Summary of findings for the main comparison. Doctor versus nurse or clinical officer for initiation and maintenance of antiretroviral therapy for HIV‐infected patients.
| Doctor versus nurse or clinical officer for initiation and maintenance of antiretroviral therapy for HIV‐infected patients | ||||||
| Patient or population: HIV‐infected patients Settings: Lower and middle income countries Intervention: Doctor versus nurse or clinical officer for initiation and maintenance of antiretroviral therapy | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Doctor versus nurse or clinical officer for initiation and maintenance of antiretroviral therapy | |||||
| Death (RCTs) Follow‐up: 12 months | 194 per 1000 | 186 per 1000 (159 to 217) | RR 0.96 (0.82 to 1.12) | 2770 (1 study) | ⊕⊕⊕⊕ high1 | |
| Death (Cohorts) Follow‐up: 12 months | 92 per 1000 | 113 per 1000 (105 to 122) | RR 1.23 (1.14 to 1.33) | 39160 (2 studies) | ⊕⊕⊝⊝ low2 | |
| Lost to follow‐up (RCTs) Follow‐up: 12 months | 77 per 1000 | 56 per 1000 (42 to 75) | RR 0.73 (0.55 to 0.97) | 2770 (1 study) | ⊕⊕⊕⊝ moderate3 | |
|
Lost to follow‐up (cohorts) Follow‐up: 12 months |
297 per 1000 | 89 per 1000 (15 to 577) | RR 0.3 (0.05 to 1.94) | 39156 (2 studies) | ⊕⊝⊝⊝ very low4 | |
|
Death or loss to follow‐up (RCTs) Follow‐up: 12 months |
271 per 1000 |
241 per 1000 (214 to 273) |
RR 0.89 (0.79 to 1.01) |
2770 (1 study) |
⊕⊕⊕⊕ high |
|
|
Death or loss to follow‐up (Cohorts) Follow‐up: 12 months |
389 per 1000 |
280 per 1000 (187 to 416) |
RR 0.72 (0.48 to 1.07) |
39160 (2 studies) |
⊕⊝⊝⊝ very low5,6 |
|
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1 The confidence interval is narrow and does not include appreciable harm or benefit. 2 Not downgraded for risk of bias. Two retrospective cohorts provided data. Bedelu 2007 included patients with higher CD4 counts at the health centre. As this is likely to favour the intervention, we did not downgrade for risk of bias. 3 Downgraded by 1 for imprecision. There was a low number of events after adjusting for clustering (<300 events). 4 Downgraded by 1 for imprecision. The confidence interval includes both appreciable harm and appreciable benefit.
5 Downgraded by 1 for imprecision. 95% CI includes appreciable benefit and null value
6Not downgraded for inconsistency. Despite quantitative heterogeneity, both studies showed that attrition was decreased with task shifting of ART initiation and maintenance to nurses or clinical officers.