Background CD4 cell count measurement remains an important diagnostic tool for HIV care in developing countries. Insufficient laboratory capacity in rural Sub-Saharan Africa is frequently mentioned but data on the impact at an individual patient level are lacking. Urban-rural discrepancies in CD4 testing have not been quantified to date. Such evidence is crucial for public health planning and to justify new yet more expensive diagnostic procedures that could circumvent access constraints in rural areas. Objective To compare CD4 testing among rural and urban HIV patients during the first year of treatment. Methods Records from 2,145 HIV positive adult patients from a Médecins sans Frontières (Doctors without Borders) HIV project in Beitbridge, Zimbabwe, during 2011 and 2012 were used for a retrospective cohort analysis. Covariate-adjusted risk ratios were calculated to estimate the effects of area of residence on CD4 testing at treatment initiation, six and 12 months among rural and urban patients. Findings While the proportion of HIV patients returning for medical consultations at six and 12 months decreased at a similar rate in both patient groups, CD4 testing during consultations dropped to 21% and 8% for urban, and 2% and 1% for rural patients at six and 12 months, respectively. Risk ratios for missing CD4 testing were 0.8 (95% CI 0.7-0.9), 9.2 (95% CI 5.5-15.3), and 7.6 (95% 3.7-17.1) comparing rural versus urban patients at treatment initiation, six and 12 months, respectively. Conclusions CD4 testing was low overall, and particularly poor in rural patients. Difficulties with specimen transportation were probably a major factor underlying this difference and requires new diagnostic approaches. Our findings point to severe health system constraints in providing CD4 testing overall that need to be addressed if effective monitoring of HIV patients is to be achieved, whether by alternative CD4 diagnostics or newly-recommended routine viral load testing.
Operational Centre Barcelona, Médecins sans Frontières/Doctors without Borders, Barcelona, Spain;Operational Research Unit Luxembourg, Médecins sans Frontières/Doctors without Borders, Luxembourg, Luxembourg;Operational Centre Barcelona, Médecins sans Frontières/Doctors without Borders, Barcelona, Spain;Department of Field Epidemiology and Training, Epicentre, Paris, France;Laboratory Department, Beitbridge District Hospital, Ministry of Health and Child Welfare, Beitbridge, Zimbabwe;Zimbabwe Mission, Médecins sans Frontières/Doctors without Borders, Harare, Zimbabwe;Beitbridge Project, Médecins sans Frontières/Doctors without Borders, Beitbridge, Zimbabwe;Beitbridge Project, Médecins sans Frontières/Doctors without Borders, Beitbridge, Zimbabwe;Centre for Operational Research, South-East Asia Regional Office, International Union against Tuberculosis and Lung Disease, New Delhi, India;Operational Research Unit Luxembourg, Médecins sans Frontières/Doctors without Borders, Luxembourg, Luxembourg;Operational Research Unit Luxembourg, Médecins sans Frontières/Doctors without Borders, Luxembourg, Luxembourg;Operational Research Unit Luxembourg, Médecins sans Frontières/Doctors without Borders, Luxembourg, Luxembourg
Recommended Citation:
Florian Vogt,Katie Tayler-Smith,Andrea Bernasconi,et al. Access to CD4 Testing for Rural HIV Patients: Findings from a Cohort Study in Zimbabwe[J]. PLOS ONE,2015-01-01,10(6)