ArticleGlobal public health2021
Influence of evolving HIV treatment guidance on CD4 counts and viral load monitoring: A mixed-methods study in three African countries.
Article in Global public health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
5 citing papers in PubMed, 34 citations in OpenAlex.
- Next-Day HIV Viral Load Test Result and Linkage to Care Among Persons Living With or at Risk of HIV: A Randomized Clinical Trial.JAMA network open · 2025Trial
- Predictive value of peripheral lymphocyte subsets in relation to opportunistic infections in people living with HIV/AIDS.BMC infectious diseases · 2026Article
- Challenges in Achieving Viral Suppression Among Adolescents and Young Adults Under a Dolutegravir-Based Regimen: Living with HIV in Gabon.Pathogens (Basel, Switzerland) · 2026Article
- Understanding Repeat Positive HIV Testing in South Africa Under Changing Treatment Guidelines.AIDS and behavior · 2022Article
- The Shinyanga Patient: A Patient's Journey through HIV Treatment Cascade in Rural Tanzania.International journal of environmental research and public health · 2021Article
Corrections and comments
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Authors and funding
12 authors at 6 institutions in 4 countries.
Funding
Abstract
Little is known about how CD4 and viral load testing have evolved following implementation of universal test and treat (UTT) in African settings. We reviewed World Health Organization (WHO) guidance from 2013 to 2018, and compared it against national HIV policies in Malawi, Tanzania and South Africa. Three surveys rounds were conducted in 2013, 2016 and 2017-2018 in 33 health facilities across the three settings to assess implementation of national policies on the use of biological markers. Qualitative interviews were conducted with 26 HIV policymakers or programme managers, 21 providers and 66 people living with HIV to explore understandings and experiences of these tests. Various factors influenced adoption and implementation of WHO guidance, including historical policies on CD4 counts, governance issues, supply chain challenges and funding mechanisms. Facility-level practices relating to the use of these tests often diverged from national policies. Patients and providers valued both tests, but did not always understand their roles. In addition to continued support for scaling-up viral load testing, renewed focus should be placed on the ongoing value of point-of-care CD4 tests in the UTT era, including its role in assessing disease progression and informing clinical management of cases to reduce HIV-related mortality.
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Registered trials
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