Diagnostic accuracy of the WHO clinical staging system for defining eligibility for ART in sub-Saharan Africa: a systematic review and meta-analysis
| Autor: | Peter MacPherson, Paul G Garner, Miriam Taegtmeyer, Nathan Ford, Chigomezgo Munthali, David G. Lalloo, Elizabeth L. Corbett, S. Bertel Squire |
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| Jazyk: | angličtina |
| Rok vydání: | 2014 |
| Předmět: |
sub-Saharan Africa
Adult medicine.medical_specialty wa_950 wc_503_2 wc_503_1 Anti-HIV Agents antiretroviral therapy systematic reviews CD4 cell count WHO clinical staging system HIV Infections wa_395 wc_503 World Health Organization Sensitivity and Specificity Severity of Illness Index Internal medicine Severity of illness Global health medicine Humans Stage (cooking) 10. No inequality Staging system Africa South of the Sahara Protocol (science) Receiver operating characteristic business.industry Public Health Environmental and Occupational Health HIV 3. Good health CD4 Lymphocyte Count Infectious Diseases Systematic review Meta-analysis Immunology Practice Guidelines as Topic business Research Article |
| Zdroj: | JOURNAL OF THE INTERNATIONAL AIDS SOCIETY Journal of the International AIDS Society |
| ISSN: | 1758-2652 |
| Popis: | Introduction: The World Health Organization (WHO) recommends that HIV-positive adults with CD4 count ≤500 cells/mm3 initiate antiretroviral therapy (ART). In many countries of sub-Saharan Africa, CD4 count is not widely available or consistently used and instead the WHO clinical staging system is used to determine ART eligibility. However, concerns have been raised regarding its discriminatory ability to identify patients eligible to start ART. We therefore reviewed the accuracy of WHO stage 3 or 4 assessment in identifying ART eligibility according to CD4 count thresholds for ART initiation.\ud \ud Methods: We systematically searched PubMed and Global Health databases and conference abstracts using a comprehensive strategy for studies that compared the results of WHO clinical staging with CD4 count thresholds. Studies performed in sub-Saharan Africa and published in English between 1998 and 2013 were eligible for inclusion according to our predefined study protocol. Two authors independently extracted data and assessed methodological quality and risk of bias using the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2) tool. Summary estimates of sensitivity and specificity were derived for each CD4 count threshold and hierarchical summary receiver operator characteristic curves were plotted.\ud \ud Results: Fifteen studies met the inclusion criteria, including 25,032 participants from 14 countries. Most studies assessed individuals attending ART clinics prior to treatment initiation. WHO clinical stage 3 or 4 disease had a sensitivity of 60% (95% CI: 45–73%, Q=914.26, p |
| Databáze: | OpenAIRE |
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