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AIDS Research and Therapy Nov 2021Programmes that merge management of Human Immunodeficiency Virus (HIV) and tuberculosis (TB) aim to improve HIV/TB co-infected patients' access to comprehensive... (Meta-Analysis)
Meta-Analysis
Barriers to and enablers of uptake of antiretroviral therapy in integrated HIV and tuberculosis treatment programmes in sub-Saharan Africa: a systematic review and meta-analysis.
INTRODUCTION
Programmes that merge management of Human Immunodeficiency Virus (HIV) and tuberculosis (TB) aim to improve HIV/TB co-infected patients' access to comprehensive treatment. However, several reports from sub-Saharan Africa (SSA) indicate suboptimal uptake of antiretroviral therapy (ART) even after integration of HIV and TB treatment. This study assessed ART uptake, its barriers and enablers in programmes integrating TB and HIV treatment in SSA.
METHOD
A systematic review was performed. Seven databases were searched for eligible quantitative, qualitative and mixed-methods studies published from March 2004 through July 2019. Random-effects meta-analysis was used to obtain pooled estimates of ART uptake. A thematic approach was used to analyse and synthesise data on barriers and enablers.
RESULTS
Of 5139 references identified, 27 were included in the review: 23/27 estimated ART uptake and 10/27 assessed barriers to and/or enablers of ART uptake. The pooled ART uptake was 53% (95% CI: 42, 63%) and between-study heterogeneity was high (I = 99.71%, p < 0.001). WHO guideline on collaborative TB/HIV activities and sample size were associated with heterogeneity. There were statistically significant subgroup effects with high heterogeneity after subgroup analyses by region, guideline on collaborative TB/HIV activities, study design, and sample size. The most frequently described socioeconomic and individual level barriers to ART uptake were stigma, low income, and younger age group. The most frequently reported health system-related barriers were limited staff capacity, shortages in medical supplies, lack of infrastructure, and poor adherence to or lack of treatment guidelines. Clinical barriers included intolerance to anti-TB drugs, fear of drug toxicity, and contraindications to antiretrovirals. Health system enablers included good management of the procurement, supply, and dispensation chain; convenience and accessibility of treatment services; and strong staff capacity. Availability of psychosocial support was the most frequently reported enabler of uptake at the community level.
CONCLUSIONS
In SSA, programmes integrating treatment of TB and HIV do not, in general, achieve high ART uptake but we observe a net improvement in uptake after WHO issued the 2012 guidelines on collaborative TB/HIV activities. The recurrence of specific modifiable system-level and patient-level factors in the literature reveals key intervention points to improve ART uptake in these programmes. Systematic review registration: CRD42019131933.
Topics: Anti-Retroviral Agents; Antitubercular Agents; HIV Infections; Humans; Social Stigma; Tuberculosis
PubMed: 34784918
DOI: 10.1186/s12981-021-00395-3 -
PLoS Neglected Tropical Diseases Sep 2021Research is urgently needed to reduce the morbidity and mortality of Lassa fever (LF), including clinical trials to test new therapies and to verify the efficacy and...
BACKGROUND
Research is urgently needed to reduce the morbidity and mortality of Lassa fever (LF), including clinical trials to test new therapies and to verify the efficacy and safety of the only current treatment recommendation, ribavirin, which has a weak clinical evidence base. To help establish a basis for the development of an adaptable, standardised clinical trial methodology, we conducted a systematic review to identify the clinical characteristics and outcomes of LF and describe how LF has historically been defined and assessed in the scientific literature.
METHODOLOGY
Primary clinical studies and reports of patients with suspected and confirmed diagnosis of LF published in the peer-reviewed literature before 15 April 2021 were included. Publications were selected following a two-stage screening of abstracts, then full-texts, by two independent reviewers at each stage. Data were extracted, verified, and summarised using descriptive statistics.
