ArticlePloS one2015
Access to CD4 Testing for Rural HIV Patients: Findings from a Cohort Study in Zimbabwe.
Article in PloS one, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
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Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Feasibility of antiretroviral treatment monitoring in the era of decentralized HIV care: a systematic review.AIDS research and therapy · 2017Pooled it
- Determinants of CD4 count recovery among severely immunosuppressed HIV patients initiated on antiretroviral therapy: a prospective cohort study in KwaZulu-Natal, South Africa.Frontiers in public health · 2026Article
- Examining and classifying reasons for missing viral loads among adults living with HIV: An extended outcome investigation and ascertainment approach in Western Kenya.PLOS global public health · 2025Article
- Empowering adolescents living with perinatally-acquired HIV: tailored CD4+ count assessment for optimized care, the EDCTP READY-study.Frontiers in medicine · 2024Article
- The Shinyanga Patient: A Patient's Journey through HIV Treatment Cascade in Rural Tanzania.International journal of environmental research and public health · 2021Article
- Qualitative assessment of South African healthcare worker perspectives on an instrument-free rapid CD4 test.BMC health services research · 2019Article
- Community health worker support to improve HIV treatment outcomes for older children and adolescents in Zimbabwe: a process evaluation of the ZENITH trial.Implementation science : IS · 2018Article
- Assessing linkage to and retention in care among HIV patients in Uganda and identifying opportunities for health systems strengthening: a descriptive study.BMC infectious diseases · 2018Article
- Clinical risk factors for in-hospital mortality in older adults with HIV infection: findings from a South African hospital administrative dataset.The Pan African medical journal · 2017Article
- Scale-up of Routine Viral Load Testing in Resource-Poor Settings: Current and Future Implementation Challenges.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2016Article
- Factors associated with access to HIV care services in eastern Uganda: the Kumi home based HIV counseling and testing program experience.BMC family practice · 2015Article
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Authors and funding
11 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCD4 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.
objectiveTo compare CD4 testing among rural and urban HIV patients during the first year of treatment.
methodsRecords 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.
findingsWhile 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.
conclusionsCD4 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.
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