POC CD4 Testing Improves Linkage to HIV Care and Timeliness of ART Initiation in a Public Health Approach: A Systematic Review and Meta-Analysis

CD4 cell count is an important test in HIV programs for baseline risk assessment, monitoring of ART where viral load is not available, and, in many settings, antiretroviral therapy (ART) initiation decisions. However, access to CD4 testing is limited, in part due to the centralized conventional labo...

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Bibliographic Details
Published in:PloS one 2016-05, Vol.11 (5), p.e0155256-e0155256
Main Authors: Vojnov, Lara, Markby, Jessica, Boeke, Caroline, Harris, Lindsay, Ford, Nathan, Peter, Trevor
Format: Article
Language:English
Subjects:
Acquired immune deficiency syndrome
Adolescent
Adult
AIDS
Analysis
Antiretroviral agents
Antiretroviral drugs
Antiretroviral therapy
Antiretroviral Therapy, Highly Active - economics
Biology and Life Sciences
CD4 antigen
CD4 Lymphocyte Count - economics
CD4 Lymphocyte Count - methods
Child
Confidence intervals
Cost-Benefit Analysis
Diagnosis
Drug therapy
Health risks
Highly active antiretroviral therapy
HIV
HIV infections
HIV Infections - drug therapy
HIV Infections - economics
HIV tests
Human immunodeficiency virus
Humans
Laboratories
Life expectancy
Life span
Literature reviews
Medical diagnosis
Medicine and health sciences
Meta-analysis
Methods
Odds Ratio
Patient Acceptance of Health Care
People and places
Point-of-Care Systems - economics
Pregnancy
Public Health
Research and Analysis Methods
Retention
Reviews
Risk assessment
Social Sciences
Studies
Systematic review
Time Factors
Young Adult
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Summary:CD4 cell count is an important test in HIV programs for baseline risk assessment, monitoring of ART where viral load is not available, and, in many settings, antiretroviral therapy (ART) initiation decisions. However, access to CD4 testing is limited, in part due to the centralized conventional laboratory network. Point of care (POC) CD4 testing has the potential to address some of the challenges of centralized CD4 testing and delays in delivery of timely testing and ART initiation. We conducted a systematic review and meta-analysis to identify the extent to which POC improves linkages to HIV care and timeliness of ART initiation. We searched two databases and four conference sites between January 2005 and April 2015 for studies reporting test turnaround times, proportion of results returned, and retention associated with the use of point-of-care CD4. Random effects models were used to estimate pooled risk ratios, pooled proportions, and 95% confidence intervals. We identified 30 eligible studies, most of which were completed in Africa. Test turnaround times were reduced with the use of POC CD4. The time from HIV diagnosis to CD4 test was reduced from 10.5 days with conventional laboratory-based testing to 0.1 days with POC CD4 testing. Retention along several steps of the treatment initiation cascade was significantly higher with POC CD4 testing, notably from HIV testing to CD4 testing, receipt of results, and pre-CD4 test retention (all p
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0155256