Dessie Getenet, Mulugeta Henok, Wagnew Fasil, Zegeye Abriham, Kiross Dessalegn, Negesse Ayenew, Aynalem Yared Asmare, Getaneh Temsgen, Ohringer Alison, Burrowes Sahai
Department of Nursing, School of Health Science, College of Medicine and Health Science, Bahr Dar University, Bahir Dar, Ethiopia.
Department of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia.
Curr Ther Res Clin Exp. 2021 Jan 5;94:100621. doi: 10.1016/j.curtheres.2020.100621. eCollection 2021.
Minimizing antiretroviral treatment failure is crucial for improving patient health and for maintaining long-term access to care in low-income settings such as eastern Africa. To develop interventions to support adherence, policymakers must understand the extent and scope of treatment failure in their programs. However, estimates of treatment failure in eastern Africa have been variable and inconclusive.
This systematic review and meta-analysis sought to determine the pooled prevalence of immunological failure among adults receiving antiretroviral therapy in eastern Africa.
We performed a systematic search of the PubMed, Google Scholar, Excerpta Medica Database, and the World Health Organization's Hinari portal (which includes the Scopus, African Index Medicus, and African Journals Online databases) databases. Unpublished studies were also accessed from conference websites and university repositories. We used Stata version 14 for data analysis. The Cochrane test and test statistic were used to test for heterogeneity across the studies. Due to high levels of heterogeneity, a random effects model was used to estimate the pooled prevalence of immunological failure. Begg and Egger tests of the intercept in the random effects model were used to check for publication bias.
After removing duplicates, 25 articles remained for assessment and screening. After quality screening, 15 articles were deemed eligible and incorporated into the final analysis. The average pooled estimate of immunological treatment failure prevalence was found to be 21.89% (95% CI, 15.14-28.64). In the subgroup analysis conducted by geographic region, the pooled prevalence of immunological treatment failure in Ethiopia was 15.2% (95% CI, 12.27-18.13) while in Tanzania it was 53.93% (95% CI, 48.14-59.73). Neither the results of Egger test or Begg tests suggested publication bias; however, on visual examination, the funnel plot appeared asymmetric. The large heterogeneity across the studies could be explained by study country.
Immunological treatment failure among patients receiving antiretroviral therapy in eastern Africa was high, and greater than previously reported. The relatively low rates of treatment failure found in Ethiopia suggest that its health extension program should be studied as a model for improving adherence in the region. ( 2021; 82:XXX-XXX) © 2021 Elsevier HS Journals, Inc.
在东非等低收入地区，尽量减少抗逆转录病毒治疗失败对于改善患者健康状况以及维持长期医疗服务可及性至关重要。为制定支持治疗依从性的干预措施，政策制定者必须了解其项目中治疗失败的程度和范围。然而，东非治疗失败的估计值一直存在差异且尚无定论。
本系统评价和荟萃分析旨在确定东非接受抗逆转录病毒治疗的成年人中免疫治疗失败的合并患病率。
我们对PubMed、谷歌学术、医学文摘数据库以及世界卫生组织的Hinari门户（包括Scopus、非洲医学索引和非洲在线期刊数据库）进行了系统检索。未发表的研究也从会议网站和大学知识库中获取。我们使用Stata 14版进行数据分析。Cochrane检验和检验统计量用于检验各研究之间的异质性。由于异质性水平较高，采用随机效应模型来估计免疫治疗失败的合并患病率。随机效应模型中的截距Begg检验和Egger检验用于检查发表偏倚。
去除重复项后，剩余25篇文章进行评估和筛选。经过质量筛选，15篇文章被认为符合要求并纳入最终分析。免疫治疗失败患病率的平均合并估计值为21.89%（95%可信区间，15.14 - 28.64）。在按地理区域进行的亚组分析中，埃塞俄比亚免疫治疗失败的合并患病率为15.2%（95%可信区间，12.27 - 18.13），而坦桑尼亚为53.93%（95%可信区间，48.14 - 59.73）。Egger检验和Begg检验的结果均未提示存在发表偏倚；然而，直观检查时，漏斗图显示不对称。各研究之间的巨大异质性可以用研究国家来解释。
东非接受抗逆转录病毒治疗的患者中免疫治疗失败率很高，且高于先前报道。埃塞俄比亚相对较低的治疗失败率表明，应将其健康推广项目作为该地区改善依从性的典范进行研究。（《2021年；82卷：XXX - XXX》）© 2021爱思唯尔健康科学期刊公司
