-line ART.<h4>Conclusion</h4>The low incidence rate of switching to second-line ART suggests that the monitoring of patients under ART is challenging and that access to second-line ART is ineffective; efforts should be made to increase access to second-line ART to those in need by providing monitoring tools, education and training, as well as a more convenient regimen.https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24376570/pdf/?tool=EBI |
| spellingShingle | Yoann Madec Sandrine Leroy Marie-Anne Rey-Cuille Florence Huber Alexandra Calmy Persistent difficulties in switching to second-line ART in sub-saharan Africa--a systematic review and meta-analysis. PLoS ONE |
| title | Persistent difficulties in switching to second-line ART in sub-saharan Africa--a systematic review and meta-analysis. |
| title_full | Persistent difficulties in switching to second-line ART in sub-saharan Africa--a systematic review and meta-analysis. |
| title_fullStr | Persistent difficulties in switching to second-line ART in sub-saharan Africa--a systematic review and meta-analysis. |
| title_full_unstemmed | Persistent difficulties in switching to second-line ART in sub-saharan Africa--a systematic review and meta-analysis. |
| title_short | Persistent difficulties in switching to second-line ART in sub-saharan Africa--a systematic review and meta-analysis. |
| title_sort | persistent difficulties in switching to second line art in sub saharan africa a systematic review and meta analysis |
| url | https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24376570/pdf/?tool=EBI |
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