Interventions to reduce mortality in sub-Saharan Africa among HIV-infected adults not yet on antiretroviral therapy

Peterson, Kevin; J, van Griensven; D, Huis in 't Veld; Colebunders, Robert

doi:10.1586/eri.11.151

Cited by 5 publications

(5 citation statements)

References 57 publications

(21 reference statements)

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“…Point-of-care CD4 devices are expected to play a significant role in the scaling up of HIV treatment and care, by reducing the infrastructure and operator skill requirements for testing thereby enabling the further decentralization of CD4 testing, and by reducing test result turn-around times and patient travel and other costs thereby improving pre-ART retention and ART initiation rates [19]–[21]. Miniaturization or less proven test methods that are not based on the established flow cytometry standard may compromise the performance of point-of-care CD4 technologies.…”

Section: Discussionmentioning

confidence: 99%

Performance of the PointCare NOW System for CD4 Counting in HIV Patients Based on Five Independent Evaluations

et al. 2012

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IntroductionPoint-of-care (POC) CD4 testing can improve access to treatment by enabling decentralization and reducing patient loss-to-follow-up. As new POC CD4 technologies become available, their performance should be assessed before widespread deployment. This study reports the findings of five independent evaluations of the PointCare NOW CD4 system.Materials/MethodsEvaluations were conducted in Southern Africa (Mozambique, South Africa) and North America (Canada, USA). 492 blood samples (55 from HIV-negative blood donors and 437 from HIV-infected patients, including 20 children aged between 12 and 59 months) were tested with both the PointCare NOW and reference flow cytometry instruments. Assessment of bias, precision and levels of clinical misclassification for absolute and percent CD4 count was conducted.ResultsPointCare NOW significantly overestimated CD4 absolute counts with a mean relative bias of +35.0%. Bias was greater in samples with CD4 counts below ≤350cells/µl (+51.3%) than in the CD4 >350cells/µl stratum (15.1%). Bias in CD4% had a similar trend with an overall relative mean bias of +25.6% and a larger bias for low CD4 stratum (+40.2%) than the higher CD4 stratum (+5.8%). Relative bias for CD4% in children was −6.8%. In terms of repeatability, PointCare NOW had a coefficient of variation of 11%. Using a threshold of 350cells/µl, only 47% of patients who qualified for antiretroviral therapy with reference CD4 testing, would have been eligible for treatment with PointCare NOW test results. This was 39% using a 200cells/µl threshold. Agreement with infant samples was higher, with 90% qualifying at a 25% eligibility threshold.ConclusionThe performance of the PointCare NOW instrument for absolute and percent CD4 enumeration was inadequate for HIV clinical management in adults. In children, the small sample size was not large enough to draw a conclusion. This study also highlights the importance of independent evaluation of new diagnostic technology platforms before deployment.

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Section: Discussionmentioning

confidence: 99%

Performance of the PointCare NOW System for CD4 Counting in HIV Patients Based on Five Independent Evaluations

et al. 2012

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“…Improving engagement in care is important as attrition of patients from HCT to care engagement is common and associated with adverse clinical outcomes [7, 36]. Cotrimoxazole use decreases morbidity and mortality [37], and clean water vessel ownership and use reduces diarrhea morbidity [38].…”

Section: Discussionmentioning

confidence: 99%

“…PLHIV who are pre-antiretroviral therapy (ART), either because they are not eligible for treatment, choose to defer ART, or are not receiving appropriate care, can still benefit from being linked and retained for CD4 and clinical monitoring [3]. They also benefit from utilization of preventive care interventions, including cotrimoxazole prophylaxis to prevent bacterial and malarial infections, safe water vessels to prevent diarrheal illnesses, and bednets to prevent malaria [4, 5]. Finally, decreasing risky sexual behaviors may reduce sexually transmitted infections and prevent onward HIV transmission [6].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Peer Support on Care Engagement and Preventive Care Intervention Utilization Among Pre-antiretroviral Therapy, HIV-Infected Adults in Rakai, Uganda: A Randomized Trial

