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Point-Of-Care CD4 Improves Patient Retention and Time-To-Initiation for

ART in MozambiqueIlesh Jani1, Nádia Sitoe 1, Eunice Alfai1,

Patrina Chongo1, Jonathan Lehe2, Beatriz Rocha2, Jorge Quevedo2 and Trevor Peter2

1 Instituto Nacional de Saúde, Mozambique2 Clinton Health Access Initiative

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Background• The scaling-up of ART is facing problems due to

delays in ART initiation and high patient loss-to-follow-up (LTFU)

• These challenges are partly due to limitations in access to CD4 testing

• Emerging Point Of Care (POC) technologies for CD4 counting could improve patient outcomes by:

Increasing access to CD4 testingReducing LTFU after HIV diagnosisShortening CD4 test turn-around timeReducing total time from enrollment to

initiation of ART in eligible patients

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• Alere PIMATM was evaluated in Mozambique and showed good agreement with the FACSCaliburTM (Bias=-50.6 cells/µL; see Jani et al. abstract THAB0104)

Objective

• The main objective is to measure the impact of POC CD4 counting (and haemoglobin determination) implementation in primary health care settings

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Methodology

• Pilot implementation of POC CD4 (and haemoglobin) at 7 sites

• Chart review for data collection performed at baseline and post-implementation (data presented for Matola Health Centre only – POC installed in the lab)

• Parameters measured included:– Complexity of patient process

flow– Total time for enrollment to

ART initiation– Access to initial CD4 result

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The complexity of patients flow decreased after implementation of

POC CD4

1. HIV diagnosis2. Patient enrollment3. CD4 requisition4. Blood drawn5. CD4 test

performed6. CD4 result received7. CD4 result given to

patient8. Clinical

consultation9. ART initiation

1. HIV diagnosis2. Patient enrollment3. CD4 requisition, CD4

test performed, CD4 result given to patient

4. Clinical consultation5. ART initiation

Before POC CD4 After POC CD4

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44 days

89 days

21 days

N=849

N=125

N=140

Total time to ART initiation was reduced from 44 days to 21 days

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20%

40%

60%

80%

100%

Before POC CD4 Pilot After POC CD4 Pilot

Per

cent

age

Patient access to initial CD4 result improved from 57% to 93%

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The improvement of access to CD4 result in not uniform across

all clinics

Factors Limiting Universal Access To CD4 Testing:

•Limited HR capacity•Patient overflow•Clinic workflow still in process of adapting

93%

4% 3%Matola

CD4 Result on time

No CD4 result

Transferred with outdated CD4 result

76%

24%

Machava

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Conclusions

• The Introduction of POC CD4 in Matola ART clinic resulted in:

− Reduction in complexity of patients’ flow− Decrease in total time to ART initiation (from 44

days to 21 days)− Improvement in access to initial CD4 result (from

57% to 93%)

• The initial impact of the introduction of POC technologies may not be uniform across all sites

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Next steps

– Measure the impact of POC CD4 in other ART clinics involved in the pilot

– Measure the impact on patient important outcomes after 6 and 12 months

– Measure impact on the health system– Perform cost-efficiency analysis– Investigate needs (e.g. human resources) for

large-scale implementation of POC technologies

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Acknowledgements

• Patients• Provincial Health Directorates (Maputo City,

Maputo Province, Sofala, Niassa)• Staff at Pilot Sites• INS Staff• CHAI Staff• ARK• UNITAID

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Northern shore of Lake Niassa (Lake Malawi) - This mobile unit brings CD4/Heam