{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T15:42:52Z","timestamp":1777563772168,"version":"3.51.4"},"reference-count":46,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2023,2,22]],"date-time":"2023-02-22T00:00:00Z","timestamp":1677024000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["203905\/Z\/16\/Z"],"award-info":[{"award-number":["203905\/Z\/16\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["091769\/Z\/10\/Z"],"award-info":[{"award-number":["091769\/Z\/10\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>People living with HIV (PLHIV) admitted to hospital have a high risk of death. We systematically appraised evidence for interventions to reduce mortality among hospitalised PLHIV in low- and middle-income countries (LMICs). Using a broad search strategy with terms for HIV, hospitals, and clinical trials, we searched for reports published between 1 Jan 2003 and 23 August 2021. Studies of interventions among adult HIV positive inpatients in LMICs were included if there was a comparator group and death was an outcome. We excluded studies restricted only to inpatients with a specific diagnosis (e.g. cryptococcal meningitis). Of 19,970 unique studies identified in search, ten were eligible for inclusion with 7,531 participants in total: nine randomised trials, and one before-after study. Three trials investigated systematic screening for tuberculosis; two showed survival benefit for urine TB screening vs. no urine screening, and one which compared Xpert MTB\/RIF versus smear microscopy showed no difference in survival. One before-after study implemented 2007 WHO guidelines to improve management of smear negative tuberculosis in severely ill PLHIV, and showed survival benefit but with high risk of bias. Two trials evaluated complex interventions aimed at overcoming barriers to ART initiation in newly diagnosed PLHIV, one of which showed survival benefit and the other no difference. Two small trials evaluated early inpatient ART start, with no difference in survival. Two trials investigated protocol-driven fluid resuscitation for emergency-room attendees meeting case-definitions for sepsis, and showed increased mortality with use of a protocol for fluid administration. In conclusion, ten studies published since 2003 investigated interventions that aimed to reduce mortality in hospitalised adults with HIV, and weren\u2019t restricted to people with a defined disease diagnosis. Inpatient trials of diagnostics, therapeutics or a package of interventions to reduce mortality should be a research priority.<\/jats:p>\n<jats:p><jats:bold>Trial registration: PROSPERO Number:<\/jats:bold> <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.crd.york.ac.uk\/prospero\/display_record.php?ID=CRD42019150341\" xlink:type=\"simple\">https:\/\/www.crd.york.ac.uk\/prospero\/display_record.php?ID=CRD42019150341<\/jats:ext-link>.<\/jats:p>","DOI":"10.1371\/journal.pgph.0001557","type":"journal-article","created":{"date-parts":[[2023,2,22]],"date-time":"2023-02-22T18:27:56Z","timestamp":1677090476000},"page":"e0001557","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":15,"title":["Interventions to reduce deaths in people living with HIV admitted to hospital in low- and middle-income countries: A systematic review"],"prefix":"10.1371","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2156-5030","authenticated-orcid":true,"given":"Rachael M.","family":"Burke","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4473-296X","authenticated-orcid":true,"given":"Hussein H.","family":"Twabi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cheryl","family":"Johnston","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marriott","family":"Nliwasa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5150-2970","authenticated-orcid":true,"given":"Ankur","family":"Gupta-Wright","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine","family":"Fielding","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1482-3967","authenticated-orcid":true,"given":"Nathan","family":"Ford","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"MacPherson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth L.","family":"Corbett","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2023,2,22]]},"reference":[{"key":"pgph.0001557.ref001","doi-asserted-by":"crossref","first-page":"S103","DOI":"10.1093\/cid\/cix1138","article-title":"The Persistent Challenge of Advanced HIV Disease and AIDS in the Era of Antiretroviral Therapy","volume":"66","author":"A Calmy","year":"2018","journal-title":"Clin Infect Dis"},{"key":"pgph.0001557.ref002","doi-asserted-by":"crossref","first-page":"e0131353","DOI":"10.1371\/journal.pone.0131353","article-title":"Trends in AIDS Deaths, New Infections and ART Coverage in the Top 30 Countries with the Highest AIDS Mortality Burden; 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Available: https:\/\/www.who.int\/publications-detail-redirect\/9789241550604."