PMID- 37692980
OWN - NLM
STAT- MEDLINE
DCOM- 20230912
LR  - 20230919
IS  - 1937-8688 (Electronic)
VI  - 45
DP  - 2023
TI  - Prevalence and predictors of virological failure in pediatric patients on HAART 
      in sub-Saharan Africa: a systematic review and meta-analysis.
PG  - 98
LID - 10.11604/pamj.2023.45.98.37017 [doi]
LID - 98
AB  - Antiretroviral treatment failure has emerged as a challenge in the management of 
      pediatric human immunodeficiency virus (HIV) patients, especially in 
      resource-limited countries despite accessibility to Highly Active Antiretroviral 
      Therapy (HAART). A systematic review and meta-analysis was conducted to 
      synthesize virological failure (VF) prevalence and ascertain its predictors in 
      children in sub-Saharan Africa. An electronic database search strategy was 
      conducted from January to September 2021 on PubMed, EMBASE, SCOPUS, HINARI, and 
      CINAHL. Further, manual searching was conducted on non-indexed journals. 
      Utilizing the JASP(c) version 0.17.2 (2023) statistical software, a meta-analysis 
      of pooled prevalence of VF was estimated using the standardized mean differences. 
      Further, selection models were used to assess the risk of bias and heterogeneity. 
      The pooled odds ratios were estimated for the respective studies reporting on 
      predictors of VF. The overall pooled estimate of the prevalence of VF in 
      sub-Saharan Africa among the sampled population was 29% (95% CI: 27.0-32.0; 
      p<0.001). Predictors of VF were drug resistance (OR: 1.68; 95% CI: 0.88-2.49; p < 
      0.001), poor adherence (OR: 5.35; 95% CI: 5.26-5.45; p < 0.001), nevirapine 
      (NVP)-based regimen (OR: 5.11; 95% CI: 4.66-5.56; p < 0.001), non-usage of 
      cotrimoxazole prophylaxis (OR: 4.30; 95% CI: 4.13-4.47; p < 0.001), higher viral 
      load at the initiation of antiretroviral therapy (ART) (OR: 244.32; 95% CI: 
      244.2-244.47; p <0.001), exposure to the prevention of mother to child 
      transmission (PMTCT) (OR: 8.02; 95%CI: 7.58-8.46; p < 0.001), increased age/older 
      age (OR: 3.37; 95% CI: 2.70-4.04; p < 0.001), advanced World Health Organization 
      (WHO) stage (OR: 6.57; 95% CI: 6.17-6.98; p < 0.001), not having both parents as 
      primary caregivers (OR: 3.01; 95% CI: 2.50-3.53; p < 0.001), and tuberclosis (TB) 
      treatment (OR: 4.22; 95% CI: 3.68-4.76; p <0.001). The mean VF prevalence 
      documented is at variance with studies in other developing countries outside the 
      sub-Saharan region. The high prevalence of HIV cases contrasting with the limited 
      expertise in the management of pediatric ART patients could explain this 
      variance.
CI  - Copyright: Nchimunya Machila et al.
FAU - Machila, Nchimunya
AU  - Machila N
AD  - Department of Disease Control and Prevention, School of Medicine, Eden 
      University, Lusaka, Zambia.
FAU - Libonda, Liyali
AU  - Libonda L
AD  - Department of Disease Control and Prevention, School of Medicine, Eden 
      University, Lusaka, Zambia.
FAU - Habineza, Paul
AU  - Habineza P
AD  - Department of Disease Control and Prevention, School of Medicine, Eden 
      University, Lusaka, Zambia.
FAU - Velu, Rachel Milomba
AU  - Velu RM
AD  - Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
FAU - Kamboyi, Harvey Kakoma
AU  - Kamboyi HK
AD  - Department of Disease Control and Prevention, School of Medicine, Eden 
      University, Lusaka, Zambia.
AD  - Division of Infection and Immunity, International Institute for Zoonosis Control, 
      Hokkaido University, Hokkaido, Japan.
FAU - Ndhlovu, Jacob
AU  - Ndhlovu J
AD  - Department of Disease Control and Prevention, School of Medicine, Eden 
      University, Lusaka, Zambia.
FAU - Wamunyima, Inonge
AU  - Wamunyima I
AD  - Department of Disease Control and Prevention, School of Medicine, Eden 
      University, Lusaka, Zambia.
FAU - Sinadambwe, Monahani Makwibba
AU  - Sinadambwe MM
AD  - Department of Women and Newborn, University Teaching Hospital, Lusaka, Zambia.
FAU - Mudenda, Steward
AU  - Mudenda S
AD  - Department of Pharmacy, School of Medicine, University of Zambia, Lusaka, Zambia.
FAU - Zyambo, Cosmas
AU  - Zyambo C
AD  - Department of Community and Family Health, School of Public Health, University of 
      Zambia, Lusaka, Zambia.
FAU - Bumbangi, Flavien Nsoni
AU  - Bumbangi FN
AD  - Department of Disease Control and Prevention, School of Medicine, Eden 
      University, Lusaka, Zambia.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20230622
PL  - Uganda
TA  - Pan Afr Med J
JT  - The Pan African medical journal
JID - 101517926
RN  - 0 (Anti-Retroviral Agents)
SB  - IM
MH  - Humans
MH  - Child
MH  - Female
MH  - *Antiretroviral Therapy, Highly Active
MH  - *Infectious Disease Transmission, Vertical
MH  - Prevalence
MH  - Anti-Retroviral Agents
MH  - Africa South of the Sahara/epidemiology
PMC - PMC10491719
OTO - NOTNLM
OT  - HAART
OT  - Virological failure
OT  - children
OT  - pediatrics
OT  - prevalence
OT  - sub-Saharan Africa
COIS- The authors declare no competing interests.
EDAT- 2023/09/11 06:42
MHDA- 2023/09/12 06:42
PMCR- 2023/06/22
CRDT- 2023/09/11 04:45
PHST- 2022/08/25 00:00 [received]
PHST- 2023/06/08 00:00 [accepted]
PHST- 2023/09/12 06:42 [medline]
PHST- 2023/09/11 06:42 [pubmed]
PHST- 2023/09/11 04:45 [entrez]
PHST- 2023/06/22 00:00 [pmc-release]
AID - PAMJ-45-98 [pii]
AID - 10.11604/pamj.2023.45.98.37017 [doi]
PST - epublish
SO  - Pan Afr Med J. 2023 Jun 22;45:98. doi: 10.11604/pamj.2023.45.98.37017. 
      eCollection 2023.