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...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Yoann Madec, Sandrine Leroy, Marie-Anne Rey-Cuille, Florence Huber, Alexandra Calmy
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/9457753a9c64446cb24202c1d3651821
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:9457753a9c64446cb24202c1d3651821
record_format	dspace
spelling	oai:doaj.org-article:9457753a9c64446cb24202c1d36518212021-11-18T08:40:42ZPersistent difficulties in switching to second-line ART in sub-saharan Africa--a systematic review and meta-analysis.1932-620310.1371/journal.pone.0082724https://doaj.org/article/9457753a9c64446cb24202c1d36518212013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24376570/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<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.Yoann MadecSandrine LeroyMarie-Anne Rey-CuilleFlorence HuberAlexandra CalmyPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 12, p e82724 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q 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.
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.
format	article
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
title	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_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_sort	persistent difficulties in switching to second-line art in sub-saharan africa--a systematic review and meta-analysis.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/9457753a9c64446cb24202c1d3651821
work_keys_str_mv	AT yoannmadec persistentdifficultiesinswitchingtosecondlineartinsubsaharanafricaasystematicreviewandmetaanalysis AT sandrineleroy persistentdifficultiesinswitchingtosecondlineartinsubsaharanafricaasystematicreviewandmetaanalysis AT marieannereycuille persistentdifficultiesinswitchingtosecondlineartinsubsaharanafricaasystematicreviewandmetaanalysis AT florencehuber persistentdifficultiesinswitchingtosecondlineartinsubsaharanafricaasystematicreviewandmetaanalysis AT alexandracalmy persistentdifficultiesinswitchingtosecondlineartinsubsaharanafricaasystematicreviewandmetaanalysis
_version_	1718421459474317312

Persistent difficulties in switching to second-line ART in sub-saharan Africa--a systematic review and meta-analysis.

Ejemplares similares