RESULTS
147 publications were included, primarily case reports (36%), case series (28%), and cohort studies (20%); only 2 quasi-randomised studies (1%) were found. Data are mostly from Nigeria (52% of individuals, 41% of publications) and Sierra Leone (42% of individuals, 31% of publications). The results corroborate the World Health Organisation characterisation of LF presentation. However, a broader spectrum of presenting symptoms is evident, such as gastrointestinal illness and other nervous system and musculoskeletal disorders that are not commonly included as indicators of LF. The overall case fatality ratio was 30% in laboratory-confirmed cases (1896/6373 reported in 109 publications).
CONCLUSION
Systematic review is an important tool in the clinical characterisation of diseases with limited publications. The results herein provide a more complete understanding of the spectrum of disease which is relevant to clinical trial design. This review demonstrates the need for coordination across the LF research community to generate harmonised research methods that can contribute to building a strong evidence base for new treatments and foster confidence in their integration into clinical care.
Topics: Clinical Trials as Topic; Humans; Lassa Fever; Lassa virus; Research Design
PubMed: 34547033
DOI: 10.1371/journal.pntd.0009788 -
Molecules (Basel, Switzerland) Jun 2021Influenza is one of the most serious respiratory viral infections worldwide. Although several studies have reported that green tea catechins (GTCs) might prevent... (Meta-Analysis)
Meta-Analysis
Influenza is one of the most serious respiratory viral infections worldwide. Although several studies have reported that green tea catechins (GTCs) might prevent influenza virus infection, this remains controversial. We performed a systematic review and meta-analysis of eight studies with 5,048 participants that examined the effect of GTC administration on influenza prevention. In a random-effects meta-analysis of five RCTs, 884 participants treated with GTCs showed statistically significant effects on the prevention of influenza infection compared to the control group (risk ratio (RR) 0.67, 95%CIs 0.51-0.89, = 0.005) without evidence of heterogeneity (= 0%, = 0.629). Similarly, in three cohort studies with 2,223 participants treated with GTCs, there were also statistically significant effects (RR 0.52, 95%CIs 0.35-0.77, = 0.001) with very low evidence of heterogeneity ( = 3%, = 0.358). Additionally, the overall effect in the subgroup analysis of gargling and orally ingested items (taking capsules and drinking) showed a pooled RR of 0.62 (95% CIs 0.49-0.77, = 0.003) without heterogeneity (= 0%, = 0.554). There were no obvious publication biases (Egger's test ( = 0.138) and Begg's test ( = 0.103)). Our analysis suggests that green tea consumption is effective in the prophylaxis of influenza infections. To confirm the findings before implementation, longitudinal clinical trials with specific doses of green tea consumption are warranted.
Topics: Antiviral Agents; Catechin; Clinical Trials as Topic; Humans; Influenza, Human; Plant Extracts; Tea
PubMed: 34209247
DOI: 10.3390/molecules26134014 -
Endocrinology, Diabetes & Metabolism Apr 2021Fibrosis is characterized by dysregulation and accumulation of extracellular matrix. Peyronie's disease and Dupuytren disease are fibroproliferative disorders of the...
INTRODUCTION
Fibrosis is characterized by dysregulation and accumulation of extracellular matrix. Peyronie's disease and Dupuytren disease are fibroproliferative disorders of the tunica albuginea of the penis and fascia of the hand, respectively. Chronic hyperglycaemia due to diabetes mellitus can also lead to tissue injury and fibrosis. A meta-analysis has shown a relationship between Dupuytren disease and diabetes (overall odds ratio, 3.1; 95% confidence interval, 2.7-3.5). This review explores commonalities in the pathogenesis of Peyronie's disease, Dupuytren disease and diabetes.
METHODS
A search of the PubMed database was conducted using the search terms "diabetes" AND "Peyronie's disease"; and "diabetes" AND "Dupuytren."
