CD4 count testing as an example of POC Testing
a) Expand timely access to CD4 testing – Most of the health facilities providing ART in Cameroon had conventional CD4 diagnostic machines by mid-2011 and only these facilities can provide same day results; even with specimen referral networks, this limits patient access to CD4 testing. Conventional CD4 testing through specimen referral requires patient’s return to the facility to receive their results; however, with POC CD4 testing, patients can receive results on-site the same day they are tested.
b) Increase timely initiation on ART – POC CD4 testing help identify HIV/AIDS patients in WHO clinical stages 1 and 2 who are eligible for ART. Access to a CD4 count is important to start ART early, i.e. before the patient is too sick. Earlier or so-called ‘‘upstream’’ ART access may reduce individual morbidity and mortality, mother-to-child transmission of HIV and the incidence of HIV-associated tuberculosis (TB). A recent study (Severe et al. 2010) showed a 75% reduction in mortality and a 50% reduction in TB incidence associated with starting ART earlier. With POC testing, clinicians can immediately use test results to drive treatment decisions.
c) Provide the correct PMTCT regimen in a timely manner – With a CD4 count, PMTCT sites will be able to implement early initiation (at 14 weeks) with the appropriate WHO PMTCT regimen. With full implementation of PMTCT option B+, it will serve as an important baseline test.
d) Establish a baseline for patients beginning treatment – Patients need a CD4 test as they are initiating antiretroviral therapy to help monitor their response to treatment and drug adherence.
e) Simplify ART at the primary care level and de-centralize care – POC CD4 testing will reduce dependence on clinical acumen and the need for WHO staging. This will increase the decision-making power and numbers initiated on ART by nurses and other health care workers and will reduce the loss due to follow-up.
f) Reduce patient loss-to-follow-up – Reduced visits and waiting time for patients before they can initiate ART can help reduce patient loss (Jani et al 2011) and reduce the patient burden of time and travel to receive care.