Poor treatment outcomes of children on highly active antiretroviral therapy: protocol for a systematic review and meta-analysis

Introduction: While access to highly active antiretroviral therapy (HAART) for children with HIV has expanded and the use of HAART has substantially reduced the morbidity and mortality of children due to HIV, poor treatment outcomes among children with HIV are still a major public health problem globally. The aim of this systematic review and meta-analysis is to quantify treatment outcomes among children with HIV.

Methods and analysis: Systematic searches will be conducted in three electronic databases (PubMed, SCOPUS and Web of Science) for recent studies published from 01 Jan 2000 up to 28 October 2020, without geographical restriction. The primary outcomes of the study will be poor treatment outcomes, which include death, treatment failure and loss to follow-up. We will include quantitative studies that report treatment outcomes among children under the age of 18 years with HIV. Studies will be excluded if they are case report, case series, conducted among adults only or do not provide data on treatment outcomes for children. Two researchers will screen the titles and abstracts of all citations identified in our search, then review the full text of the remaining papers to identify those that meet the inclusion criteria. The Newcastle-Ottawa Scale will be used for quality assessment. A random-effects meta-analysis will be used to obtain pooled estimates of the proportion of poor treatment outcomes. The heterogeneity between studies will be checked visually by using forest plots and quantitatively measured by the index of heterogeneity (I²). Pooled estimates of poor treatment outcomes will be calculated with a random-effects model. Subgroup analysis will be conducted by study settings, treatment regimen, comorbidity (such as tuberculosis), study period and HIV type (HIV-1 and HIV-2).

Ethics and dissemination: Ethical approval will not be required for this study as it will be based on published papers. The final report of this review will be published in a peer-reviewed scientific journal.