Table 2.
Reported results of included studies
| Study ID | Intervention | Comparison | Outcome | Timing of outcome | N intervention (control) | Risk/rate intervention (control) | Effect size | 95% confidence interval | p | Interpretation |
|---|---|---|---|---|---|---|---|---|---|---|
| Counselling and support | ||||||||||
| Barnabas 1 | Clinic visit facilitation | Standard of care referral | ART initiation | 431 (423) | 0.37 (0.34) | RR 1.11 | 0.92–1.34 | 0.26 | Clinic visit facilitation was not associated with any difference in ART initiation | |
| Barnabas 2 | Lay counsellor home follow-up | Standard of care referral | ART initiation | 449 (423) | 0.41 (0.34) | RR 1.23 | 1.02–1.47 | 0.028 | Lay counsellor follow-up was associated with an increase in ART initiation | |
| Bassett | Patient navigators using a strengths-based case-management approach and scheduled phone calls and text messages over four months | Standard of care | On ART for those ART eligible | Three months on ART | 618 (528) | 0.34 (0.37) | RR 0.92a | 0.79–1.07a | 0.6 | This approach to patient navigation was not associated with an increase in linkage to care |
| Chang | Peer supporters with monthly visits to provide support and counselling | Standard of care | Currently on ART | One year | 216 (215) | 0.32 (0.30) | RR 1.09 | 0.81–1.45 | This approach to peer support was not associated with an increase in treatment initiation | |
| Faal 1 | Immediate receipt of CD4 count results (FACSCount) | Standard collection of CD4 result only | ART initiation | One month | 35 (36) | 0.37 (0.25) | RR 1.49a | 0.37–3.03a | Leaflets were not associated with a significant increase in ART initiation among those ART eligible. | |
| HIV/TB integration | ||||||||||
| Hermans | Integrated TB/HIV care and treatment | Standard of care | ART initiation | 243 (228) | 0.57 (0.66) | RR 0.86 | 0.75–1.0a | 0.034 | ART and TB treatment integration did not lead to an increase in ART initiation | |
| Louwagie | ART and TB care at same site (“semi-integrated”) | Geographically separately rendered HIV and TB care | ART initiation | 105 (233) | 0.71 (0.45) | sHR 2.49 | 1.06–5.88 | ART and TB treatment under one roof was associated with an increase in ART initiation for HIV-positive TB patients | ||
| Van Rie | Integrated TB/HIV care and treatment | Standard of care referral to centralized ART facility after diagnosis | ART initiation | 513 (373) | 0.69 (0.17) | RR 4.06a | 3.21–5.13a | Integrated services was associated with an increase in ART initiation | ||
| Provider-initiated HIV testing | ||||||||||
| Clouse | Systematic opt-out HCT for all adult clients | Targeted PICT and voluntary counselling and testing | ART initiation | Twelve months after diagnosis | 717 (744) | 0.64 (0.59) | RR 1.08a | 1.00–1.18a | 0.05 | Systematic opt-out HCT was associated with a small increase in ART initiation among those ART eligible |
| Topp | Provider-initiated testing and counselling for adults and children | Voluntary counselling and testing | ART initiation | 1655 (6520) | 0.72 (0.69) | aOR 0.9 | 0.82–0.97 | 0.01 | Integrated care was associated with a small decrease in the odds of being initiated on ART if eligible | |
| Interventions combined with home-based HIV testing | ||||||||||
| Desai | POC CD4 count at home-based HIV testing with referral | Standard of care home-based HIV testing and referral | ART initiation | 371 (321) | 0.17 (0.10) | RR 1.65a | 1.11–2.54a | 0.01 | POC CD4 during home-based HCT was associated with an increase in ART initiation | |
| MacPherson | HIV self-testing followed by optional home initiation of HIV care | HIV self-testing accompanied by facility-based HIV care | ART initiation | Six months | 8194 (8466) | 0.022 (0.007) | aRR 2.44 | 1.61–3.68 | <0.001 | HIV self-testing followed by optional home initiation was associated with a significant increase in ART initiation over six months among all testers |
| Rapid/Point-of-care CD4 count | ||||||||||
| Barnabas 3 | POC CD4 count (Pima) | Standard of care referral | ART initiation | 627 (676) | 0.39 (0.36) | RR 1.08 | 0.94–1.26 | 0.28 | POC CD4 count staging was not associated with a significant increase in ART initiation | |
