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Prevalence of delayed antiretroviral therapy initiation among people living with HIV: A systematic review and meta-analysis

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  • Yan Tao
  • Xueling Xiao
  • Ci Zhang
  • Ying Xie
  • Honghong Wang

Abstract

Objective: HIV continues to be a global challenge. Key recommendations for HIV prevention and treatment are presented on rapid antiretroviral therapy (ART) initiation. However, several studies showed a high prevalence of delayed ART initiation. The aim of this systematic review and meta-analysis was to assess the prevalence of delayed ART initiation among HIV-infected patients globally. Methods: This review summarised eligible studies conducted between January 2015 and August 2022 on the prevalence of delayed ART initiation in HIV-infected adults (age ≥ 15). Relevant studies were systematic searched through PubMed/Medline, EMBASE, Web of Science, China National Knowledge Infrastructure, Wanfang, and Chongqing VIP databases. Random-effects models were used to calculate pooled prevalence estimates. The heterogeneity was evaluated using Cochran’s Q test and I2 statistics. Moreover, potential sources of heterogeneity were explored using univariate subgroup analysis. Results: Data on the prevalence of delayed ART initiation was pooled across 29 studies involving 34,937 participants from 15 countries. The overall pooled prevalence of delayed ART initiation was 36.1% [95% confidence interval (CI), 29.7–42.5%]. In subgroup analysis, the estimated pooled prevalence decreased with age. By sex, the prevalence was higher among male patients (39.3%, 95% CI: 32.2–46.4%) than female (36.5%, 95% CI: 26.9–50.7%). Patients with high CD4 cell count were more likely to delay ART initiation than those with low CD4 cell count (>500cells/mm3: 40.3%; 201-500cells/mm3: 33.4%; and ≤200cells/mm3: 25.3%). Conclusions: Our systematic review and meta-analysis identified a high prevalence of delayed ART initiation. The prolonged time interval between diagnosis and treatment is a prevalent and unaddressed problem that should spur initiatives from countries globally. Further research is urgently needed to identify effective strategies for promoting the early ART initiation.

Suggested Citation

  • Yan Tao & Xueling Xiao & Ci Zhang & Ying Xie & Honghong Wang, 2023. "Prevalence of delayed antiretroviral therapy initiation among people living with HIV: A systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 18(10), pages 1-17, October.
    • Handle: RePEc:plo:pone00:0286476
    DOI: 10.1371/journal.pone.0286476
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    1. Hibbard, Judith H. & Pope, Clyde R., 1983. "Gender roles, illness orientation and use of medical services," Social Science & Medicine, Elsevier, vol. 17(3), pages 129-137, January.
    2. repec:plo:pmed00:1002433 is not listed on IDEAS
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    1. Wubet Tazeb Wondie & Chalachew Adugna Wubneh & Bruck Tesfaye Legesse & Gebrehiwot Berie Mekonen & Alemu Birara Zemariam & Zenebe Abebe Gebreegziabher & Gezahagn Demsu Gedefaw & Gemechu Gelan Bekele & , 2025. "Mortality and predictors among HIV-TB co-infected patients in Ethiopia: A systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 20(1), pages 1-20, January.

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