Point-of-care CD4+ technology implementation in Free State, South Africa, was associated with improved patient health outcomes

Abstract

CD4+ testing is the most predictable indicator of HIV disease progression, and owing to limited resources is widely used to determine whether a patient is eligible for antiretroviral therapy (ART). Currently, in settings where it is available, CD4+ testing is used to determine whether a patient is eligible for ART, and it is more reliable in determining ART eligibility than symptomatic staging. [1,2] Patients who do not have reliable on-site access to testing must often make numerous visits to healthcare facilities for testing blood draws, receiving test results, and routine clinical care visits due to sample and result transportation to and from centralised testing facilities. Furthermore, it has been suggested that up to 80% of patients are lost to follow-up before ART initiation. [3] To overcome some of the challenges associated with centralised laboratory testing and patient loss to follow-up, high-quality pointof-care (POC) diagnostic technologies are available to alleviate critical testing needs in facilities lacking on-site CD4+ testing and provide same-day test results. [4] Firstly, POC CD4+ technologies have the potential to increase patient access to CD4+ testing by reducing test turnaround time, allowing for more immediate clinical decisions, reducing patient loss to follow-up, and increasing the number of patients initiating ART. [5,6] Secondly, POC technologies can reduce the burden of managing an extensive sample transportation network that cannot fully meet patient need and a growing network of conventional instruments that are increasingly difficult to maintain. Thirdly, providing POC testing administered by personnel with minimal technical training can make remote healthcare facilities more self-sufficient and allow for efficient task-shifting of testing and related tasks. [7] Objectives In 2012, the Free State Department of Health in South Africa (SA) implemented the Alere Pima POC CD4+ technology at 30 healthcare facilities. These technologies are used exclusively to determine ART This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Assessment of POC CD4 Detecting Mode in District or County Labs — Jiangsu Province, China, 2021

“…The findings indicated a good consistency and relevance between POC devices and flow cytometry test results with correlation coefficients >0.8. Moreover, the consistency was also close to the results reported in other research (11,(13)(14). This study did find variations in the CD4 cell counts test results for the same PLWH samples from different laboratories using POC devices and flow cytometers.…”

“…In some countries, studies have shown that adopting POC CD4 detection instruments can meaningfully improve the timeliness of initiating antiviral therapies (6,(11)(12). Timeliness plays a vital role in the care and therapeutic evaluation of HIV patients; this is especially witnessed in mobile HIV testing services (HTS) delivery, which patients are often more willing to use (11). Therefore, using POC CD4 cell detectors, based on their accuracy and reliability, for PLWH in districts or counties without high-standard laboratories is a novel strategy in HIV prevention and control work that will help promote detection accessibility.…”

“…It can ultimately help PLWH get their CD4 count test results faster and facilitate their timely initiation into or adjustment to antiviral treatment regimens ( 9 - 10 ). In some countries, studies have shown that adopting POC CD4 detection instruments can meaningfully improve the timeliness of initiating antiviral therapies ( 6 , 11 - 12 ). Timeliness plays a vital role in the care and therapeutic evaluation of HIV patients; this is especially witnessed in mobile HIV testing services (HTS) delivery, which patients are often more willing to use ( 11 ).…”

Advanced HIV disease: A review of diagnostic and prophylactic strategies

“…[ 21 ] A recent study among 1053 venous samples from Botswana demonstrated 94% (112/119) sensitivity compared to flow cytometry but positive predictive value for CD4 <200 cells/mm [ 3 ] was only 46% [ 22 ]. If the goal is to identify and screen persons at highest risk of undiagnosed OIs, false-positive results may be a reasonable trade-off for a highly sensitive POC test that can allow for rapid OI screening prior to ART initiation [ 23 ]. One additional drawback is that healthcare workers often prefer a precise CD4 value over a semiquantitative CD4 range [ 24 , 21 ].…”