Maulana Sidik, Ibrahim Kusman, Pramukti Iqbal, Amirah Shakira, Hartantri Yovita
Postgraduate Program of Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Indonesia.
Department of Medical-Surgical Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Indonesia.
Belitung Nurs J. 2025 May 27;11(3):264-277. doi: 10.33546/bnj.3719. eCollection 2025.
Despite the effectiveness of antiretroviral therapy (ART) in reducing HIV-related morbidity and mortality, the retention of HIV care remains suboptimal in Southeast Asia.
This systematic review and meta-analysis aimed to investigate the coverage of retention in care and the likelihood factors for retention in HIV care among Southeast Asian people living with HIV, to inform targeted interventions and policy improvements.
Following the Preferred Reporting Item for Systematic Review and Meta-analysis (PRISMA) guidelines, this study included observational studies reporting factors associated with retention in HIV care among Southeast Asian adults, with searches conducted in PubMed, Scopus, Cochrane Library, and CINAHL up to July 15, 2024. Demographic and clinical factors were analyzed using a random-effects model with the generalized linear mixed-effect model (GLLM) to estimate proportion and the DerSimonian-Laird method to estimate odds ratios (OR) with 95% confidence intervals (CI), assessing heterogeneity using the ² statistic.
Among the eleven studies with 46,480 pooled participants analyzed, the coverage of retention in care revealed a pooled proportion of 75.2% (95% CI: 66.7-82.1). Significant clinical factors associated with a higher likelihood of retention included high CD4 count (≥200 cells/mm³) (OR 2.17 (95%CI: 1.19-3.97, = 0.01), WHO stage 3-4 (OR 2.06, 95%CI: 1.09-3.87, = 0.02), not being on ART (OR 6.88, 95%CI: 1.89-25.06, = 0.001), hemoglobin levels ≥10 g/dL (OR 0.50, 95% CI: 0.25-0.99, = 0.04), and demographic factors of employment (OR 1.18, 95% CI: 1.02-1.38; = 0.03). Other clinical factors, such as HIV stage, TB co-infection, drug abuse/substance use, and hemoglobin levels, did not significantly affect the likelihood of retention. Similarly, demographic factors such as age, gender, education, marital status, and geographic setting also showed no significant impact on likelihood retention.
Retention in care among Southeast Asian people living with HIV was still below 95%. Clinical factors, particularly high CD4 counts, WHO stage, and the absence of ART, were likelihood factors for retention in HIV care, whereas other clinical and demographic factors studied did not show a significant impact. A universal test and treatment strategy is required to improve retention in care.
尽管抗逆转录病毒疗法（ART）在降低与HIV相关的发病率和死亡率方面有效，但东南亚地区HIV护理的留存率仍不尽人意。
本系统评价和荟萃分析旨在调查东南亚HIV感染者护理留存率及其相关因素，为针对性干预措施和政策改进提供依据。
按照系统评价和荟萃分析的首选报告项目（PRISMA）指南，本研究纳入了报告东南亚成年人HIV护理留存相关因素的观察性研究，检索截至2024年7月15日的PubMed、Scopus、Cochrane图书馆和CINAHL。使用广义线性混合效应模型（GLLM）的随机效应模型分析人口统计学和临床因素，以估计比例，并采用DerSimonian-Laird方法估计比值比（OR）及95%置信区间（CI），使用²统计量评估异质性。
在分析的11项共46480名参与者的研究中，护理留存率的合并比例为75.2%（95%CI：66.7-82.1）。与较高留存可能性相关的显著临床因素包括高CD4计数（≥200个细胞/mm³）（OR 2.17（95%CI：1.19-3.97， = 0.01））、WHO 3-4期（OR 2.06，95%CI：1.09-3.
