BACKGROUND: Loss to follow-up of HIV-positive patients before initiation of antiretroviral therapy can exceed 50% in low-income settings and is a challenge to the scale-up of treatment. We implemented point-of-care counting of CD4 cells in Mozambique and assessed the effect on loss to follow-up before immunological staging and treatment initiation. METHODS: In this observational cohort study, data for enrolment into HIV management and initiation of antiretroviral therapy were extracted retrospectively from patients' records at four primary health clinics providing HIV treatment and point-of-care CD4 services. Loss to follow-up and the duration of each preparatory step before treatment initiation were measured and compared with baseline data from before the introduction of point-of-care CD4 testing. FINDINGS: After the introduction of point-of-care CD4 the proportion of patients lost to follow-up before completion of CD4 staging dropped from 57% (278 of 492) to 21% (92 of 437) (adjusted odds ratio [OR] 0·2, 95% CI 0·15-0·27). Total loss to follow-up before initiation of antiretroviral treatment fell from 64% (314 of 492) to 33% (142 of 437) (OR 0·27, 95% CI 0·21-0·36) and the proportion of enrolled patients initiating antiretroviral therapy increased from 12% (57 of 492) to 22% (94 of 437) (OR 2·05, 95% CI 1·42-2·96). The median time from enrolment to antiretroviral therapy initiation reduced from 48 days to 20 days (p<0·0001), primarily because of a reduction in the median time taken to complete CD4 staging, which decreased from 32 days to 3 days (p<0·0001). Loss to follow-up between staging and antiretroviral therapy initiation did not change significantly (OR 0·84, 95% CI 0·49-1·45). INTERPRETATION: Point-of-care CD4 testing enabled clinics to stage patients rapidly on-site after enrolment, which reduced opportunities for pretreatment loss to follow-up. As a result, more patients were identified as eligible for and initiated antiretroviral treatment. Point-of-care testing might therefore be an effective intervention to reduce pretreatment loss to follow-up. FUNDING: Absolute Return for Kids and UNITAID.
BACKGROUND: Loss to follow-up of HIV-positive patients before initiation of antiretroviral therapy can exceed 50% in low-income settings and is a challenge to the scale-up of treatment. We implemented point-of-care counting of CD4 cells in Mozambique and assessed the effect on loss to follow-up before immunological staging and treatment initiation. METHODS: In this observational cohort study, data for enrolment into HIV management and initiation of antiretroviral therapy were extracted retrospectively from patients' records at four primary health clinics providing HIV treatment and point-of-care CD4 services. Loss to follow-up and the duration of each preparatory step before treatment initiation were measured and compared with baseline data from before the introduction of point-of-care CD4 testing. FINDINGS: After the introduction of point-of-care CD4 the proportion of patients lost to follow-up before completion of CD4 staging dropped from 57% (278 of 492) to 21% (92 of 437) (adjusted odds ratio [OR] 0·2, 95% CI 0·15-0·27). Total loss to follow-up before initiation of antiretroviral treatment fell from 64% (314 of 492) to 33% (142 of 437) (OR 0·27, 95% CI 0·21-0·36) and the proportion of enrolled patients initiating antiretroviral therapy increased from 12% (57 of 492) to 22% (94 of 437) (OR 2·05, 95% CI 1·42-2·96). The median time from enrolment to antiretroviral therapy initiation reduced from 48 days to 20 days (p<0·0001), primarily because of a reduction in the median time taken to complete CD4 staging, which decreased from 32 days to 3 days (p<0·0001). Loss to follow-up between staging and antiretroviral therapy initiation did not change significantly (OR 0·84, 95% CI 0·49-1·45). INTERPRETATION: Point-of-care CD4 testing enabled clinics to stage patients rapidly on-site after enrolment, which reduced opportunities for pretreatment loss to follow-up. As a result, more patients were identified as eligible for and initiated antiretroviral treatment. Point-of-care testing might therefore be an effective intervention to reduce pretreatment loss to follow-up. FUNDING: Absolute Return for Kids and UNITAID.
Authors: Ingrid V Bassett; Susan Regan; Hlengiwe Mbonambi; Jeffrey Blossom; Stacy Bogan; Benjamin Bearnot; Marion Robine; Rochelle P Walensky; Bright Mhlongo; Kenneth A Freedberg; Hilary Thulare; Elena Losina Journal: AIDS Behav Date: 2015-10
Authors: Larry W Chang; Gertrude Nakigozi; Veena G Billioux; Ronald H Gray; David Serwadda; Thomas C Quinn; Maria J Wawer; Robert C Bollinger; Steven J Reynolds Journal: AIDS Behav Date: 2015-10
Authors: Zunyou Wu; Zhenzhu Tang; Yurong Mao; Paul Van Veldhuisen; Walter Ling; David Liu; Zhiyong Shen; Roger Detels; Guanghua Lan; Lynda Erinoff; Robert Lindblad; Diane Gu; Houlin Tang; Lian Hu; Qiuying Zhu; Li Lu; Neal Oden; Albert L Hasson; Yan Zhao; Jennifer M McGoogan; Xianmin Ge; Nanci Zhang; Keming Rou; Jinhui Zhu; Hui Wei; Cynthia X Shi; Xia Jin; Jian Li; Julio S G Montaner Journal: Lancet HIV Date: 2017-08-31 Impact factor: 12.767
Authors: Monique Givens; Amanda Weaver; Sarah Bickman; Cathy Logan; Emilia V Noormahomed; Sam Patel; Robert T Schooley; Constance A Benson; Michael J Lochhead Journal: Cytometry B Clin Cytom Date: 2015-05-27 Impact factor: 3.058
Authors: Bharat S Parekh; Chin-Yih Ou; Peter N Fonjungo; Mireille B Kalou; Erin Rottinghaus; Adrian Puren; Heather Alexander; Mackenzie Hurlston Cox; John N Nkengasong Journal: Clin Microbiol Rev Date: 2018-11-28 Impact factor: 26.132
Authors: Larry W Chang; David Serwadda; Thomas C Quinn; Maria J Wawer; Ronald H Gray; Steven J Reynolds Journal: Lancet Infect Dis Date: 2013-01 Impact factor: 25.071
Authors: Emily P Hyle; Ilesh V Jani; Katherine L Rosettie; Robin Wood; Benjamin Osher; Stephen Resch; Pamela P Pei; Paolo Maggiore; Kenneth A Freedberg; Trevor Peter; Robert A Parker; Rochelle P Walensky Journal: AIDS Date: 2017-09-24 Impact factor: 4.177