},{"key":"pgph.0001557.ref036","article-title":"Lateral flow urine lipoarabinomannan assay for detecting active tuberculosis in people living with HIV","author":"S Bjerrum","year":"2019","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"pgph.0001557.ref037","article-title":"Impact of diagnostic strategies for tuberculosis using lateral flow urine lipoarabinomannan assay in people living with HIV","author":"RR Nathavitharana","year":"2021","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"pgph.0001557.ref038","doi-asserted-by":"crossref","first-page":"e25162","DOI":"10.1002\/jia2.25162","article-title":"High HIV and active tuberculosis prevalence and increased mortality risk in adults with symptoms of TB: a systematic review and meta-analyses","volume":"21","author":"M Nliwasa","year":"2018","journal-title":"J Int AIDS Soc"},{"key":"pgph.0001557.ref039","doi-asserted-by":"crossref","first-page":"e27","DOI":"10.1016\/S2352-3018(19)30266-8","article-title":"Algorithm-guided empirical tuberculosis treatment for people with advanced HIV (TB Fast Track): an open-label, cluster-randomised trial.","volume":"7","author":"AD Grant","year":"2020","journal-title":"Lancet HIV."},{"key":"pgph.0001557.ref040","doi-asserted-by":"crossref","first-page":"2397","DOI":"10.1056\/NEJMoa1910708","article-title":"Systematic or Test-Guided Treatment for Tuberculosis in HIV-Infected Adults","volume":"382","author":"F-X Blanc","year":"2020","journal-title":"N Engl J Med"},{"key":"pgph.0001557.ref041","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1016\/S0140-6736(16)00546-8","article-title":"Empirical tuberculosis therapy versus isoniazid in adult outpatients with advanced HIV initiating antiretroviral therapy (REMEMBER): a multicountry open-label randomised controlled trial.","volume":"387","author":"MC Hosseinipour","year":"2016","journal-title":"Lancet"},{"key":"pgph.0001557.ref042","doi-asserted-by":"crossref","first-page":"1265","DOI":"10.4269\/ajtmh.16-0239","article-title":"Prevention of Early Mortality by Presumptive Tuberculosis Therapy Study: An Open Label, Randomized Controlled Trial","volume":"95","author":"YC Manabe","year":"2016","journal-title":"Am J Trop Med Hyg"},{"key":"pgph.0001557.ref043","doi-asserted-by":"crossref","first-page":"e60","DOI":"10.1016\/S2352-3018(14)70027-X","article-title":"Effect of the CCR5 antagonist maraviroc on the occurrence of immune reconstitution inflammatory syndrome in HIV (CADIRIS): a double-blind, randomised, placebo-controlled trial.","volume":"1","author":"JG Sierra-Madero","year":"2014","journal-title":"Lancet HIV"},{"key":"pgph.0001557.ref044","doi-asserted-by":"crossref","first-page":"2173","DOI":"10.1016\/S0140-6736(15)60164-7","article-title":"Cryptococcal meningitis screening and community-based early adherence support in people with advanced HIV infection starting antiretroviral therapy in Tanzania and Zambia: an open-label, randomised controlled trial","volume":"385","author":"S Mfinanga","year":"2015","journal-title":"Lancet"},{"key":"pgph.0001557.ref045","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1056\/NEJMoa1615822","article-title":"Enhanced Prophylaxis plus Antiretroviral Therapy for Advanced HIV Infection in Africa.","volume":"377","author":"J Hakim","year":"2017","journal-title":"New England Journal of Medicine"},{"key":"pgph.0001557.ref046","doi-asserted-by":"crossref","first-page":"e1002776","DOI":"10.1371\/journal.pmed.1002776","article-title":"Risk score for predicting mortality including urine lipoarabinomannan detection in hospital inpatients with HIV-associated tuberculosis in sub-Saharan Africa: Derivation and external validation cohort study.","volume":"16","author":"A Gupta-Wright","year":"2019","journal-title":"PLoS Med."}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0001557","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,22]],"date-time":"2023-02-22T18:28:27Z","timestamp":1677090507000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0001557"}},"subtitle":[],"editor":[{"given":"Godfrey Nyangadzayi","family":"Musuka","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2023,2,22]]},"references-count":46,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,2,22]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0001557","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,22]]}}}