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Task-shifting point-of-care CD4+ testing to lay health workers in HIV care and treatment services in Namibia
INTRODUCTION: Access to CD4+ testing remains a common barrier to early initiation of antiretroviral therapy among persons living with HIV/AIDS in low- and middle-income countries. The feasibility of task-shifting of point-of-care (POC) CD4+ testing to lay health workers in Namibia has not been evalu...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
AOSIS
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5684646/ https://www.ncbi.nlm.nih.gov/pubmed/29159139 http://dx.doi.org/10.4102/ajlm.v6i1.643 |
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author | Kaindjee-Tjituka, Francina Sawadogo, Souleymane Mutandi, Graham Maher, Andrew D. Salomo, Natanael Mbapaha, Claudia Neo, Marytha Beukes, Anita Gweshe, Justice Muadinohamba, Alexinah Lowrance, David W. |
author_facet | Kaindjee-Tjituka, Francina Sawadogo, Souleymane Mutandi, Graham Maher, Andrew D. Salomo, Natanael Mbapaha, Claudia Neo, Marytha Beukes, Anita Gweshe, Justice Muadinohamba, Alexinah Lowrance, David W. |
author_sort | Kaindjee-Tjituka, Francina |
collection | PubMed |
description | INTRODUCTION: Access to CD4+ testing remains a common barrier to early initiation of antiretroviral therapy among persons living with HIV/AIDS in low- and middle-income countries. The feasibility of task-shifting of point-of-care (POC) CD4+ testing to lay health workers in Namibia has not been evaluated. METHODS: From July to August 2011, Pima CD4+ analysers were used to improve access to CD4+ testing at 10 selected public health facilities in Namibia. POC Pima CD4+ testing was performed by nurses or lay health workers. Venous blood samples were collected from 10% of patients and sent to centralised laboratories for CD4+ testing with standard methods. Outcomes for POC Pima CD4+ testing and patient receipt of results were compared between nurses and lay health workers and between the POC method and standard laboratory CD4+ testing methods. RESULTS: Overall, 1429 patients received a Pima CD4+ test; 500 (35.0%) tests were performed by nurses and 929 (65.0%) were performed by lay health workers. When Pima CD4+ testing was performed by a nurse or a lay health worker, 93.2% and 95.2% of results were valid (p = 0.1); 95.6% and 98.1% of results were received by the patient (p = 0.007); 96.2% and 94.0% of results were received by the patient on the same day (p = 0.08). Overall, 97.2% of Pima CD4+ results were received by patients, compared to 55.4% of standard laboratory CD4+ results (p < 0.001). CONCLUSIONS: POC CD4+ testing was feasible and effective when task-shifted to lay health workers. Rollout of POC CD4+ testing via task-shifting can improve access to CD4+ testing and retention in care between HIV diagnosis and antiretroviral therapy initiation in low- and middle-income countries. |
format | Online Article Text |
id | pubmed-5684646 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | AOSIS |
record_format | MEDLINE/PubMed |
spelling | pubmed-56846462017-11-20 Task-shifting point-of-care CD4+ testing to lay health workers in HIV care and treatment services in Namibia Kaindjee-Tjituka, Francina Sawadogo, Souleymane Mutandi, Graham Maher, Andrew D. Salomo, Natanael Mbapaha, Claudia Neo, Marytha Beukes, Anita Gweshe, Justice Muadinohamba, Alexinah Lowrance, David W. Afr J Lab Med Lessons from the Field INTRODUCTION: Access to CD4+ testing remains a common barrier to early initiation of antiretroviral therapy among persons living with HIV/AIDS in low- and middle-income countries. The feasibility of task-shifting of point-of-care (POC) CD4+ testing to lay health workers in Namibia has not been evaluated. METHODS: From July to August 2011, Pima CD4+ analysers were used to improve access to CD4+ testing at 10 selected public health facilities in Namibia. POC Pima CD4+ testing was performed by nurses or lay health workers. Venous blood samples were collected from 10% of patients and sent to centralised laboratories for CD4+ testing with standard methods. Outcomes for POC Pima CD4+ testing and patient receipt of results were compared between nurses and lay health workers and between the POC method and standard laboratory CD4+ testing methods. RESULTS: Overall, 1429 patients received a Pima CD4+ test; 500 (35.0%) tests were performed by nurses and 929 (65.0%) were performed by lay health workers. When Pima CD4+ testing was performed by a nurse or a lay health worker, 93.2% and 95.2% of results were valid (p = 0.1); 95.6% and 98.1% of results were received by the patient (p = 0.007); 96.2% and 94.0% of results were received by the patient on the same day (p = 0.08). Overall, 97.2% of Pima CD4+ results were received by patients, compared to 55.4% of standard laboratory CD4+ results (p < 0.001). CONCLUSIONS: POC CD4+ testing was feasible and effective when task-shifted to lay health workers. Rollout of POC CD4+ testing via task-shifting can improve access to CD4+ testing and retention in care between HIV diagnosis and antiretroviral therapy initiation in low- and middle-income countries. AOSIS 2017-09-18 /pmc/articles/PMC5684646/ /pubmed/29159139 http://dx.doi.org/10.4102/ajlm.v6i1.643 Text en © 2017. The Authors https://creativecommons.org/licenses/by/4.0/ Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License. |
spellingShingle | Lessons from the Field Kaindjee-Tjituka, Francina Sawadogo, Souleymane Mutandi, Graham Maher, Andrew D. Salomo, Natanael Mbapaha, Claudia Neo, Marytha Beukes, Anita Gweshe, Justice Muadinohamba, Alexinah Lowrance, David W. Task-shifting point-of-care CD4+ testing to lay health workers in HIV care and treatment services in Namibia |
title | Task-shifting point-of-care CD4+ testing to lay health workers in HIV care and treatment services in Namibia |
title_full | Task-shifting point-of-care CD4+ testing to lay health workers in HIV care and treatment services in Namibia |
title_fullStr | Task-shifting point-of-care CD4+ testing to lay health workers in HIV care and treatment services in Namibia |
title_full_unstemmed | Task-shifting point-of-care CD4+ testing to lay health workers in HIV care and treatment services in Namibia |
title_short | Task-shifting point-of-care CD4+ testing to lay health workers in HIV care and treatment services in Namibia |
title_sort | task-shifting point-of-care cd4+ testing to lay health workers in hiv care and treatment services in namibia |
topic | Lessons from the Field |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5684646/ https://www.ncbi.nlm.nih.gov/pubmed/29159139 http://dx.doi.org/10.4102/ajlm.v6i1.643 |
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