Title

A Meta-Analysis of the Effectiveness and cost-effectiveness of HIV Viral Load

Monitoring Frequency if measured at 3 months compared to 6 months among HIVInfected Patients on Antiretroviral Therapy

Efficiency

Summary of topic

Short literature review

Expected contribution of the study

The Meta-analysis intends to guide program planning decisions to ensure that
resources are utilised to implement the most efffective initiatives.
A meta-analysis needs to tell an interesting and useful story about your phenomena
of interest. Review the debates within the literature and offer a clear and compelling
analysis of the available data. Finally, write a story that makes your reader glad to
have picked up your paper in the first place.

Methodology to be followed

Availability of the data

Further, because meta-analysis is a synthesis of data that have already been

collected, it is not necessary to obtain external funding or recruit participants. All
you need to conduct a meta-analysis is use of one or more comprehensive literature
search engines (e.g., Web of Science, PsycINFO, PubMed), access to a basic
statistics program such as SPSS or SAS at your disposal, and a good idea for a metaanalysis topic.

List of references

Reasons why you are interested in the topic

The purpose of a meta-analysis is to cover all of the available studies for your topic.
This includes not only published research, but also dissertations, studies in nonEnglish language journals, and unpublished studies

Cooper, H., & Hedges, L. V. (1994). The handbook of research synthesis. New York:
Russell Sage Foundation.
Hunter, J.E. & Schmidt, F.L. (1990). Methods of Meta-Analysis: Correcting Error and
Bias in Research Findings, Newbury Park, CA: SAGE Publications.
Johnson, B.T. & Boynton, M.H. (2008). Cumulating Evidence about the Social Animal:
Meta-analysis in Social-Personality Psychology, Personality & Social Psychology
Compass, 2, 1-25.
Lipsey, M. W., & Wilson, D. B. (2001). Practical meta-analysis. Thousand Oaks, CA:
Sage Publications, Inc.
Useful Meta-Analysis Software
Biostat Corporation (2005). Comprehensive Meta-analysis Version 2, Englewood NJ:
Author.
Johnson, B. T. (1993). DSTAT 1.10: Software for the meta-analytic review of research
literatures. Hillsdale, NJ: Erlbaum
Wilson, D. B. (2006). SPSS, STATA, & SAS macros for performing meta-analytic
analyses. Retrieved August 9, 2007 from http://mason.gmu.edu/~dwilsonb/ma.html.

Initiation onto ART interrupts viral replication, leading to a decreased level of virions
(virus particles) in the hosts bloodstream. This slows the progression of the disease
and improves the patients prognosis. Once initi- ated onto ART, reduction in an
individuals viral load levels can be used as an indicator of the efficiency of therapy,
along with clinical symptoms and CD4 counts. Viral load testing is used to
determine whether the virus is undetectable in the patients blood (below the limit
of detection of currently available technologies as measured in copies of the virus
per millimeter) and is considered to be the most effective means of identifying
virological failure in patients. Although still being used, especially in resourcelimited settings, clinical signs and immunological (CD4) monitoring are generally
lagging indicators of treatment failure, with misclassification of ART failure by these
methods as high as 45 percent [53,54,55].

Despite a possible move towards test and treat approaches to HIV care and
treatment and towards more routine viral load testing for patients on ART, scale-up
of CD4 testing
One of the critical clinical decisions made in antiretroviral therapy (ART) is when to
switch from an initial regimen to another due to treatment failure. This complex
process requires consideration of multiple factors including: (1) what type of
monitoring (e.g. clinical, immunologic, virologic) is available to guide switching; (2)
establishing criteria for treatment failure (e.g. viral load >10,000 copies/mL); (3)
integrating data from different types of monitoring; (4) making a decision; and, if
possible, (5) follow-up and monitoring to determine patient outcomes. The initial
step in this model of deciding when to switch is determining what type of
monitoring for guiding when to switch is available and appropriate. This review
seeks to find and summarize evidence on optimal monitoring strategies for guiding
when to switch first-line regimens due to treatment failure among adults and
adolescents living with HIV in low-resource settings. This review was one of a series
of reviews prepared in 2009 at the request of the World Health Organization to
inform the development of new guidelines on ART for adults and adolescents.
evidence from observational studies suggested that virologic, immunologic, and
clinical monitoring led to more frequent switching, earlier switching, and switching
at higher CD4 counts compared with immunologic and clinical monitoring.
There is some evidence that 'adding on' services (or linkages) may improve the
utilisation and outputs of healthcare delivery. However, there is no evidence to date
that a fuller form of integration improves healthcare delivery or health status.
Available evidence suggests that full integration probably decreases the knowledge
and utilisation of specific services and may not result in any improvements in health
status.