RESULTS
Genome-wide association and gene expression studies conducted with tissue from people with Peyronie's disease or Dupuytren disease identified signalling pathways associated with wingless-type mammary-tumour virus integration site signalling, extracellular matrix modulation and inflammation. Biochemical studies confirmed the importance of these pathways in the pathogenesis of fibrosis with Peyronie's disease and Dupuytren disease. Dysregulation of matrix metalloproteinase activity associated with extracellular matrix breakdown was implicated in fibroproliferative complications of diabetes and in the aetiology of Peyronie's disease and Dupuytren disease. A notable percentage of people with diabetes have comorbid Peyronie's disease and/or Dupuytren disease.
CONCLUSIONS
Studies have not been performed to identify fibroproliferative pathways that all 3 conditions might have in common, but data suggest that common pathways are involved in the fibroproliferative processes of Peyronie's disease, Dupuytren disease, and diabetes.
Topics: Chronic Disease; Diabetes Complications; Diabetes Mellitus; Dupuytren Contracture; Extracellular Matrix; Fascia; Female; Fibrosis; Genome-Wide Association Study; Hand; Humans; Hyperglycemia; Male; Matrix Metalloproteinases; Penile Induration; Penis; Signal Transduction
PubMed: 33855203
DOI: 10.1002/edm2.195 -
The Lancet. Global Health Apr 2021Increasing access to hepatitis C virus (HCV) care and treatment will require simplified service delivery models. We aimed to evaluate the effects of decentralisation and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Increasing access to hepatitis C virus (HCV) care and treatment will require simplified service delivery models. We aimed to evaluate the effects of decentralisation and integration of testing, care, and treatment with harm-reduction and other services, and task-shifting to non-specialists on outcomes across the HCV care continuum.
METHODS
For this systematic review and meta-analysis, we searched PubMed, Embase, WHO Global Index Medicus, and conference abstracts for studies published between Jan 1, 2008, and Feb 20, 2018, that evaluated uptake of HCV testing, linkage to care, treatment, cure assessment, and sustained virological response at 12 weeks (SVR12) in people who inject drugs, people in prisons, people living with HIV, and the general population. Randomised controlled trials, non-randomised studies, and observational studies were eligible for inclusion. Studies with a sample size of ten or less for the largest denominator were excluded. Studies were categorised according to the level of decentralisation: full (testing and treatment at same site), partial (testing at decentralised site and referral elsewhere for treatment), or none. Task-shifting was categorised as treatment by specialists or non-specialists. Data on outcomes across the HCV care continuum (linkage to care, treatment uptake, and SVR12) were pooled using random-effects meta-analysis.
FINDINGS
Our search identified 8050 reports, of which 132 met the eligibility criteria, and an additional ten reports were identified from reference citations and grey literature. Therefore, the final synthesis included 142 studies from 34 countries (20 [14%] studies from low-income and middle-income countries) and a total of 489 996 patients (239 446 [49%] from low-income and middle-income countries). Rates of linkage to care were higher with full decentralisation compared with partial or no decentralisation among people who inject drugs (full 72% [95% CI 57-85] vs partial 53% [38-67] vs none 47% [11-84]) and among people in prisons (full 94% [79-100] vs partial 50% [29-71]), although the CIs overlap for people who inject drugs. Similarly, treatment uptake was higher with full decentralisation compared with partial or no decentralisation (people who inject drugs: full 73% [65-80] vs partial 66% [55-77] vs none 35% [23-48]; people in prisons: full 72% [48-91] vs partial 39% [17-63]), although CIs overlap for full versus partial decentralisation. The results in the general population studies were more heterogeneous. SVR12 rates were high (≥90%) across different levels of decentralisation in all populations. Task-shifting of care and treatment to a non-specialist was associated with similar SVR12 rates to treatment delivered by specialists. There was a severe or critical risk of bias for 46% of studies, and heterogeneity across studies tended to be very high (I>90%).
