Table 6. Review evidence certainty assessment (GRADE): Reduced clinical appointment frequency (6- or 12-monthly) versus 3-monthly clinical appointments.
| Number of studies | Certainty assessment | Number of patients with outcome/number of patients total (%) | Effect estimate: Risk ratio (95% CI) | Certainty | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Study design | Risk of bias | Inconsistency | Indirectness | Imprecision | Other considerations | Reduced clinic appointment frequency | 3-monthly clinic appointments | |||
| Retention in care among all enrolled at longest time point: Any reduced frequency versus 3-monthly clinic appointment frequency | ||||||||||
| 8 | RCTs & observational studies | Seriousa | Seriousb | Not serious | Not serious | None | 11,526/12,638 (91.2%) | 8,454/9,623 (87.9%) | 1.01 (0.97 to 1.04) | ⨁⨁◯◯ Low |
| Retention in care among all enrolled at longest time point: RCTs | ||||||||||
| 6 | RCTs | Not serious | Seriousb | Not serious | Not serious | None | 9,892/10,759 (91.9%) | 6,932/7,815 (88.7%) | 1.00 (0.95 to 1.04) | ⨁⨁⨁◯ Moderate |
| Retention in care among all enrolled at longest time point: Cohort studies | ||||||||||
| 3 | Observational studies | Seriousc | Not serious | Not serious | Not serious | None | 1,634/1,879 (87.0%) | 1,522/1,808 (84.2%) | 1.02 (0.97 to 1.09) | ⨁◯◯◯ Very low |
| Retention in care among all enrolled at longest time point: 6-monthly versus 3-monthly clinic appointment frequency | ||||||||||
| 4 | RCTs & observational studies | Seriousa | Not serious | Not serious | Not serious | None | 2,602/3,013 (86.4%) | 2,262/2,696 (83.9%) | 1.03 (0.98 to 1.08) | ⨁⨁⨁◯ Moderate |
| Retention in care among all enrolled at longest time point: 12-monthly versus 3-monthly clinic appointment frequency | ||||||||||
| 4 | RCTs | Not serious | Seriousb | Not serious | Not serious | None | 8,924/9,625 (92.7%) | 6,192/6,927 (89.3%) | 0.99 (0.94 to 1.04) | ⨁⨁⨁◯ Moderate |
| Viral suppression among all enrolled at longest time point: RCTs | ||||||||||
| 4 | RCTs | Very seriousd | Seriousb | Not serious | Not serious | None | 3,424/6,801 (50.3%) | 2,777/4,325 (64.2%) | 0.74 (0.59 to 0.94) | ⨁◯◯◯ Very low |
| Viral suppression among all enrolled at longest time point: Cohort studies | ||||||||||
| 2 | Observational studies | Not serious | Seriousb | Not serious | Not serious | None | 1,941/2,345 (82.8%) | 2,934/6,729 (43.6%) | 1.40 (0.95 to 2.08) | ⨁◯◯◯ Very low |
| Viral suppression among all who received viral load testing at longest time point: RCTs | ||||||||||
| 4 | RCTs | Not serious | Seriousb | Not serious | Not serious | None | 3,424/3,489 (98.1%) | 2,777/2,826 (98.3%) | 1.00 (0.92 to 1.08) | ⨁⨁⨁◯ Moderate |
| Viral suppression among all who received viral load testing at longest time point: Cohort studies | ||||||||||
| 2 | Observational studies | Not serious | Seriousb | Not serious | Not serious | None | 1,941/2,295 (84.6%) | 2,934/2,962 (99.1%) | 1.44 (1.24 to 1.66) | ⨁◯◯◯ Very low |
| Mortality among all enrolled at longest time point: Any reduced frequency versus 3-monthly clinic appointment frequency | ||||||||||
| 6 | RCTs & observational studies | Seriousa | Not serious | Not serious | Very seriouse | None | 166/11,015 (1.5%) | 101/7,810 (1.3%) | 1.12 (0.75 to 1.66) | ⨁◯◯◯ Very low |
| Mortality among all enrolled at longest time point: RCTs | ||||||||||
| 5 | RCTs | Seriousd | Not serious | Not serious | Very seriouse | None | 163/10,484 (1.6%) | 100/7,521 (1.3%) | 1.10 (0.73 to 1.65) | ⨁⨁◯◯ Low |
| Mortality among all enrolled at longest time point: Cohort studies | ||||||||||
| 1 | Observational studies | Seriousf | Not serious | Not serious | Very seriouse | None | 3/531 (0.6%) | 1/289 (0.3%) | 1.63 (0.17 to 15.63) | ⨁◯◯◯ Very low |
| Mortality among all enrolled at longest time point: 6-monthly versus 3-monthly clinic appointment frequency | ||||||||||
| 2 | RCTs & observational studies | Seriousd | Not serious | Not serious | Very seriouse | None | 120/1,390 (8.6%) | 81/883 (9.2%) | 1.05 (0.66 to 1.66) | ⨁◯◯◯ Very low |
| Mortality among all enrolled at longest time point: 12-monthly versus 3-monthly clinic appointment frequency | ||||||||||
| 4 | RCTs | Not serious | Not serious | Not serious | Very seriouse | None | 46/9,625 (0.5%) | 20/6,927 (0.3%) | 1.35 (0.61 to 2.98) | ⨁⨁◯◯ Low |
CI, confidence interval; RCT, randomized controlled trial. Explanations
aCombination of cohort and RCT data. In addition, contributing observational study was ranked as poor quality.
bStatistical heterogeneity.
cVariable study quality.
dStudies with high risk of bias and/or some concerns of bias contribute substantially to estimate.
eDowngraded due to very wide confidence intervals including benefit and harm.
fEstimate consists of only 1 study.