Incidence of lost to follow up among HIV-positive children on antiretroviral therapy in Ethiopia: Systematic review and meta-analysis

At the end of 2022, globally, only 46% of children (aged 0-14 years) on ART had suppressed viral loads. Viral load suppression is crucial to reduce HIV-related deaths. To suppress the viral load at the expected level, children must be retained in ART treatment. Nevertheless, lost to follow-up from A...

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Bibliographic Details
Published in:	PloS one Vol. 19; no. 5; p. e0304239
Main Authors:	Girma, Desalegn, Abita, Zinie, Lemu, Lidya Gutema, Asmelash, Daniel, Bambo, Getachew Mesfin, Alie, Melesew Setegn, Abebe, Gossa Fetene
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 22-05-2024 Public Library of Science (PLoS)
Subjects:	Adolescent Analysis Anti-HIV Agents - therapeutic use Anti-Retroviral Agents - therapeutic use Antiretroviral agents Antiretroviral drugs Antiretroviral therapy Antiviral agents Biology and Life Sciences Child Child, Preschool Children Children & youth Cohort analysis Content analysis Developing countries Drug dosages Drug resistance Drug therapy Ethiopia - epidemiology Female Health aspects Heterogeneity Highly active antiretroviral therapy HIV HIV (Viruses) HIV Infections - drug therapy HIV Infections - epidemiology HIV patients Human immunodeficiency virus Humans Immune system Incidence Infant LDCs Lost to Follow-Up Male Medicine and Health Sciences Meta-analysis Online data bases Opportunist infection Patient compliance People and Places Physical Sciences Public health Research and Analysis Methods Statistical analysis Systematic review Viral Load - drug effects Ethiopia
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Summary:	At the end of 2022, globally, only 46% of children (aged 0-14 years) on ART had suppressed viral loads. Viral load suppression is crucial to reduce HIV-related deaths. To suppress the viral load at the expected level, children must be retained in ART treatment. Nevertheless, lost to follow-up from ART treatment continues to be a global challenge, particularly, in developing countries. Previously, primary studies were conducted in Ethiopia to assess the incidence of lost to follow-up among HIV-positive children on ART treatment. However, variations have been seen among the studies. Therefore, this systematic review and meta-analysis aimed to estimate the pooled incidence of lost to follow-up among HIV-positive children on ART and identify its associated factors in Ethiopia. We searched PubMed, HINARI, Science Direct, Google Scholar, and African Journals Online to obtain articles published up to November 20, 2023. Critical appraisal was done using the Joanna Briggs Institute checklist. Heterogeneity was identified using I-square statistics. Funnel plot and Egger's tests were used to identify publication bias. Data was presented using forest plots and tables. Random and fixed-effect models were used to compute the pooled estimate. Twenty-four studies were included in the final analysis. The pooled incidence of lost to follow-up among HIV-positive children on ART was 2.79 (95% CI: 1.99, 3.91) per 100-child-year observations. Advanced HIV disease (HR: 2.20, 95% CI: 1.71, 2.73), having opportunistic infection (HR: 2.59, 95% CI: 1.39; 4.78), fair or poor ART treatment adherence (HR: 2.92, 95% CI: 1.31; 6.54) and children aged between 1-5 years (HR: 2.1,95% CI: 1.44; 2.95) were factors associated with lost to follow up among HIV positive children on ART. The overall pooled incidence of lost to follow-up among HIV-positive children on ART is low in Ethiopia. Therefore, counseling on ART drug adherence should be strengthened. Moreover, emphasis has to be given to children with advanced HIV stage and opportunistic infection to reduce the rate of lost to follow up among HIV-positive children on ART. Registered in PROSPERO with ID: CRD42024501071.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-Undefined-3 Competing Interests: The authors have declared that no competing interests exist.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0304239