Assessment of laboratory test utilization for HIV/AIDS care in urban ART clinics of Lilongwe, Malawi|
Palchaudhuri, Sonali; Tweya, Hannock & Hosseinipour, Mina
The 2011 Malawi HIV guidelines promote CD4 monitoring
for pre-ART assessment and considering HIVRNA
monitoring for ART response assessment, while some clinics
used CD4 for both. We assessed clinical ordering practices
as compared to guidelines, and determined whether the
samples were successfully and promptly processed.
We conducted a retrospective review of all patients seen in
from August 2010 through July 2011,, in two urban HIV-care
clinics that utilized 6-monthly CD4 monitoring regardless
of ART status. We calculated the percentage of patients
on whom clinicians ordered CD4 or HIVRNA analysis.
For all samples sent, we determined rates of successful labprocessing,
and mean time to returned results.
Of 20581 patients seen, 8029 (39%) had at least one blood
draw for CD4 count. Among pre-ART patients, 2668/2844
(93.8%) had CD4 counts performed for eligibility. Of all CD4
samples sent, 8082/9207 (89%) samples were successfully
processed. Of those, mean time to processing was 1.6 days
(s.d 1.5) but mean time to results being available to clinician
was 9.3 days (s.d. 3.7). Regarding HIVRNA, 172 patients of
17737 on ART had a blood draw and only 118/213 (55%)
samples were successfully processed. Mean processing time
was 39.5 days (s.d. 21.7); mean time to results being available
to clinician was 43.1 days (s.d. 25.1). During the one-year
evaluated, there were multiple lapses in processing HIVRNA
samples for up to 2 months.
Clinicians underutilize CD4 and HIVRNA as monitoring
tools in HIV care. Laboratory processing failures and
turnaround times are unacceptably high for viral load
analysis. Alternative strategies need to be considered in order
to meet laboratory monitoring needs.