Mugglin, Catrina AndreaCatrina AndreaMugglinEstill, Janne Anton MarkusJanne Anton MarkusEstillWandeler, GillesGillesWandelerBender, NicoleNicoleBender0000-0002-3838-587XEgger, MatthiasMatthiasEgger0000-0001-7462-5132Gsponer, ThomasThomasGsponerKeiser, OliviaOliviaKeiser0000-0001-8191-2789for IeDEA Southern Africa2024-10-112024-10-112012https://boris-portal.unibe.ch/handle/20.500.12422/84005Objectives  To assess the proportion of patients lost to programme (died, lost to follow-up, transferred out) between HIV diagnosis and start of antiretroviral therapy (ART) in sub-Saharan Africa, and determine factors associated with loss to programme. Methods  Systematic review and meta-analysis. We searched PubMed and EMBASE databases for studies in adults. Outcomes were the percentage of patients dying before starting ART, the percentage lost to follow-up, the percentage with a CD4 cell count, the distribution of first CD4 counts and the percentage of eligible patients starting ART. Data were combined using random-effects meta-analysis. Results  Twenty-nine studies from sub-Saharan Africa including 148 912 patients were analysed. Six studies covered the whole period from HIV diagnosis to ART start. Meta-analysis of these studies showed that of the 100 patients with a positive HIV test, 72 (95% CI 60-84) had a CD4 cell count measured, 40 (95% CI 26-55) were eligible for ART and 25 (95% CI 13-37) started ART. There was substantial heterogeneity between studies (P < 0.0001). Median CD4 cell count at presentation ranged from 154 to 274 cells/μl. Patients eligible for ART were less likely to become lost to programme (25%vs. 54%, P < 0.0001), but eligible patients were more likely to die (11%vs. 5%, P < 0.0001) than ineligible patients. Loss to programme was higher in men, in patients with low CD4 cell counts and low socio-economic status and in recent time periods. Conclusions  Monitoring and care in the pre-ART time period need improvement, with greater emphasis on patients not yet eligible for ART.en600 - Technology::610 - Medicine & healtharticle10.7892/boris.139352299415100031139490001210.1111/j.1365-3156.2012.03089.x