Providing Immediate CD4 Count Results at HIV Testing Improves ART Initiation

Faal, Mamsallah; Naidoo, Nicolette; Glencross, Deborah K.; Venter, François; Osih, Regina

doi:10.1097/qai.0b013e3182303921

Cited by 104 publications

(102 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…42,43 Studies of POC CD4 count tests have demonstrated good agreement with lab-based testing, 44–49 and two studies have demonstrated accelerated time to antiretroviral therapy initiation and a higher rate of people initiating antiretroviral therapy. 50,51 Novel POC tests for pulmonary tuberculosis have shown promising sensitivity for detecting disease, 52–54 and Xpert MTB/RIF testing accelerated time to treatment for smear-negative tuberculosis. 55 A POC test for Plasmodium falciparum malaria demonstrated good agreement with thick smear microscopy, 56,57 while reducing overdiagnosis of malaria among children presenting with fevers.…”

Section: Studies Of Point-of-care Tests In Resource-limited Settingsmentioning

confidence: 99%

Diagnostic point-of-care tests in resource-limited settings

Drain

Hyle

Noubary

et al. 2014

The Lancet Infectious Diseases

567

461

View full text Add to dashboard Cite

Diagnostic point-of-care (POC) testing is intended to minimize the time to obtain a test result, thereby allowing clinicians and patients to make an expeditious clinical decision. As POC tests expand into resource-limited settings (RLS), the benefits must outweigh the costs. To optimize POC testing in RLS, diagnostic POC tests need rigorous evaluations focused on relevant clinical outcomes and operational costs, which differ from evaluations of conventional diagnostic tests. Here, we reviewed published studies on POC testing in RLS, and found no clearly defined metric for the clinical utility of POC testing. Therefore, we propose a framework for evaluating POC tests, and suggest and define the term “test efficacy” to describe a diagnostic test’s capacity to support a clinical decision within its operational context. We also proposed revised criteria for an ideal diagnostic POC test in resource-limited settings. Through systematic evaluations, comparisons between centralized diagnostic testing and novel POC technologies can be more formalized, and health officials can better determine which POC technologies represent valuable additions to their clinical programs.

show abstract

Section: Studies Of Point-of-care Tests In Resource-limited Settingsmentioning

confidence: 99%

Diagnostic point-of-care tests in resource-limited settings

Drain

Hyle

Noubary

et al. 2014

The Lancet Infectious Diseases

567

461

View full text Add to dashboard Cite

show abstract

“…The type of HIV test used for the study population was not specified in one study (38). Although two studies reported on the impact of POC diagnostics on HIV-infected women, the maternal status of these women was not reported and the impact of POC diagnostics on maternal outcomes could not be determined (39, 40). …”

Section: Resultsmentioning

confidence: 99%

“…CD4 count testing is specifically aimed at improving the health outcomes of HIV infected patients by enabling the determination of the clinical staging of the appropriate ART regime (39). The WHO B+ approach advocates for all pregnant and breastfeeding woman who test HIV-positive to be initiated on the lifelong antiretroviral therapy (ART), regardless of CD4 count or clinical staging (52).…”

Section: Discussionmentioning

confidence: 99%

“…Elevated HIV viral load (>1,000 IU/mL) can put infants at risk of HIV transmission during delivery and for other T-cell related abnormalities (54). Viral load and CD4 count tests have been demonstrated to reduce pre-treatment loss to follow-up and increasing ART initiation rates for HIV-infected patients in settings with limited laboratory infrastructure (39, 55–57). Therefore, a comparative study on determining the impact of CD4 count and viral load POC tests on determination of ART efficacy and maternal and child outcomes is recommended.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Effect of Point-of-Care Diagnostics on Maternal Outcomes in Human Immunodeficiency Virus–Infected Women

