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Point-of-care CD4 testing: Differentiated care for the most vulnerable

BACKGROUND: South Africa, with the highest burden of HIV infection globally, has made huge strides in its HIV/ART programme, but AIDS deaths have not decreased proportionally to ART uptake. Advanced HIV disease (CD4 < 200 cells/mm(3)) persists, and CD4 count testing is being overlooked since univ...

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Autores principales: Spooner, Elizabeth, Reddy, Tarylee, Mchunu, Nobuhle, Reddy, Shabashini, Daniels, Brodie, Ngomane, Noluthando, Luthuli, Nozipho, Kiepiela, Photini, Coutsoudis, Anna
Formato: Online Artículo Texto
Lenguaje:English
Publicado: International Society of Global Health 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8818294/
https://www.ncbi.nlm.nih.gov/pubmed/35136596
http://dx.doi.org/10.7189/jogh.12.04004
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author Spooner, Elizabeth
Reddy, Tarylee
Mchunu, Nobuhle
Reddy, Shabashini
Daniels, Brodie
Ngomane, Noluthando
Luthuli, Nozipho
Kiepiela, Photini
Coutsoudis, Anna
author_facet Spooner, Elizabeth
Reddy, Tarylee
Mchunu, Nobuhle
Reddy, Shabashini
Daniels, Brodie
Ngomane, Noluthando
Luthuli, Nozipho
Kiepiela, Photini
Coutsoudis, Anna
author_sort Spooner, Elizabeth
collection PubMed
description BACKGROUND: South Africa, with the highest burden of HIV infection globally, has made huge strides in its HIV/ART programme, but AIDS deaths have not decreased proportionally to ART uptake. Advanced HIV disease (CD4 < 200 cells/mm(3)) persists, and CD4 count testing is being overlooked since universal test-and-treat was implemented. Point-of-care CD4 testing could address this gap and assure differentiated care to these vulnerable patients with low CD4 counts. METHODS: A time randomised implementation trial was conducted, enrolling 603 HIV positive non-ART, not pregnant patients at a primary health care clinic in Durban, South Africa. Weeks were randomised to either point-of-care CD4 testing (n = 305 patients) or standard-of-care central laboratory CD4 testing (n = 298 patients) to assess the proportion initiating ART at 3 months. Cox regression, with robust standard errors adjusting for clustering by week, were used to assess the relationship between treatment initiation and arm. RESULTS: Among the 578 (299 point-of-care and 279 standard-of-care) patients eligible for analysis, there was no significant difference in the number of eligible patients initiating ART within 3 months in the point-of-care (73%) and the standard-of-care (68%) groups (P = 0.112). The time-to-treat analysis was not significantly different in patients with CD4 counts of 201-500 cells/mm(3) which could have been due to appointment scheduling to cope with the large burden of cases. However, in patients with advanced HIV disease (CD4 < 200cells/mm(3)) 65% more patients started ART earlier in the point-of-care group (HR 1.65 (95% confidence interval (CI) = 0.99-2.75; P = 0.052) compared to the standard-of-care group. CONCLUSIONS: Point-of-care testing decreased time-to-treatment in those with advanced HIV disease. With universal test and treat for HIV, rollout of simple point-of-care CD4 testing would ensure early diagnosis of advanced HIV disease and facilitate differentiated care for these vulnerable patients as per the World Health Organisation 2020 target product profile for point-of-care CD4 testing. TRIAL REGISTRATION: ISRCTN14220457.
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spelling pubmed-88182942022-02-07 Point-of-care CD4 testing: Differentiated care for the most vulnerable Spooner, Elizabeth Reddy, Tarylee Mchunu, Nobuhle Reddy, Shabashini Daniels, Brodie Ngomane, Noluthando Luthuli, Nozipho Kiepiela, Photini Coutsoudis, Anna J Glob Health Articles BACKGROUND: South Africa, with the highest burden of HIV infection globally, has made huge strides in its HIV/ART programme, but AIDS deaths have not decreased proportionally to ART uptake. Advanced HIV disease (CD4 < 200 cells/mm(3)) persists, and CD4 count testing is being overlooked since universal test-and-treat was implemented. Point-of-care CD4 testing could address this gap and assure differentiated care to these vulnerable patients with low CD4 counts. METHODS: A time randomised implementation trial was conducted, enrolling 603 HIV positive non-ART, not pregnant patients at a primary health care clinic in Durban, South Africa. Weeks were randomised to either point-of-care CD4 testing (n = 305 patients) or standard-of-care central laboratory CD4 testing (n = 298 patients) to assess the proportion initiating ART at 3 months. Cox regression, with robust standard errors adjusting for clustering by week, were used to assess the relationship between treatment initiation and arm. RESULTS: Among the 578 (299 point-of-care and 279 standard-of-care) patients eligible for analysis, there was no significant difference in the number of eligible patients initiating ART within 3 months in the point-of-care (73%) and the standard-of-care (68%) groups (P = 0.112). The time-to-treat analysis was not significantly different in patients with CD4 counts of 201-500 cells/mm(3) which could have been due to appointment scheduling to cope with the large burden of cases. However, in patients with advanced HIV disease (CD4 < 200cells/mm(3)) 65% more patients started ART earlier in the point-of-care group (HR 1.65 (95% confidence interval (CI) = 0.99-2.75; P = 0.052) compared to the standard-of-care group. CONCLUSIONS: Point-of-care testing decreased time-to-treatment in those with advanced HIV disease. With universal test and treat for HIV, rollout of simple point-of-care CD4 testing would ensure early diagnosis of advanced HIV disease and facilitate differentiated care for these vulnerable patients as per the World Health Organisation 2020 target product profile for point-of-care CD4 testing. TRIAL REGISTRATION: ISRCTN14220457. International Society of Global Health 2022-02-05 /pmc/articles/PMC8818294/ /pubmed/35136596 http://dx.doi.org/10.7189/jogh.12.04004 Text en Copyright © 2022 by the Journal of Global Health. All rights reserved. https://creativecommons.org/licenses/by/4.0/This work is licensed under a Creative Commons Attribution 4.0 International License.
spellingShingle Articles
Spooner, Elizabeth
Reddy, Tarylee
Mchunu, Nobuhle
Reddy, Shabashini
Daniels, Brodie
Ngomane, Noluthando
Luthuli, Nozipho
Kiepiela, Photini
Coutsoudis, Anna
Point-of-care CD4 testing: Differentiated care for the most vulnerable
title Point-of-care CD4 testing: Differentiated care for the most vulnerable
title_full Point-of-care CD4 testing: Differentiated care for the most vulnerable
title_fullStr Point-of-care CD4 testing: Differentiated care for the most vulnerable
title_full_unstemmed Point-of-care CD4 testing: Differentiated care for the most vulnerable
title_short Point-of-care CD4 testing: Differentiated care for the most vulnerable
title_sort point-of-care cd4 testing: differentiated care for the most vulnerable
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8818294/
https://www.ncbi.nlm.nih.gov/pubmed/35136596
http://dx.doi.org/10.7189/jogh.12.04004
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