Point-of-care CD4 testing may improve efficacy of HIV treatment services

Jani IV. Lancet. 2011;doi:10.1016/S0140-6736(11)61052-0.

Implementation of point-of-care CD4 testing across four clinics in the Republic of Mozambique allowed rapid, onsite CD4 staging after enrollment. This led to decreased opportunities for pretreatment loss to follow-up and increased initiation of antiretroviral treatment, according to new findings published in The Lancet.

“Despite significant recent advances in the provision of ART for HIV patients in resource-limited settings, inefficiencies in the care and management of patients before they start treatment remain an important concern,” Ilesh V. Jani, MD, director of the NIH in Maputo, Mozambique, told Infectious Disease News. “Many treatment-eligible patients are lost from the health care system without receiving the care they need. Point-of-care CD4 cell testing can help significantly reduce this loss by simplifying preparatory steps for treatment and reducing the time spent on these steps. Point-of-care CD4 cell testing may, therefore, be able to improve the efficiency of HIV treatment services.”

Ilesh V. Jani, MD

In the retrospective, observational, cohort study, Jani and colleagues implemented point-of-care counting of CD4 cells among 492 patients at four public primary health clinics from March to April 2010. The researchers further assessed patient retention and the rates for ART initiation. Loss to follow-up and the duration of preparatory steps before treatment were compared with baseline data from September to November 2009.

The number of patients lost to follow-up decreased from 57% before CD4 staging to 21% after staging (OR=0.2; 95% CI, 0.15-0.27). The number of patients who initiated ART increased from 12% before staging to 22% after staging (OR=2.05; 95% CI, 1.42-2.96); and overall loss to follow-up decreased from 64% to 33% after ART initiation (OR=0.27; 95% CI, 0.21-0.36).

Due to the reduced time it took to complete CD4 staging (from 32 days to 3 days; P<.0001), researchers observed a decrease in the median time from enrollment to initiation of ART (from 48 days to 20 days; P<.0001).

“The reduction in pretreatment patient loss associated with the use of point-of-care CD4 testing is the most significant finding of this study,” Jani said. “Also significant is the observation that even after the introduction of point-of-care CD4 tests, approximately one-third of all patients were still lost before initiating ART. This indicates that while point-of-care testing is an effective intervention, additional initiatives are needed to reduce overall patient loss.” – by Ashley DeNyse

Disclosure: This research was funded by the Absolute Return for Kids and UNITAID.

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