INTERPRETATION
Decentralisation and integration of HCV care to harm-reduction sites or primary care showed some evidence of improved access to testing, linkage to care, and treatment, and task-shifting of care and treatment to non-specialists was associated with similarly high cure rates to care delivered by specialists, across a range of populations and settings. These findings provide support for the adoption of decentralisation and task-shifting to non-specialists in national HCV programmes.
FUNDING
Unitaid.
Topics: Antiviral Agents; Delivery of Health Care, Integrated; Health Services Accessibility; Hepacivirus; Hepatitis C; Humans; Models, Organizational; National Health Programs; Observational Studies as Topic; Patient Acceptance of Health Care; Randomized Controlled Trials as Topic; Sustained Virologic Response
PubMed: 33639097
DOI: 10.1016/S2214-109X(20)30505-2 -
Depression Research and Treatment 2020Low- and middle-income countries of which Ethiopia is one bears the high burden of depression among human immune deficiency virus and acquired immune deficiency syndrome...
BACKGROUND
Low- and middle-income countries of which Ethiopia is one bears the high burden of depression among human immune deficiency virus and acquired immune deficiency syndrome (HIV/AIDS) patients. Several factors have been identified as being associated with increased depression among HIV/AIDS patients including poor social support. However, studies examining the effect of poor social support on depression among HIV/AIDS patients in Ethiopia have had inconsistent findings. This systematic review and meta-analysis is therefore aimed at estimating the pooled effect of poor social support on depression among HIV/AIDS patients in Ethiopia.
METHODS
All relevant articles published prior to July 1, 2020, were retrieved from scientific databases: PubMed, Scopus, and Google Scholar systematically. The identified studies reporting the association of depression and poor social support among HIV patients in Ethiopia were included. tests were used to assess the heterogeneity of the studies. Subgroup analysis was done based on tools to determine how pooled estimates of depression vary across tools. The pooled estimate of association between poor social support and depression was reported.
RESULTS
The aggregated meta-analysis revealed a higher odds of depression among patients with poor social support than those who had strong social support (OR: 2.31, 95% CI: 1.69, 2.93). The pooled prevalence of depression among HIV/AIDS patients in Ethiopia was 38.93% (95%: CI: 32.01, 45.84); ( = 94.44%, ≤ 0.001). The subgroup analysis was performed based on tools, and the result showed that the highest pooled prevalence (44.42%) was among primary studies that used the Hospital Anxiety and Depression Scale (HADS) tool.
CONCLUSIONS
Human immune deficiency virus and acquired immune deficiency syndrome (HIV/AIDS) patients with poor social support were more likely to develop depression. The pooled prevalence of depression among HIV/AIDS patient was high in Ethiopia. The highest prevalence of depression was observed among studies that used HADS to screen depression. Therefore, we recommend integration of mental health and psychosocial support services into the HIV/AIDS care. Prevention of HIV/AIDS-related stigma for people with HIV/AIDS is also needed to reduce the impact of poor social support.
PubMed: 33489371
DOI: 10.1155/2020/6633686 -
Archives of Public Health = Archives... Nov 2020Increased Anti-Retroviral Therapy (ART) coverage improves health status and the survival of people living with Human Immunodeficiency Virus (HIV) as a result,... (Review)
Review
BACKGROUND
Increased Anti-Retroviral Therapy (ART) coverage improves health status and the survival of people living with Human Immunodeficiency Virus (HIV) as a result, reproductive health needs of the clients are increased. As part of continuum HIV care, understanding fertility desire and reproductive health care needs of HIV positive peoples will play paramount role in planning and delivering appropriate health services. The finding of studies conducted on the fertility desire and associated factors among People Living with HIV in Ethiopia presented inconclusive. Therefore, this study aimed to assess the pooled prevalence of fertility desire and associated factors among people living with HIV in Ethiopia.
