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

Anti-HIV Agents / therapeutic use CD4 Lymphocyte Count Female HIV Infections / drug therapy Humans Point-of-Care Systems Pregnancy South Africa

Journal

Journal of global health
ISSN: 2047-2986
Titre abrégé: J Glob Health
Pays: Scotland
ID NLM: 101578780

Informations de publication

Date de publication:
2022
Historique:
entrez: 9 2 2022
pubmed: 10 2 2022
medline: 11 2 2022
Statut: epublish

Résumé

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 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. 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 ( 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. ISRCTN14220457.

Sections du résumé

BACKGROUND 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
METHODS 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 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 (
CONCLUSIONS 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 BACKGROUND
ISRCTN14220457.

Identifiants

DOI: 10.7189/jogh.12.04004 PMID: 35136596 PMC: PMC8818294
pubmed: 35136596
doi: 10.7189/jogh.12.04004
pii: jogh-12-04004
pmc: PMC8818294
doi:

Substances chimiques

Anti-HIV Agents 0

Types de publication

Journal Article Randomized Controlled Trial

Langues

eng

Sous-ensembles de citation

IM

Pagination

04004

Informations de copyright

Copyright © 2022 by the Journal of Global Health. All rights reserved.

Déclaration de conflit d'intérêts

Competing interests: The authors completed the ICMJE Unified Competing Interest Form (available upon request from the corresponding author), and declare no conflicts of interest.

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Auteurs

Elizabeth Spooner (E)

Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa.
South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa.

Tarylee Reddy (T)

South African Medical Research Council, Biostatistics Unit, Durban, South Africa.

Nobuhle Mchunu (N)

South African Medical Research Council, Biostatistics Unit, Durban, South Africa.
School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa.

Shabashini Reddy (S)

South African Medical Research Council, Durban, South Africa.

Brodie Daniels (B)

South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa.

Noluthando Ngomane (N)

Occupational Health, Durban, South Africa.

Nozipho Luthuli (N)

eThekwini Health Unit, Durban, South Africa.

Photini Kiepiela (P)

South African Medical Research Council, Durban, South Africa.

Anna Coutsoudis (A)

Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa.

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Classifications MeSH

Recherchemedicale.com › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Anti-infectieux › Antiviraux › Antirétroviraux › Agents antiVIH › Point-of-care CD4 testing: Differentiated care...
Recherchemedicale.com › Phénomènes physiologiques respiratoires et circulatoires › Phénomènes physiogiques du sang › Hémogramme › Numération des leucocytes › Numération des lymphocytes › Numération des lymphocytes CD4 › Point-of-care CD4 testing: Differentiated care...
Recherchemedicale.com › Maladies du système immunitaire › Déficits immunitaires › Infections à VIH › Point-of-care CD4 testing: Differentiated care...
Recherchemedicale.com › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Point-of-care CD4 testing: Differentiated care...
Recherchemedicale.com › Administration des services de santé › Gestion des soins aux patients › Systèmes automatisés lit malade › Point-of-care CD4 testing: Differentiated care...
Recherchemedicale.com › Phénomènes physiologiques des appareils urinaire et reproducteur › Phénomènes physiologiques de la reproduction › Reproduction › Grossesse › Point-of-care CD4 testing: Differentiated care...
Recherchemedicale.com › Régions géographiques › Afrique › Afrique subsaharienne › Afrique australe › République d'Afrique du Sud › Point-of-care CD4 testing: Differentiated care...