Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA.
Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
J Int AIDS Soc. 2018 Nov;21(11):e25209. doi: 10.1002/jia2.25209.
Identification and retention of HIV-exposed infants in early infant diagnosis (EID) services helps to ensure optimal health outcomes. This systematic review and meta-analysis examines the magnitude of attrition from EID services in low- and middle-income countries (LMICs).
We performed a comprehensive database search through April 2016. We included original studies reporting retention/attrition data for HIV-exposed infants in LMICs. Outcomes included loss to follow-up (LTFU), death and overall attrition (LTFU + death) at time points along the continuum of EID services. At least two authors determined study eligibility, performed data extraction and made quality assessments. We used random-effects meta-analytic methods to aggregate effect sizes and perform meta-regression analyses. This study adhered to PRISMA reporting guidelines.
We identified 3040 unique studies, of which 92 met eligibility criteria and were included in the quantitative synthesis. The included studies represent data from 110,805 HIV-exposed infants, the majority of whom were from Africa (77%). LTFU definitions varied widely, and there was significant variability in outcomes across studies. The bulk of attrition occurred in the first six months of follow-up, with additional losses over time. Overall, 39% of HIV-exposed infants were no longer in care at 18 months. When restricted to non-intervention studies, 43% were not retained at 18 months.
These findings underscore the high attrition of HIV-exposed infants from EID services in LMICs and the urgent need for implementation research and resources to improve retention among this vulnerable population.
在早期婴儿诊断（EID）服务中识别和保留艾滋病毒暴露婴儿有助于确保获得最佳健康结果。本系统评价和荟萃分析检查了中低收入国家（LMICs）EID 服务中流失的程度。
我们通过 2016 年 4 月进行了全面的数据库搜索。我们纳入了报告 LMIC 中艾滋病毒暴露婴儿保留/流失数据的原始研究。结果包括在 EID 服务连续体中的各个时间点上的失访（LTFU）、死亡和总体流失（LTFU+死亡）。至少两名作者确定了研究的合格性，进行了数据提取并进行了质量评估。我们使用随机效应荟萃分析方法汇总效应大小并进行荟萃回归分析。本研究符合 PRISMA 报告指南。
我们确定了 3040 项独特的研究，其中 92 项符合入选标准并纳入定量综合分析。纳入的研究代表了来自非洲（77%）的 110805 名艾滋病毒暴露婴儿的数据。LTFU 的定义差异很大，而且研究之间的结果也存在很大差异。大部分流失发生在随访的前六个月，随着时间的推移会有额外的流失。总体而言，18 个月时，39%的艾滋病毒暴露婴儿不再接受治疗。当仅限于非干预研究时，18 个月时，43%的婴儿未保留下来。
这些发现突显了中低收入国家 EID 服务中艾滋病毒暴露婴儿的高流失率，迫切需要实施研究和资源，以改善这一脆弱人群的保留率。
