Kebede Hafte Kahsay, Gesesew Hailay Abrha, Gebremedhin Amanuel Tesfay, Ward Paul
Tigray Health Research Institute, Mekelle, Tigray, Ethiopia.
College of Health Sciences, Mekelle University, Mekelle, 231, Ethiopia.
Confl Health. 2024 May 17;18(1):40. doi: 10.1186/s13031-024-00591-8.
Despite the fact that Sub-Saharan Africa bears a disproportionate burden of armed conflicts and HIV infection, there has been inadequate synthesis of the impact of armed conflict on HIV treatment outcomes. We summarized the available evidence on the impact of armed conflicts on HIV treatment outcomes in Sub-Saharan Africa from 2002 to 2022.
We searched four databases; MEDLINE, PubMed, CINHAL, and Scopus. We also explored grey literature sources and reviewed the bibliographies of all articles to identify any additional relevant studies. We included quantitative studies published in English from January 1, 2002 to December 30, 2022 that reported on HIV treatment outcomes for patients receiving antiretroviral therapy (ART) in conflict and post-conflict areas, IDP centers, or refugee camps, and reported on their treatment outcomes from sub-Saharan Africa. Studies published in languages other than English, reporting on non-ART patients and reporting on current or former military populations were excluded. We used EndNote X9 and Covidence to remove duplicates, extracted data using JBI-MAStARI, assessed risk of bias using AHRQ criteria, reported results using PRISMA checklist, and determined Statistical heterogeneity using Cochran Q test and Higgins I, R- and RevMan-5 software were used for meta-analysis.
The review included 16 studies with participant numbers ranging from 102 to 2572. Lost To Follow-Up (LTFU) percentages varied between 5.4% and 43.5%, virologic non-suppression rates ranged from 25 to 33%, adherence rates were over 88%, and mortality rates were between 4.2% and 13%. A pooled meta-analysis of virologic non-suppression rates from active conflict settings revealed a non-suppression rate of 30% (0.30 (0.26-0.33), I2 = 0.00%, p = 0.000). In contrast, a pooled meta-analysis of predictors of loss to follow-up (LTFU) from post-conflict settings identified a higher odds ratio for females compared to males (1.51 (1.05, 2.17), I2 = 0%, p = 0.03).
The review highlights a lack of research on the relationship between armed conflicts and HIV care outcomes in SSA. The available documents lack quality of designs and data sources, and the depth and diversity of subjects covered.
尽管撒哈拉以南非洲承受着不成比例的武装冲突和艾滋病毒感染负担，但关于武装冲突对艾滋病毒治疗结果的影响的综合研究仍显不足。我们总结了2002年至2022年期间关于武装冲突对撒哈拉以南非洲艾滋病毒治疗结果影响的现有证据。
我们检索了四个数据库；MEDLINE、PubMed、CINHAL和Scopus。我们还探索了灰色文献来源，并查阅了所有文章的参考文献，以确定任何其他相关研究。我们纳入了2002年1月1日至2022年12月30日期间以英文发表的定量研究，这些研究报告了冲突地区和冲突后地区、国内流离失所者中心或难民营中接受抗逆转录病毒疗法（ART）的患者的艾滋病毒治疗结果，并报告了他们在撒哈拉以南非洲的治疗结果。排除以非英语发表的研究、报告非ART患者的研究以及报告现役或退役军人的研究。我们使用EndNote X9和Covidence去除重复项，使用JBI-MAStARI提取数据，使用AHRQ标准评估偏倚风险，使用PRISMA清单报告结果，并使用Cochran Q检验和Higgins I确定统计异质性，使用R-和RevMan-5软件进行荟萃分析。
该综述纳入了16项研究，参与者人数从102人到2572人不等。失访（LTFU）百分比在5.4%至43.5%之间，病毒学未抑制率在25%至33%之间，依从率超过88%，死亡率在4.2%至13%之间。对活跃冲突地区病毒学未抑制率的汇总荟萃分析显示未抑制率为30%（0.30（置信区间0.26 - 0.33），I2 = 0.00%，p =
0.000）。相比之下，对冲突后地区失访（LTFU）预测因素的汇总荟萃分析发现，女性失访的比值比高于男性（1.51（置信区间1.05, 2.17），I2 = 0%，p = 0.03）。
该综述强调了撒哈拉以南非洲地区武装冲突与艾滋病毒护理结果之间关系的研究不足。现有文献在设计质量、数据来源以及所涵盖主题的深度和多样性方面存在欠缺。
