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Outcomes of HIV treatment from the private sector in low-income and middle-income countries: a systematic review protocol
  1. Gitau Mburu1,2,
  2. Ewemade Igbinedion3,
  3. Sin How Lim4,
  4. Aung Zayar Paing5,
  5. Siyan Yi6,7,8,
  6. Stefan Elbe1,
  7. Grace W Mwai9
  1. 1 Centre for Global Health Policy, University of Sussex, Brighton, East Sussex, UK
  2. 2 Division of Health Research, Lancaster University, Lancaster, UK
  3. 3 Department of Community Health, Igbinedion University Teaching Hospital, Okada, Nigeria
  4. 4 Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
  5. 5 Programs Department, Alliance Myanmar, Yangon, Myanmar
  6. 6 Center for Global Health Research, Touro University California, Vallejo, California, USA
  7. 7 Saw Swee Hock School of Public Health, National University Singapore, Singapore, Singapore
  8. 8 Center for Population Health Research, KHANA, Phnom Penh, Cambodia
  9. 9 Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
  1. Correspondence to Dr Gitau Mburu; g.mburu{at}


Introduction Private sector provision of HIV treatment is increasing in low-income and middle-income countries (LMIC). However, there is limited documentation of its outcomes. This protocol reports a proposed systematic review that will synthesise clinical outcomes of private sector HIV treatment in LMIC.

Methods and analysis This review will be conducted in accordance with the preferred reporting items for systematic review and meta-analyses protocols. Primary outcomes will include: (1) proportion of eligible patients initiating antiretroviral therapy (ART); (2) proportion of those on ART with <1000 copies/mL; (3) rate of all-cause mortality among ART recipients. Secondary outcomes will include: (1) proportion receiving Pneumocystis jiroveci pneumonia prophylaxis; (2) proportion with >90% ART adherence (based on any measure reported); (3) proportion screened for non-communicable diseases (specifically cervical cancer, diabetes, hypertension and mental ill health); (iv) proportion screened for tuberculosis. A search of five electronic bibliographical databases (Embase, Medline, PsychINFO, Web of Science and CINAHL) and reference lists of included articles will be conducted to identify relevant articles reporting HIV clinical outcomes. Searches will be limited to LMIC. No age, publication date, study-design or language limits will be applied. Authors of relevant studies will be contacted for clarification. Two reviewers will independently screen citations and abstracts, identify full text articles for inclusion, extract data and appraise the quality and bias of included studies. Outcome data will be pooled to generate aggregative proportions of primary and secondary outcomes. Descriptive statistics and a narrative synthesis will be presented. Heterogeneity and sensitivity assessments will be conducted to aid interpretation of results.

Ethics and dissemination The results of this review will be disseminated through a peer-reviewed scientific manuscript and at international scientific conferences. Results will inform quality improvement strategies, replication of identified good practices, potential policy changes, and future research.

PROSPERO registration number CRD42016040053.

  • HIV
  • treatment
  • ART
  • private sector
  • low-income and middle-income countries

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Contributors GM and GWM conceived this study. GM drafted the manuscript. IE, SHL, AZP, SY, SE and GWM critically reviewed the manuscript and provided comments. All authors approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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