title: Male sex and the risk of mortality among individuals enrolled in antiretroviral therapy programs in Africa:  a systematic review and meta-analysis.
abstract: BACKGROUND
  HIV/AIDS has historically had a sex and gender-focused approach to prevention and care. Some evidence suggests that HIV-positive men have worse treatment outcomes than their women counterparts in Africa.
  
  
  METHODS
  We conducted a systematic review and meta-analysis of the effect of sex on the risk of death among participants enrolled in antiretroviral therapy (ART) programs in Africa since the rapid scale-up of ART. We included all cohort studies evaluating the effect of sex (male, female) on the risk of death among participants enrolled in regional and national ART programs in Africa. We identified these studies by searching MedLine, EMBASE, and Cochrane CENTRAL. We used a DerSimonian-Laird random-effects method to pool the proportions of men receiving ART and the hazard ratios for death by sex.
  
  
  RESULTS
  Twenty-three cohort studies, including 216 008 participants (79 892 men) contributed to our analysis. The pooled proportion of men receiving ART was 35% [95% confidence interval (CI): 33-38%]. The pooled hazard ratio estimate indicated a significant increase in the risk of death for men when compared to women [hazard ratio: 1.37 (95% CI: 1.28-1.47)]. This was consistent across sensitivity analyses.
  
  
  CONCLUSIONS
  The proportion of men enrolled in ART programs in Africa is lower than women. Additionally, there is an increased risk of death for men enrolled in ART programs. Solutions that aid in reducing these sex inequities are needed.
authors.affiliation: Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Druyts
authors.forename: Mark
authors.initials: M
authors.lastname: Dybul
authors.forename: Steve
authors.initials: S
authors.lastname: Kanters
authors.forename: Jean
authors.initials: J
authors.lastname: Nachega
authors.forename: Josephine
authors.initials: J
authors.lastname: Birungi
authors.forename: Nathan
authors.initials: N
authors.lastname: Ford
authors.forename: Kristian
authors.initials: K
authors.lastname: Thorlund
authors.forename: Joel
authors.initials: J
authors.lastname: Negin
authors.forename: Richard
authors.initials: R
authors.lastname: Lester
authors.forename: Sanni
authors.initials: S
authors.lastname: Yaya
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Mills
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D019317:Evidence-Based Medicine; D006679:HIV Seropositivity / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D016017:Odds Ratio; D012307:Risk Factors; D017678:Sex Distribution
chemical_list: D019380:Anti-HIV Agents