Tuberculosis preventive treatment care pathways in people living with HIV: a systematic review and meta-analysis.

However, low levels of screening and uptake, poor adherence, and loss to follow-up considerably reduce its effectiveness.

然而，筛查和接受治疗的水平低，依从性差，以及随访丢失大大降低了其有效性。

We therefore aimed to assess the losses within all steps of the screening and treatment cascade.

因此，我们的目标是评估筛查和治疗过程中所有步骤的损失。

Methods

We carried out a comprehensive, global systematic reviewof the TPT cascade of care in people living with HIV (PROSPERO: CRD42020162396).

我们对HIV感染者中的TPT护理流程进行了全面的全球系统综述（PROSPERO: CRD42020162396）。

To enhance data generalisability we included articles which reported the proportion of people living with HIV completing any step of the TPT cascade in low and high TB burden countries published before March 2024.

为了增强数据的普遍适用性，我们纳入了报告了HIV感染者完成结核病预防治疗（TPT）流程中任何步骤比例的文章，这些文章涉及低结核病负担和高结核病负担国家，并且发表日期截止到2024年3月前。

Random effects meta-analysisproduced pooled estimates of the proportion proceeding to the next step along the cascade.

随机效应的荟萃分析产生了沿流程进行到下一步的合并估计比例。

Results were explored through subgroup analyses and meta-regression.

结果通过亚组分析和元回归进行探索。

Results

Data from 368 cohorts containing 2.7 million participants were included.

共纳入了包含270万参与者的数据，来自368个队列。

High levels of heterogeneity in outcomes were seen.

观察到的结果显示出高度的异质性。

Most participants were from Africa (80.6%).

大多数参与者来自非洲（80.6%）。

Isoniazid monotherapy was used for TPT in 92.6% of cohorts, usually for 6 months.

在92.6%的队列中，使用异烟肼单药治疗作为预防性治疗（TPT），通常治疗期为6个月。

Substantial loss to follow-up was found throughout the treatment cascade, with more than one in six patients lost at the following steps: initial screening, immunological testing, treatment start and completion.

在整个治疗过程中，发现有大量患者失访，超过六分之一的患者在以下步骤中失访：初步筛查、免疫学检测、治疗开始和完成。

Regimens lasting <6 months had higher completion rates (88.4%) than those lasting 6-9 months (74.4%) or >9 months (61.6%).

持续时间小于6个月的方案完成率较高（88.4%），而持续时间为6-9个月的方案完成率为74.4%，大于9个月的方案完成率为61.6%。

Conclusions

Our analysis highlights substantial loss to follow-up at multiple steps during the care cascade.

我们的分析强调了在护理过程中多个步骤中随访的大量流失。

This may significantly lower the reported effectiveness of TPT in real-world settings.

这可能会显著降低TPT在现实世界环境中的报告效果。

Research and policy should focus on simplified care pathways and novel, shorter treatment regimens that optimise retention in care.

研究和政策应关注简化护理路径和优化护理保持率的新颖、更短的治疗方案。