Malawi Medical Journal
College of Medicine, University of Malawi and Medical Association of Malawi
Vol. 24, No. 2, 2012, pp. 25-28
Bioline Code: mm12008
Full paper language: English
Document type: Research Article
Document available free of charge
Malawi Medical Journal, Vol. 24, No. 2, 2012, pp. 25-28
© Copyright 2012 - Malawi Medical Journal
CD4 testing at clinics to assess eligibility for Antiretroviral therapy|
Lumala, Rumours; van den Akker, Thomas; Metcalf, Carol Ann; Diggle, Emma; Zamadenga, Bote; Mbewa, Kingsley & Akkeson, Ann
In 2011, the Ministry of Health raised the CD4 threshold for
antiretroviral therapy (ART) eligibility from <250 cells/μl and
<350 cells/μl, but at the same time only 8.8% of facilities in Malawi
with HIV services provided CD4 testing. We conducted a record
review at 10 rural clinics in Thyolo District to assess the impact of
introducing CD4 testing on identifying patients eligible for ART.
We abstracted CD4 counts of all ART-naïve, HIV-infected patients
with WHO clinical stages 1 and 2 and an initial CD4 test between
May 2008 and June 2009. At four clinics, we also abstracted CD4
counts of patients not initially eligible for ART who were retested
before April 2010.
Of 1,113 patients tested, the initial CD4 was “≤250 cells/μl” and
“≤350 cells/μl” in 534 (48.0%). Of 203 patients with follow-up
results, the most recent CD4 was ≤250 cells/μl in 34 (24.5%), and
≤350 cells/μl in 64 (46.0%).
CD4 testing in rural clinics is feasible and identifies many patients
eligible for ART who would not be identified without CD4 testing.
CD4 testing needs to be scaled-up to identify patients eligible for
ART. ART services need to be scaled-up concurrently to meet the
resulting increased demand.
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