| Faal 2 | Same day CD4 count results (FACSCount) | Standard collection of CD4 result only | ART initiation | One month | 43 (36) | 0.65 (0.25) | RR 2.1 | 1.39–3.17 | Same day receipt of CD4 counts was associated with a significant increase in ART initiation among those ART eligible. | |
| Jani | POC CD4 count (Pima) | Standard of care lab referral of blood for CD4 staging | ART initiation | 437 (492) | 0.65 (0.61) | OR 1.07a | 0.87–1.30a | POC CD4 count staging was not associated with a significant increase in ART initiation among those eligible | ||
| Larson | Same day CD4 count results (FACSCount) | Standard of care | ART initiation | ≤16 weeks | 273 (223) | 0.49 (0.46) | aRR 1.2 | 0.99–1.46 | 0.06 | Rapid POC CD4 results were associated with a small non-significant increase in ART initiation among eligible |
| Matambo | Integrated mobile HIV/TB primary health care with POC CD4 testing (Pima) | Standard of care | ART initiation | 226 (380) | 0.83 (0.51) | RR 1.63a | 1.45–1.83a | <0.0001 | Integrated services was associated with an increase in linkage to care | |
| Moyo | Point-of-care CD4 count (Pima) | Standard of care | ART initiation | RR 1.33 | 0.01 | POC led to an increase in ART initiation | ||||
| Nicholas | Point-of-care CD4 count (Pima) | Standard of care | ART initiation | Any time | 253 (259) | RR 0.96 | 0.91–1.01 | POC led to no overall increase in ART initiation among those eligible | ||
| Improved clinic operations | ||||||||||
| Fairall | Prescribing nurses given educational outreach training sessions about ART prescribing and task shifting to nurses | Standard of care | ART initiation | At least 12 months | 5390 (3862) | 0.69 (0.63) | RR 1.24b | 0.88–1.73 | 0.218 | Training and task shifting to nurses was associated with a small non-significant increase in ART initiation |
| Pfeiffer | HIV service integration including co-location of services; training personnel to provide multiple services; training to link separate services; strengthening linkages between facility levels; and harmonization of data collection | Standard of care | ART initiation | ≤90 days of eligibility | RR 1.58 | 1.17–2.14 | HIV service integration was associated with an increase in ART initiation | |||
| Rosen | Immediate (rapid) ART initiation including POC technology and service delivery acceleration | Standard of care | ART initiation | ≤90 days after testing HIV positive and ART eligible | 187 (190) | 0.97 (0.72) | RR 1.36 | 1.25–1.49 | Immediate ART initiation was associated with an increase in uptake of ART within 90 days | |
| Package of patient services | ||||||||||
| Burtle | Introduction of pre-ART interventions, including task shifting, counselling, clinical staging, timely ART initiation, social and psychological support | Standard of care | ART initiation | 419 (68) | 0.81 (0.53) | RR 1.53a | 1.22–1.92a | The intervention was associated with a 50% increase in ART initiation among those ART eligible | ||
| Siedner | SMS notifying patients of CD4 results; if early return to clinic required, one of three messages and transport reimbursement | Standard of care | ART initiation | 110 (26) | 0.96 (0.81) | aHR 2.26 | 1.38–3.73 | 0.001 | SMS notification was associated with a significant increase in ART initiation | |
| Wanyenze | Enhanced linkage with case-management referral (counselling, assisted disclosure of HIV status, staff introduction and scheduling, reminder via telephone or home visit one week before the scheduled appointment) and tracing of lost patients | Standard linkage to care (explanation of services, hours, and locations of the clinics nearby) | ART initiation among those eligible | One year | 202 (183) | 0.78 (0.71) | aHR 1.29c | 1.03–1.67c | 0.03 | Enhanced linkage was associated with a significant increase in ART initiation among those eligible |
RR, relative risk; aRR, adjusted relative risk; aIRR, adjusted incidence rate ratio; OR, odds ratio; aOR, adjusted odds ratio; aHR, adjusted hazard ratio; PR, prevalence ratio.
a
Relative risk and 95% CI not reported but approximated from the data.
b
Adjusted for clustering.
c
Presenting the invers of the results (i.e. 1/(results presented)) as the comparison provided was the effect of standard of care vs. intervention.