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Meta-Analysis
. 2013 Dec 23;8(12):e82724.
doi: 10.1371/journal.pone.0082724. eCollection 2013.

Persistent difficulties in switching to second-line ART in sub-saharan Africa--a systematic review and meta-analysis

Yoann Madec  1 , Sandrine Leroy  1 , Marie-Anne Rey-Cuille  1 , Florence Huber  2 , Alexandra Calmy  3
Affiliations
Meta-Analysis

Persistent difficulties in switching to second-line ART in sub-saharan Africa--a systematic review and meta-analysis

Yoann Madec et al. PLoS One. .

Erratum in

  • PLoS One. 2014;9(4):e95820

Abstract

Objectives: Switching to second-line antiretroviral therapy (ART) largely depends on careful clinical assessment and access to biological measurements. We performed a systematic review and meta-analysis to estimate the incidence of switching to second-line ART in sub-Saharan Africa and its main programmatic determinants.

Methods: We searched 2 databases for studies reporting the incidence rate of switching to second-line ART in adults living in sub-Saharan Africa. Data on the incidence rate of switching were pooled, and random-effect models were used to evaluate the effect of factors measured at the programme level on this incidence rate.

Results: Nine studies (157,340 patients) in 21 countries were included in the meta-analysis. All studies considered patients under first-line ART and conditions to initiate ART were similar across studies. Overall, 3,736 (2.4%) patients switched to second-line ART. Incidence rate of switch was in mean 2.65 per 100 person-years (PY) (95% confidence interval: 2.01-3.30); it ranged from 0.42 to 4.88 per 100 PY and from 0 to 4.80 per 100 PY in programmes with and without viral load monitoring, respectively. No factors measured at the programme level were associated with the incidence rate of switching to second-line ART.

Conclusion: The low incidence rate of switching to second-line ART suggests that the monitoring of patients under ART is challenging and that access to second-line ART is ineffective; efforts should be made to increase access to second-line ART to those in need by providing monitoring tools, education and training, as well as a more convenient regimen.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flow diagram of study selection process.
Figure 2
Figure 2. Incidence rate of switching to second-line ART (expressed per 100 person-years) – Estimation from 9 studies providing 11 incidences of switching to second-line ART.
See this image and copyright information in PMC

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