September 28, 2011
The proportion of HIV patients lost to follow-up before the initiation of antiretroviral (ARV) therapy "can exceed 50 percent in low-income settings, and is a challenge to the scale-up of treatment," according to the authors of a new study. This proportion, however, was dramatically reduced after the introduction of rapid CD4 test kits.
"Before the introduction of point-of-care CD4 tests, to obtain a CD4 result involved several steps, each with delays," wrote the authors from the Mozambique Instituto Nacional de Sáude and the Clinton Health Access Initiative. On average, the process took 10 days. Considering that many patients must walk long distances to reach a health care facility, each additional clinic visit is seen as a barrier to remaining in care.
After the introduction of CD4 rapid test kits, the proportion of patients lost to follow-up before completion of CD4 staging dropped from 57 percent to 21 percent. Total loss to follow-up before ARV treatment was started dropped from 64 percent to 33 percent. The proportion of enrolled patients who began ARV treatment grew from 12 percent to 22 percent, while the median time from enrollment to beginning treatment fell from 48 days to 20 days, chiefly because the median time to complete CD4 staging decreased from 32 days to 3 days.
"Point-of-care CD4 testing enabled clinics to stage patients rapidly onsite after enrollment, which reduced opportunities for pretreatment loss to follow-up," the authors concluded. "As a result, more patients were identified as eligible for and initiated [ARV] treatment. Point-of-care testing might therefore be an effective intervention to reduce pretreatment loss to follow-up."
The study, "Effect of Point-of-Care CD4 Cell Count Tests on Retention of Patients and Rates of Antiretroviral Therapy Initiation in Primary Health Clinics: An Observational Cohort Study," was published early online in the Lancet (2011; doi:10.1016/S0140-6736(11)61052-0).