First line antiretroviral treatment failure and its association with drug substitution and sex among children in Ethiopia: systematic review and meta-analysis

Abstract

Antiretroviral Treatment (ART) has significantly decreased HIV-related morbidity and mortality among children despite the issue of drug resistance and subsequent treatment failure appearing as a challenge. Different studies have been conducted in Ethiopia regarding the prevalence of first-line ART failure among children but the magnitudes of these studies were inconsistent and had great variability. This review aimed to estimate the pooled prevalence of first line ART failure among children and its association with drug substitution and sex of children among first-line ART users in Ethiopia. The review was conducted using both published and unpublished studies until September 2020 in Ethiopia. MEDLINE, PubMed, Hinari, Web of Science, Google Scholar, Africa journal online (AJOL), Open gray literature, and online repository articles were searched. The quality of individual studies was assessed by Joanna Briggs Institute's (JBI) critical appraisal checklist. The statistical analysis was done by STATA-14 software and a random effect model was used. Heterogeneity was assessed using forest plot Cochrane Q–test and I-squared statistic. Publication bias was checked by using a funnel plot and Egger’s and Begg’s statistical tests. The interpretation was made by an odds ratio and with their respective 95% confidence intervals. The heterogeneity rate was 90% and Begg’s and Egger’s for publication bias were insignificant with p-values of 0.89 and 0.11 respectively. The pooled prevalence of pediatric first line ART failure in Ethiopia was 14.98% (95% CI 11.74, 18.21). Subgroup analysis showed that the highest failure rate was virological (9.13%). Female children had 1.4 times more risk of first-line ART failure (OR = 1.42; 95% CI 1.08, 1.85). First-line ART failure among children in Ethiopia is considerably high. Being female increases the likelihood of facing first line ART failure. More attention should be given to female children.

Clinical and Immunological Profiles of HIV/AIDS Patients With First-Line Antiretroviral Treatment Failure Attending a Tertiary Care Hospital

“…In contrast to our observations, a recent systematic review observed that female children were at higher risk of first-line ART failure than male children [ 11 ]. However, a systematic review of observational studies published between January 1998 and November 2013 revealed no sex difference in virologic or immunologic treatment outcomes [ 12 ].…”

Tuberculosis infection control practice among healthcare workers in Ethiopia: a protocol for systematic review and meta-analysis

“…Using the tool as a protocol, the reviewers (MG, TF) will use the blinded review approach to evaluate the quality of the original articles. Those studies with scores five or more in JBI criteria will be considered to have a good quality 22. Discrepancies in the quality assessment will be resolved through a third author (ET).…”

“…Those studies with scores five or more in JBI criteria will be considered to have a good quality. 22 Discrepancies in the quality assessment will be resolved through a third author (ET). Risk of bias will be assessed by Cochrane collaboration's tool for assessing risk of Open access bias, 23 classification of 'high', 'low' or 'unclear' risk of bias, and it can be found as online supplemental file 3.…”

Tuberculosis infection control practice and associated factors among health care workers in Ethiopia: Systematic review and meta-analysis

“…Using the tool as a protocol, the three reviewers (MG, ET and EK) evaluate the quality of the original articles independently. Those studies, scores 5 or more in JBI criteria were considered to have good quality and included in the review [ 35 ]. Discrepancies in the quality assessment were resolved through the involvement of the authors (TF and AM).…”