The effects of decentralising antiretroviral therapy care delivery on health outcomes for adolescents and young adults in low- and middle-income countries: a systematic review
| Autor: | Haghighat, R, Steinert, J, Cluver, L |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Gerontology
Male Adolescent antiretroviral therapy Human immunodeficiency virus (HIV) facility-based HIV Infections hiv Review Article Health outcomes medicine.disease_cause Care provision 03 medical and health sciences Young Adult 0302 clinical medicine Health care Outcome Assessment Health Care Medicine Humans 030212 general & internal medicine adolescents Young adult 10. No inequality Child Developing Countries youth business.industry 030503 health policy & services Health Policy lcsh:Public aspects of medicine 1. No poverty Public Health Environmental and Occupational Health virus diseases decentralisation healthcare lcsh:RA1-1270 Antiretroviral therapy 3. Good health Anti-Retroviral Agents Low and middle income countries Female 0305 other medical science business |
| Zdroj: | Global Health Action, Vol 12, Iss 1 (2019) Global Health Action |
| ISSN: | 1654-9880 |
| Popis: | Background: Decentralisation of antiretroviral therapy has been implemented to scale up HIV care provision for patients in resource-limited countries. Youth living with HIV demonstrate the poorest care outcomes, compared to other age groups. Objectives: To systematically evaluate evidence on the effects of decentralising facility-based HIV care on care outcomes for youth living with HIV in low- and middle-income countries. Methods: A systematic review was conducted through 12 electronic databases of peer-reviewed articles, conference abstracts, and grey literature; contacting relevant experts; and hand-searching references. Records were included if they were published after 1 January 1996 (advent of triple-drug ART) and reported health outcomes for decentralised and centralised care, separately, or evaluated the effect of decentralised care on care outcomes. Two authors independently screened search results. When age-disaggregated data (10–24 years old) were required for inclusion, we contacted study authors for data abstraction. Implementation fidelity of decentralisation, study quality, and risk of bias was assessed using the TIDieR checklist, CASP checklists, and ROBINS-I tool, respectively. Results: Of 11 potentially eligible studies, two studies from sub-Saharan Africa met inclusion criteria after data disaggregation by age. The studies and abstracted data were insufficiently homogenous in implementation and study design to justify meta-analysis. However, evidence suggests the potential for decentralised care to result in at least equivalent attrition-related outcomes (retention in care and mortality) for youth within decentralised HIV care. Limited sample size and significant selection and allocation bias confound clear, generalisable conclusions for youth living with HIV in resource-limited settings. Conclusions: There is a paucity of evidence for the effects of decentralising HIV care for youth living in resource-limited settings, particularly recent evidence reflective of the current HIV care landscape. Further work is required to rigorously analyse the effects of decentralising HIV care to inform policymakers and care providers, particularly as demand for HIV care in this population grows. |
| Databáze: | OpenAIRE |
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