Adherence to Antiretroviral Therapy in Sub-Saharan Africa and North America

Mills, Edward J.; Nachega, Jean B.; Buchan, Iain; Orbinski, James; Attaran, Amir; Singh, Sonal; Rachlis, Beth; Wu, Ping; Cooper, Curtis; Thabane, Lehana; Wilson, Kumanan; Guyatt, Gordon; Bangsberg, David R.

doi:10.1001/jama.296.6.679

Cited by 777 publications

(709 citation statements)

References 72 publications

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“…Due to variability in study methods and a lack of placebo-controlled studies, we conducted a proportion meta-analysis of fever rates using similar single-arm data from trials (StatsDirect statistical software version 2.7.9) to calculate pooled fever proportions. This method has been used previously in systematic reviews across different disciplines [16][17][18][19][20][21]. A random effects model with the DerSimonian-Laird method was used to account for variability in study design and results.…”

Section: Methodsmentioning

confidence: 99%

Systematic review of fever, febrile convulsions and serious adverse events following administration of inactivated trivalent influenza vaccines in children

et al. 2015

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In 2010, increased febrile convulsions (FC) occurred after administration of inactivated trivalent influenza vaccine (TIV) in Australia. We systematically reviewed the rates of fever, FC and serious adverse events (SAEs) after TIV, focussing on published and unpublished clinical trial data from 2005 to 2012, and performed meta-analysis of fever rates. From 4,372 records in electronic databases, 18 randomised controlled trials (RCTs), 14 non-randomised clinical trials, six observational studies and 12 registered trials (five RCTs and seven non-randomised) were identified. In published RCTs, fever ≥ 38 °C rates after first dose of non-adjuvanted TIV were 6.7% and 6.9% for children aged 6-35 months and ≥ 3 years, respectively. Analysis of RCTs by vaccine manufacturer showed pooled fever estimates up to 5.1% with Sanofi or GlaxoSmithKline vaccines; bioCSL vaccines were used in two non-randomised clinical trials and one unpublished RCT and were associated with fever in 22.5-37.1% for children aged 6-35 months. In RCTs, FCs occurred at a rate of 1.1 per 1,000 vaccinated children. While most TIVs induced acceptably low fever rates, bioCSL influenza vaccines were associated with much higher rates of fever in young children. Future standardised study methodology and access to individual level data would be illuminating.

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Section: Methodsmentioning

confidence: 99%

Systematic review of fever, febrile convulsions and serious adverse events following administration of inactivated trivalent influenza vaccines in children

et al. 2015

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“…Since most of the staff and all counselors are local people, some HIV-positive themselves, they are able to comprehend and discuss many problems that patients in the program encounter. Given that adherence is vital to good treatment outcomes [10,[33][34][35], we feel that the emphasis on counseling and adherence were essential for the program's success. However, even in this closely monitored, strictly counseled, and fully funded environment, with no monetary costs for the patient, over 15% of patients were lost to follow-up.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of highly active antiretroviral therapy administered by general practitioners in rural South Africa

Barth

Meer

Hoepelman

et al. 2008

Eur J Clin Microbiol Infect Dis

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The purpose of this study was to assess the oneyear efficacy of highly active antiretroviral therapy (HAART) administered by general practitioners in a primary care community clinic in rural South Africa. We performed an observational cohort study of 675 treatmentnaïve human immunodeficiency virus (HIV)-infected patients (including 66 children) who began HAART at least 12 months prior to the data analyses. Throughout treatment, the CD4+ T-cell count (percentage of CD4+ Tcells in children) and plasma HIV-RNA level were determined and the patient's weight was recorded. The primary outcome was mortality. Secondary outcomes were viral suppression, immunological response, and weight gain. One year after the start of HAART, 100 of the 675 (15%) patients were lost to follow-up and 119 patients (18%), including six children, died. Mortality was highest during the first few months of treatment. Based on an ontreatment analysis at one year after the start of therapy, 83% of adults and 71% of children had a viral load <400 copies/ ml; the viral load was <50 copies/ml in 70% of adults and 61% of children. At one year, the mean CD4+ T-cell count in adults had increased by 236/mm 3 , and the mean body mass index (BMI) had increased by 3.5 kg/m 2 . In children, the mean CD4% had increased by 17.6. A low Karnofsky score and a low baseline CD4+ T-cell count were independently associated with death. In addition to these factors, a low baseline BMI and gender were predictive of a poor immunological outcome. Our study shows that adequately monitored HIV/acquired immunodeficiency syndrome (AIDS) care administered by general practitioners and their staff is feasible and leads to good results in a rural, primary care center in sub-Saharan Africa. In order to achieve even better results, early mortality should be reduced and efforts should be made to start HAART earlier.

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“…To pool the sensitivity and specificity, the variances of the raw proportions (r/n) were stabilized using a Freeman-Tukey-type arcsine square root transformation [35,38]. To prevent division by 0 when pooling the ln DOR, conventional correction was applied by adding 0.5 to each cell when the 2 9 2 table for a study contained one or more 0 values.…”

Section: Methodsmentioning

confidence: 99%

Diagnosing Suspected Scaphoid Fractures: A Systematic Review and Meta-analysis

Yin

Zhang

Kan

et al. 2010

Clinical Orthopaedics &Amp; Related Research

140

152

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Imaging protocols for suspected scaphoid fractures among investigators and hospitals are markedly inconsistent. We performed a systematic review and metaanalysis to assess and compare the diagnostic performance of bone scintigraphy, MRI, and CT for diagnosing suspected scaphoid fractures. Twenty-six studies were included. Sensitivity, specificity, and diagnostic odds ratio were pooled separately and summary receiver operating characteristic curves were fitted for each modality. Metaregression analyses were performed to compare these modalities. We obtained likelihood ratios derived from the pooled sensitivity and specificity and, using Bayes' theorem, calculated the posttest probability by application of the tests. The pooled sensitivity, specificity, natural logarithm of the diagnostic odds ratio, and the positive and negative likelihood ratios were, respectively, 97%, 89%, 4.78, 8.82, and 0.03 for bone scintigraphy; 96%, 99%, 6.60, 96, and 0.04 for MRI; and 93%, 99%, 6.11, 93, and 0.07 for CT. Bone scintigraphy and MRI have equally high sensitivity and high diagnostic value for excluding scaphoid fracture; however, MRI is more specific and better for confirming scaphoid fracture. We believe additional studies are needed to assess diagnostic performance of CT, especially paired design studies or randomized controlled trials to compare CT with MRI or bone scintigraphy.

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Adherence to Antiretroviral Therapy in Sub-Saharan Africa and North America

Abstract: Our findings indicate that favorable levels of adherence, much of which was assessed via patient self-report, can be achieved in sub-Saharan African settings and that adherence remains a concern in North America.

Cited by 777 publications

References 72 publications

Systematic review of fever, febrile convulsions and serious adverse events following administration of inactivated trivalent influenza vaccines in children

Systematic review of fever, febrile convulsions and serious adverse events following administration of inactivated trivalent influenza vaccines in children

Effectiveness of highly active antiretroviral therapy administered by general practitioners in rural South Africa

Diagnosing Suspected Scaphoid Fractures: A Systematic Review and Meta-analysis

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