Background Despite antiretroviral therapy (ART) being widely available, HIV continues to cause substantial illness and premature death in low‐and‐middle‐income countries. High rates of loss to follow‐up after HIV diagnosis can delay people starting ART. Starting ART within seven days of HIV diagnosis (rapid ART initiation) could reduce loss to follow‐up, improve virological suppression rates, and reduce mortality. Objectives To assess the effects of interventions for rapid initiation of ART (defined as offering ART within seven days of HIV diagnosis) on treatment outcomes and mortality in people living with HIV. We also aimed to describe the characteristics of rapid ART interventions used in the included studies. Search methods We searched CENTRAL, the Cochrane Database of Systematic Reviews, MEDLINE, Embase, and four other databases up to 14 August 2018. There was no restriction on date, language, or publication status. We also searched ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform, and websites for unpublished literature, including conference abstracts. Selection criteria We included randomized controlled trials (RCTs) that compared rapid ART versus standard care in people living with HIV. Children, adults, and adolescents from any setting were eligible for inclusion. Data collection and analysis Two review authors independently assessed the eligibility of the studies identified in the search, assessed the risk of bias and extracted data. The primary outcomes were mortality and virological suppression at 12 months. We have presented all outcomes using risk ratios (RR), with 95% confidence intervals (CIs). Where appropriate, we pooled the results in meta‐analysis. We assessed the certainty of the evidence using the GRADE approach. Main results We included seven studies with 18,011 participants in the review. All studies were carried out in low‐ and middle‐income countries in adults aged 18 years old or older. Only one study included pregnant women. In all the studies, the rapid ART intervention was offered as part of a package that included several cointerventions targeting individuals, health workers and health system processes delivered alongside rapid ART that aimed to facilitate uptake and adherence to ART. Comparing rapid ART with standard initiation probably results in greater viral suppression at 12 months (RR 1.18, 95% CI 1.10 to 1.27; 2719 participants, 4 studies; moderate‐certainty evidence) and better ART uptake at 12 months (RR 1.09, 95% CI 1.06 to 1.12; 3713 participants, 4 studies; moderate‐certainty evidence), and may improve retention in care at 12 months (RR 1.22, 95% CI 1.11 to 1.35; 5001 participants, 6 studies; low‐certainty evidence). Rapid ART initiation was associated with a lower mortality estimate, however the CIs included n...

Background. Low-cost, portable fingertip pulse oximeters are widely available to health professionals and the public. They are often not tested to International Organization for Standardization standards, or only undergo accuracy studies in healthy volunteers under ideal laboratory conditions. Objectives. To pragmatically evaluate the agreement between one such device and a conventional bedside pulse oximeter in a clinical setting, in patients with varied comorbidities and skin pigmentations. Methods. A single-centre equipment comparison study was conducted. Simultaneous measurements were obtained in 220 patients with both a Contec CMS50D Fingertip Pulse Oximeter and a Nihon Kohden Life Scope MU-631 RK conventional bedside monitor. Peripheral oxygen saturations (SpO 2) and pulse rates were documented, and patients' skin tone was recorded using the Fitzpatrick scale. Data were assessed using a Bland-Altman analysis with bias, precision and limits of agreement (LOA) calculated with 95% confidence intervals (CIs). A priori acceptability for LOA was determined to be 3%, in keeping with international standards. Results. The mean difference (therefore bias) between the conventional and fingertip oximeters for all data was-0.55% (95% CI-0.73-0.36). Upper and lower limits of agreement were 2.16% (95% CI 1.84-2.47) and-3.25% (95% CI-3.56-2.94). Regression analysis demonstrated worsening agreement with decreasing SpO 2. When samples were separated into 'normal' (SpO 2 ≥93%) and 'hypoxaemic' (SpO 2 <93%) groups, the normal range displayed acceptable agreement between the two oximeters (bias-0.20% with LOA 2.20-2.27), while the hypoxaemic group fell outside the study's a priori limits. Heart rate measurements had a mean difference of-0.43 bpm (LOA-5.61-4.76). The study was not powered to detect differences among the skin tones, but demonstrated no trend for this parameter to alter the SpO 2 measurements. Conclusions. During normoxia, portable fingertip pulse oximeters are reliable indicators of SpO 2 and pulse rates in patients with various comorbidities in a pragmatic clinical context. However, they display worsening agreement with conventional pulse oximeters during hypoxaemia. Skin tones do not appear to affect measurements adversely.

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