Chang¹,

Nakigozi

Billioux

et al. 2015

AIDS Behav

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442 pre-ART, HIV-infected adults were randomized to peer support consisting of structured home visits to promote clinic attendance and preventive care intervention use or standard of care. At baseline, 62% reported previously visiting an HIV clinic, 45% reported taking cotrimoxazole prophylaxis, and 31% were “care-naïve” (no previous clinic visit and not on cotrimoxazole). After one year, intervention participants were more likely to report being in care (92% vs 84%; PRR 1.09, p=0.039), on cotrimoxazole (89% vs 81%; PRR 1.10, p=0.047), and safe water vessel adherence (23% vs 14%; PRR 1.64, p=0.024). The effect was observed only among care-naïve participants (n=139) with 83% intervention vs 53% controls reporting being in HIV care (PRR 1.47, p=0.006), 78% vs 58% on cotrimoxazole (PRR 1.35, p=0.04), and 20% vs 4% safe water vessel adherence (PRR 5.78, p=0.017). Peer support may be an effective intervention to facilitate pre-ART care compliance in this important population.

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“…Point-of-care CD4 devices are expected to play a significant role in the scaling up of HIV treatment and care, by reducing the infrastructure and operator skill requirements for testing thereby enabling the further decentralization of CD4 testing, and by reducing test result turn-around times and patient travel and other costs thereby improving pre-ART retention and ART initiation rates [19][20][21]. Miniaturization or less proven test methods that are not based on the established flow cytometry standard may compromise the performance of point-of-care CD4 technologies.…”

Section: Discussionmentioning

confidence: 99%

Correction: Performance of the PointCare NOW System for CD4 Counting in HIV Patients Based on Five Independent Evaluations

Bergeron¹,

Daneau²,

Ding³

et al. 2012

PLoS ONE

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Introduction: Point-of-care (POC) CD4 testing can improve access to treatment by enabling decentralization and reducing patient loss-to-follow-up. As new POC CD4 technologies become available, their performance should be assessed before widespread deployment. This study reports the findings of five independent evaluations of the PointCare NOW CD4 system.Materials/Methods: Evaluations were conducted in Southern Africa (Mozambique, South Africa) and North America (Canada, USA). 492 blood samples (55 from HIV-negative blood donors and 437 from HIV-infected patients, including 20 children aged between 12 and 59 months) were tested with both the PointCare NOW and reference flow cytometry instruments. Assessment of bias, precision and levels of clinical misclassification for absolute and percent CD4 count was conducted.Results: PointCare NOW significantly overestimated CD4 absolute counts with a mean relative bias of +35.0%. Bias was greater in samples with CD4 counts below #350cells/ml (+51.3%) than in the CD4 .350cells/ml stratum (15.1%). Bias in CD4% had a similar trend with an overall relative mean bias of +25.6% and a larger bias for low CD4 stratum (+40.2%) than the higher CD4 stratum (+5.8%). Relative bias for CD4% in children was 26.8%. In terms of repeatability, PointCare NOW had a coefficient of variation of 11%. Using a threshold of 350cells/ml, only 47% of patients who qualified for antiretroviral therapy with reference CD4 testing, would have been eligible for treatment with PointCare NOW test results. This was 39% using a 200cells/ml threshold. Agreement with infant samples was higher, with 90% qualifying at a 25% eligibility threshold. Conclusion:The performance of the PointCare NOW instrument for absolute and percent CD4 enumeration was inadequate for HIV clinical management in adults. In children, the small sample size was not large enough to draw a conclusion. This study also highlights the importance of independent evaluation of new diagnostic technology platforms before deployment.

show abstract

Interventions to reduce mortality in sub-Saharan Africa among HIV-infected adults not yet on antiretroviral therapy

Cited by 5 publications

References 57 publications

Performance of the PointCare NOW System for CD4 Counting in HIV Patients Based on Five Independent Evaluations

Performance of the PointCare NOW System for CD4 Counting in HIV Patients Based on Five Independent Evaluations

Effectiveness of Peer Support on Care Engagement and Preventive Care Intervention Utilization Among Pre-antiretroviral Therapy, HIV-Infected Adults in Rakai, Uganda: A Randomized Trial

Correction: Performance of the PointCare NOW System for CD4 Counting in HIV Patients Based on Five Independent Evaluations

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