@article{fdi:010069993,
  title = {{V}irological success after 12 and 24 months of antiretroviral therapy in sub-{S}aharan {A}frica : comparing results of trials, cohorts and cross-sectional studies using a systematic review and meta-analysis},
  author = {{T}aieb, {F}. and {M}adec, {Y}. and {C}ournil, {A}mandine and {D}elaporte, {E}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground {UNAIDS} recently defined the 90-90-90 target as a way to end the {HIV} epidemic. {H}owever, the proportion of virological success following antiretroviral therapy ({ART}) may not be as high as the anticipated 90%, and may in fact be highly heterogeneous. {W}e aimed to describe the proportion of virological success in sub-{S}aharan {A}frica and to identify factors associated with the proportion of virological success. {M}ethods {W}e performed a systematic review and meta-analysis focusing on the proportion of patients in sub-{S}aharan {A}frica who demonstrate virological success at 12 and 24 months since {ART} initiation, as well as at 6 and 36 months, where possible. {P}rogramme factors associated with the proportion of virological success were identified using meta-regression. {A}nalyses were conducted using both on-treatment ({OT}) and intention-to-treat ({ITT}) approaches. {R}esults {E}ighty-five articles were included in the meta-analysis, corresponding to 125 independent study populations. {U}sing an on-treatment approach, the proportions (95% confidence interval ({CI})) of virological success at 12 (n = 64) and at 24 (n = 32) months since {ART} initiation were 87.7% (81.3-91.0) and 83.7% (79.8-87.6), respectively. {U}nivariate analysis indicated that the proportion of virological success was not different by study design. {M}ultivariate analysis at 24 months showed that the proportion of virological success was significantly larger in studies conducted in public sector sites than in other sites (p = 0.045). {U}sing an {ITT} approach, the proportions (95% {CI}) of virological success at 12 (n = 50) and at 24 (n = 20) months were 65.4% (61.8-69.1) and 56.8% (51.3-62.4), respectively. {A}t 12 months, multivariate analysis showed that the proportion of success was significantly lower in cohort studies than in trials (63.0% vs. 71.1%; p = 0.017). {A}t 24 months, univariate analysis demonstrated that the proportion of success was also lower in cohorts. {D}iscussion {R}egardless of the time following {ART} initiation, and of the threshold, proportions of virological success were highly variable. {E}vidence from this review suggests that the new international target of 90% of patients controlled is not yet being achieved, and that in order to improve the virological outcome, efforts should be made to improve retention in care.},
  keywords = {{AFRIQUE} {SUBSAHARIENNE}},
  booktitle = {},
  journal = {{P}los {O}ne},
  volume = {12},
  numero = {4},
  pages = {e0174767 [28 p.]},
  ISSN = {1932-6203},
  year = {2017},
  DOI = {10.1371/journal.pone.0174767},
  URL = {https://www.documentation.ird.fr/hor/fdi:010069993},
}