METHODS
A total of 26 studies conducted in Ethiopia were included in this Meta-analysis. Pub Med, HINARI, Google scholar and Google data bases were searched. Data from the included articles were extracted using a standardized data extraction tool. The included studies were analyzed using a random effects meta-analysis model. Analysis was done Using STATA version 14 statistical software. Heterogeneity was assessed statistically using the standard Chi-square, I The association between fertility desire and factors were examined using a random effects model.
RESULT
In this meta-analysis, the pooled prevalence of fertility desire in Ethiopia is 42.21% (95%CI 39.18, 45.25). Fertility desire is significantly associated with sex: being female (OR = 0.71,95%CI 0.57,0.86), partners desire (OR = 16.8, 95% CI: 9.45, 29.88), not having child (OR = 5.46 95%CI 4.24, 7.040), age < 30(OR = 2.34, 95%CI 2.10, 2.60), formal education (OR = 1.31 95%CI 1.09, 1.59)). However, use of family planning, residence, and Knowledge on Prevention of Mother to Child Transmission and disclosure status didn't show association with fertility desire.
CONCLUSION
In this finding, significant people of living with HIV have a desire to have a child. The finding showed the need to strengthen fertility desire and reproductive health care needs of HIV positive peoples. Therefore, strengthening the integration of fertility related issues with HIV continuum care will play a paramount role in averting risky sexual behaviors and Prevention of Mother to Child Transmission among peoples on ART.
PubMed: 33292626
DOI: 10.1186/s13690-020-00504-0 -
F1000Research 2020Geographic information science (GIS) has established itself as a distinct domain and incredibly useful whenever the research is related to geography, space, and other...
Geographic information science (GIS) has established itself as a distinct domain and incredibly useful whenever the research is related to geography, space, and other spatio-temporal dimensions. However, the scientific landscape on the integration of GIS in COVID-related studies is largely unknown. In this systematic review, we assessed the current evidence on the implementation of GIS and other geospatial tools in the COVID-19 pandemic. We systematically retrieved and reviewed 79 research articles that either directly used GIS or other geospatial tools as part of their analysis. We grouped the identified papers under six broader thematic groups based on the objectives and research questions of the study- environmental, socio-economic, and cultural, public health, spatial transmission, computer-aided modeling, and data mining. The interdisciplinary nature of how geographic and spatial analysis was used in COVID-19 research was notable among the reviewed papers. Geospatial techniques, especially WebGIS, have even been widely used to visualize the data on a map and were critical to informing the public regarding the spread of the virus, especially during the early days of the pandemic. This review not only provided an overarching view on how GIS has been used in COVID-19 research so far but also concluded that geospatial analysis and technologies could be used in future public health emergencies along with statistical and other socio-economic modeling techniques. Our review also highlighted how scientific communities and policymakers could leverage GIS to extract useful information to make an informed decision in the future. Despite the limited applications of GIS in identifying the nature and spatio-temporal pattern of this raging pandemic, there are opportunities to utilize these techniques in handling the pandemic. The use of spatial analysis and GIS could significantly improve how we understand the pandemic as well as address the underserviced demographic groups and communities.
Topics: COVID-19; Geographic Information Systems; Humans; Information Science; Pandemics; SARS-CoV-2
PubMed: 35186280
DOI: 10.12688/f1000research.27544.2 -
The Lancet. Digital Health Nov 2020Evidence for the use of automated or partly automated contact-tracing tools to contain severe acute respiratory syndrome coronavirus 2 is scarce. We did a systematic...
