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Point-of-Care CD4 Counting Cuts Loss of Follow-Up in HIV

Point-of-care CD4 testing decreases staging time, reduces patients lost before HIV treatment

MONDAY, Sept. 26 (HealthDay News) -- Rapid immunological staging by point-of-care counting of CD4 cells in patients with HIV reduces loss to follow-up before initiating antiretroviral therapy, according to a study published online Sept. 26 in The Lancet.

Ilesh V. Jani, M.D., from the Instituto Nacional da Saúde in Maputo, Mozambique, and colleagues investigated whether the use of point-of-care counting of CD4 cells for immunological staging reduces loss to follow-up before initiating antiretroviral therapy in HIV-positive patients in Mozambique. Data were collected on enrollment into HIV management and initiation of antiretroviral therapy from patients from four clinics. Loss to follow-up after the introduction of point-of-care CD4 testing, and the duration of each preparatory step were compared with baseline data.

The investigators found that the proportion of patients lost to follow-up before completion of CD4 staging reduced from 57 to 21 percent (adjusted odds ratio [OR], 0.2), after the introduction of point-of-care counting of CD4 cells. The total loss to follow-up prior to start of antiretroviral treatment decreased from 64 to 33 percent (OR, 0.27), while the proportion of participants starting antiretroviral therapy increased from 12 to 22 percent (OR, 2.05). The median time taken to complete CD4 staging decreased from 32 to three days, and was primarily responsible for the reduction in the median time from enrollment to antiretroviral therapy from 48 to 20 days. There was no significant change in loss to follow-up between staging and antiretroviral therapy initiation.

"Point-of-care CD4 testing enabled clinics to stage patients rapidly on-site after enrollment, which reduced opportunities for pretreatment loss to follow-up," the authors write.

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