Proportions of CD4 test results indicating advanced HIV disease remain consistently high at primary health care facilities across four high HIV burden countries


Autoři: Katherine Lamp aff001;  Seth McGovern aff001;  Youyi Fong aff002;  Charles Diko Atem aff003;  Jean Bosco Elat Nfetam aff004;  Divine Nzuobontane aff003;  Timothy Bollinger aff005;  Ilesh Jani aff006;  Nadia Sitoe aff006;  Charles Kiyaga aff007;  George Senyama aff008;  Phibeon M. Mangwendeza aff009;  Sekesai Mtapuri-Zinyowera aff010;  Naoko Doi aff001;  Trevor Peter aff001;  Jilian A. Sacks aff001;  Lara Vojnov aff001
Působiště autorů: Clinton Health Access Initiative, Boston, MA, United States of America aff001;  Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America aff002;  Clinton Health Access Initiative, Yaoundé, Cameroon aff003;  National AIDS Control Committee, Yaoundé, Cameroon aff004;  Clinton Health Access Initiative, Maputo, Mozambique aff005;  Instituto Nacional de Saúde, Maputo, Mozambique aff006;  Central Public Health Laboratory, Kampala, Uganda aff007;  Clinton Health Access Initiative, Kampala, Uganda aff008;  Clinton Health Access Initiative, Harare, Zimbabwe aff009;  Ministry of Health and Child Care, Harare, Zimbabwe aff010
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
prolekare.web.journal.doi_sk: 10.1371/journal.pone.0226987

Souhrn

Background

Globally, nearly 22 million HIV-infected patients are currently accessing antiretroviral treatment; however, almost one million people living with HIV died of AIDS-related illnesses in 2018. Advanced HIV disease remains a significant issue to curb HIV-related mortality.

Methods

We analyzed 864,389 CD4 testing records collected by 1,016 Alere Pima Analyzers implemented at a variety of facilities, including peripheral facilities, between January 2012 and December 2016 across four countries in sub-Saharan Africa. Routinely collected data and programmatic records were used to analyze the median CD4 counts and proportions of patients with advanced HIV disease by country, facility type, and year.

Results

Median CD4 counts were between 409–444 cells/ul each year since 2012 with a median in 2016 of 444 cells/ul (n = 319,829). The proportion of test results returning CD4 counts above 500 cells/ul has increased slowly each year with 41.8% (95% CI: 41.6–41.9%) of tests having a CD4 count above 500 cells/ul in 2016. Median CD4 counts were similar across facility types. The proportion of test results indicating advanced HIV disease has remained fairly consistent: 19.4% (95% CI: 18.8–20.1%) in 2012 compared to 16.1% (95% CI: 16.0–16.3%) in 2016. The proportion of test results indicating advanced HIV disease annually ranged from 14.5% in Uganda to 29.8% in Cameroon. 6.9% (95% CI: 6.8–7.0%) of test results showed very advanced HIV disease (CD4<100 cells/ul) in 2016.

Conclusions

The proportion of CD4 test results indicating advanced disease was relatively high and consistent across four high HIV burden countries.

Klíčová slova:

Cameroon – Health care facilities – HIV – HIV diagnosis and management – Morbidity – Mozambique – Viral load – Zimbabwe


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