Evidence for the use of automated or partly automated contact-tracing tools to contain severe acute respiratory syndrome coronavirus 2 is scarce. We did a systematic review of automated or partly automated contact tracing. We searched PubMed, EMBASE, OVID Global Health, EBSCO Medical COVID Information Portal, Cochrane Library, medRxiv, bioRxiv, arXiv, and Google Advanced for articles relevant to COVID-19, severe acute respiratory syndrome, Middle East respiratory syndrome, influenza, or Ebola virus, published from Jan 1, 2000, to April 14, 2020. We also included studies identified through professional networks up to April 30, 2020. We reviewed all full-text manuscripts. Primary outcomes were the number or proportion of contacts (or subsequent cases) identified. Secondary outcomes were indicators of outbreak control, uptake, resource use, cost-effectiveness, and lessons learnt. This study is registered with PROSPERO (CRD42020179822). Of the 4036 studies identified, 110 full-text studies were reviewed and 15 studies were included in the final analysis and quality assessment. No empirical evidence of the effectiveness of automated contact tracing (regarding contacts identified or transmission reduction) was identified. Four of seven included modelling studies that suggested that controlling COVID-19 requires a high population uptake of automated contact-tracing apps (estimates from 56% to 95%), typically alongside other control measures. Studies of partly automated contact tracing generally reported more complete contact identification and follow-up compared with manual systems. Automated contact tracing could potentially reduce transmission with sufficient population uptake. However, concerns regarding privacy and equity should be considered. Well designed prospective studies are needed given gaps in evidence of effectiveness, and to investigate the integration and relative effects of manual and automated systems. Large-scale manual contact tracing is therefore still key in most contexts.
Topics: Automation; COVID-19; Contact Tracing; Humans
PubMed: 32839755
DOI: 10.1016/S2589-7500(20)30184-9 -
Obstetrics and Gynecology Aug 2020To inform the current coronavirus disease 2019 (COVID-19) outbreak, we conducted a systematic literature review of case reports of Middle East respiratory syndrome...
OBJECTIVE
To inform the current coronavirus disease 2019 (COVID-19) outbreak, we conducted a systematic literature review of case reports of Middle East respiratory syndrome coronavirus (MERS-CoV), severe acute respiratory syndrome coronavirus (SARS-CoV), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, during pregnancy and summarized clinical presentation, course of illness, and pregnancy and neonatal outcomes.
DATA SOURCES
We searched MEDLINE and ClinicalTrials.gov from inception to April 23, 2020.
METHODS OF STUDY SELECTION
We included articles reporting case-level data on MERS-CoV, SARS-CoV, and SARS-CoV-2 infection in pregnant women. Course of illness, indicators of severe illness, maternal health outcomes, and pregnancy outcomes were abstracted from included articles.
TABULATION, INTEGRATION, AND RESULTS
We identified 1,328 unique articles, and 1,253 articles were excluded by title and abstract review. We completed full-text review on 75, and 29 articles were excluded by full-text review. Among 46 publications reporting case-level data, eight described 12 cases of MERS-CoV infection, seven described 17 cases of SARS-CoV infection, and 31 described 98 cases of SARS-CoV-2 infection. Clinical presentation and course of illness ranged from asymptomatic to severe fatal disease, similar to the general population of patients. Severe morbidity and mortality among women with MERS-CoV, SARS-CoV, or SARS-CoV-2 infection in pregnancy and adverse pregnancy outcomes, including pregnancy loss, preterm delivery, and laboratory evidence of vertical transmission, were reported.
CONCLUSION
Understanding whether pregnant women may be at risk for adverse maternal and neonatal outcomes from severe coronavirus infections is imperative. Data from case reports of SARS-CoV, MERS-CoV, and SAR-CoV-2 infections during pregnancy are limited, but they may guide early public health actions and clinical decision-making for COVID-19 until more rigorous and systematically collected data are available. The capture of critical data is needed to better define how this infection affects pregnant women and neonates. This review was not registered with PROSPERO.
Topics: Abortion, Spontaneous; Betacoronavirus; COVID-19; Coronavirus Infections; Female; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Pandemics; Pneumonia, Viral; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Premature Birth; SARS-CoV-2
PubMed: 32544146
DOI: 10.1097/AOG.0000000000004011