et al. 2017

View full text Add to dashboard Cite

Introduction The World Health Organization advocates for increased accessibility of HIV-related point-of-care (POC) diagnostics in settings that lack laboratory infrastructure. The aim of this study is to assess the impact of POC diagnostics on maternal health outcomes in HIV-infected women. Methods A systematic literature review used multiple data sources as follows: Cochrane Infectious Disease Group Specialized Register; Cochrane Central Register of Control Trials, published in The Cochrane Library; PubMed; EBSCOhost and LILACS from January 2000 to October 2015. References of included studies were hand searched. Randomized controlled trials (RCTs) and observational studies examining health outcomes of HIV-infected women were eligible for inclusion in this review. The Cochrane Risk of Bias tool was used for bias assessment of the included studies. PRISMA guidelines were used for reporting. Results Of the 695 studies identified, six retrievable studies (five cross-sectional studies and one case control study) met the inclusion criteria and were included in this study. These studies examined a total of 167 HIV-infected women in different study settings. No studies reported evidence of CD4 count, viral load and TB, and the syphilis POC test impact on HIV-infected women was not found by this study. Included studies reported the impact of various HIV rapid tests across the following five maternal outcomes: timely receipt of results with pooled effect size (ES) = 1.00 (95% confidence interval [CI]: (0.98; 1.02); enabling partner testing, ES = 0.95 (0.85; 1.04); prevention of mother-to-child transmission of HIV, ES = 0.86 (0.79; 0.93); linkage to antiretroviral treatment (ART), ES = 0.76 (0.69; 0.84); and linkage to HIV care, ES = 0.50 (0.18; 0.82). No studies reported evidence of the impact of POC testing on maternal mortality or maternal and child morbidity of HIV-infected women. Conclusions The review provides an international overview of the impact of HIV POC diagnostics on maternal outcomes in HIV-infected women, showing the evidence that the HIV POC test is significantly associated with decreased mother-to-child transmission of HIV and increased linkage to ART and HIV care for HIV-infected women. It also revealed a gap in the literature aimed at assessing the impact of POC diagnostics on maternal morbidity and mortality in HIV-infected women.

show abstract

“…Prompt availability of CD4 test results has been demonstrated to increase ART initiation and retention of patients in care [26,27].…”

Section: Technologies For Disease Staging and Treatment Monitoring CDmentioning

confidence: 99%

HIV point-of-care diagnostics: meeting the special needs of sub-Saharan Africa

Aleku

Adoga

Agwale³

2014

J Infect Dev Ctries

View full text Add to dashboard Cite

Sub-Saharan Africa, accounting for 70% of the 35 million people living with HIV worldwide, obviously carries the heaviest burden of the HIV epidemic. Moreover, the region's poor health system occasioned by limited resources and inadequate skilled clinical personnel usually makes decentralization of HIV care difficult. Therefore, quality diagnostics that are easy to use, inexpensive, and amenable for use at point of care (POC) are a dire necessity. Clearly, such diagnostics will significantly lessen the pressure on the existing over-stretched centralized HIV laboratory services. Thankfully, some POC diagnostics are already being validated, while others are in the pipeline. As POC test kits emerge, implementation hurdles should be envisaged and planned for. This review examines emerging HIV diagnostic platforms, HIV POC product pipelines, gaps, perceived POC implementation challenges, and general recommendations for quality care.

show abstract

Providing Immediate CD4 Count Results at HIV Testing Improves ART Initiation

Abstract: Receipt of a CD4 count at the time of HIV testing increases ART initiation rates. Point-of-care diagnostics can be used to improve retention, but losses to pre-ART care remain high.

Cited by 104 publications

References 13 publications

Diagnostic point-of-care tests in resource-limited settings

Diagnostic point-of-care tests in resource-limited settings

Effect of Point-of-Care Diagnostics on Maternal Outcomes in Human Immunodeficiency Virus–Infected Women

HIV point-of-care diagnostics: meeting the special needs of sub-Saharan Africa

Contact Info

Product

Resources

About