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J Int AIDS Soc. 2018 Nov;21(11):e25209. doi: 10.1002/jia2.25209.

Attrition of HIV-exposed infants from early infant diagnosis services in low- and middle-income countries: a systematic review and meta-analysis.

Author information

1
Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA.
2
Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
3
Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA.
4
College of Charleston, Charleston, SC, USA.
5
Meharry Medical College, Nashville, TN, USA.
6
Yale School of Public Health, Yale University, New Haven, CT, USA.

Abstract

INTRODUCTION:

Identification and retention of HIV-exposed infants in early infant diagnosis (EID) services helps to ensure optimal health outcomes. This systematic review and meta-analysis examines the magnitude of attrition from EID services in low- and middle-income countries (LMICs).

METHODS:

We performed a comprehensive database search through April 2016. We included original studies reporting retention/attrition data for HIV-exposed infants in LMICs. Outcomes included loss to follow-up (LTFU), death and overall attrition (LTFU + death) at time points along the continuum of EID services. At least two authors determined study eligibility, performed data extraction and made quality assessments. We used random-effects meta-analytic methods to aggregate effect sizes and perform meta-regression analyses. This study adhered to PRISMA reporting guidelines.

RESULTS:

We identified 3040 unique studies, of which 92 met eligibility criteria and were included in the quantitative synthesis. The included studies represent data from 110,805 HIV-exposed infants, the majority of whom were from Africa (77%). LTFU definitions varied widely, and there was significant variability in outcomes across studies. The bulk of attrition occurred in the first six months of follow-up, with additional losses over time. Overall, 39% of HIV-exposed infants were no longer in care at 18 months. When restricted to non-intervention studies, 43% were not retained at 18 months.

CONCLUSIONS:

These findings underscore the high attrition of HIV-exposed infants from EID services in LMICs and the urgent need for implementation research and resources to improve retention among this vulnerable population.

KEYWORDS:

HIV ; attrition; infants; loss to follow-up; low- and middle-income countries; retention

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