Point of Care CD4 Testing in National Household Surveys - Results and Quality Indicators from Eleven Population-Based HIV Impact Assessment (PHIA) Surveys.

Autor:	Birhanu S; Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA., Winterhalter FS; ICAP at Columbia University, New York, New York, USA., Stupp P; Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA., Cates M; Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA., Rottinghaus E; Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA., Yavo D; Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA., Wray-Gordon F; Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA., Lupoli K; Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA., Ndongmo CB; Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA., Longwe H; ICAP at Columbia University, New York, New York, USA., Reid GA; ICAP at Columbia University, New York, New York, USA., Metz M; ICAP at Columbia University, New York, New York, USA., Saito S; ICAP at Columbia University, New York, New York, USA., McCracken S; Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA., Brown K; Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA., Voetsch AC; Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA., Duong YT; ICAP at Columbia University, New York, New York, USA., Parekh BS; Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA., Patel HK; Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA.
Jazyk:	angličtina
Zdroj:	Microbiology spectrum [Microbiol Spectr] 2023 Jun 15; Vol. 11 (3), pp. e0314822. Date of Electronic Publication: 2023 Apr 18.
DOI:	10.1128/spectrum.03148-22
Abstrakt:	Population-based HIV Impact Assessments (PHIAs) are national household (HH) surveys that provide HIV diagnosis and CD4 testing with an immediate return of results. Accurate CD4 results improve HIV-positive participants' clinical care and inform the effectiveness of HIV programs. Here, we present CD4 results from the PHIA surveys that were conducted in 11 countries in sub-Saharan Africa between 2015 and 2018. All of the HIV-positive participants and 2 to 5% of the HIV-negative participants were offered Pima CD4 (Abbott, IL, USA) point-of-care (POC) tests. The quality of the CD4 test was ensured by conducting instrument verification, comprehensive training, quality control, a review of testing errors and an analysis of unweighted CD4 data by HIV status, age, gender, and antiretroviral (ARV) treatment status. Overall, CD4 testing was completed for 23,085 (99.5%) of the 23,209 HIV-positive and 7,329 (2.7%) of the 270,741 negative participants in 11 surveys. The instrument error rate was 11.3% (range, 4.4% to 15.7%). The median CD4 values among HIV-positive and HIV-negative participants (aged 15+) were 468 cells/mm 3 (interquartile range [IQR], 307 to 654) and 811 cells/mm 3 (IQR, 647 to 1,013), respectively. Among the HIV-positive participants (aged 15+), those with detectable ARVs had higher CD4 values (508 cells/mm 3 ) than those with undetectable ARVs (385.5 cells/mm 3 ). Among the HIV-positive participants (aged 15+), 11.4% (2,528/22,253) had a CD4 value of less than 200 cells/mm 3 , and approximately half of them (1,225/2,528 = 48.5%) had detectable ARVs, whereas 51.5% (1,303/2,528) had no detectable ARVs ( P < 0.0001). We successfully implemented high quality POC CD4 testing using Pima instruments. Our data come from nationally representative surveys in 11 countries and provide unique insights regarding the CD4 distribution among HIV-positive individuals as well as the baseline CD4 values among HIV-negative individuals. IMPORTANCE The manuscript describes CD4 levels among HIV-positive individuals and baseline CD4 levels among HIV-negative individuals from 11 sub-Saharan countries, thereby highlighting the importance of CD4 markers in the context of the HIV epidemic. Despite increased ARV access in each country, advanced HIV disease (CD4 < 200 cells/mm 3 ) persists among approximately 11% of HIV-positive individuals. Therefore, it is important that our findings are shared with the scientific community to assist with similar implementations of point-of-care testing and to conduct a review of HIV programmatic gaps. Competing Interests: The authors declare no conflict of interest.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu