ArticleBMC global and public health2025
Monitoring for advanced disease in the universal test and treat era: trends in CD4 count testing in South Africa.
Article in BMC global and public health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Indirect Effects of HIV Differentiated Service Delivery Programmes on Quality of Clinic Care: A Retrospective Cohort Study of Clients Starting Antiretroviral Therapy.Journal of acquired immune deficiency syndromes (1999) · 2026Article
- Geostatistical point process modelling of HIV prevalence using disease progression and CD4 cell count dynamics.iScience · 2026Article
- Quality assessment of data for decentralised antiretroviral therapy referrals and laboratory results in the South African national electronic HIV management register TIER.Net.PLOS global public health · 2026Article
- "If your CD4 count lowers, that is when you are similar to a person that is non-existent" A qualitative exploration of perceptions around advanced HIV disease in South Africa.BMC public health · 2025Article
- Monitoring for advanced disease in the universal test and treat era: trends in CD4 count testing in South Africa.BMC global and public health · 2025Article
- Characteristics and six-month viral load suppression of clients presenting with advanced HIV disease in South Africa.PLOS global public health · 2025Article
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Authors and funding
9 authors.
Funding
Abstract
backgroundUnder South Africa's Universal Test and Treat (UTT) policy, CD4 counts are no longer required to determine HIV treatment eligibility. However, CD4 count at presentation remains an important marker of disease progression. We assessed whether CD4 testing declined in the UTT era and, if so, by how much.
methodsWe analysed CD4 count data from the National Health Laboratory Service (NHLS) National HIV Cohort and TIER.Net database for individuals in HIV care across five South African provinces. "First CD4 count" was defined as the first CD4 test recorded for each patient. In TIER.Net, "date of presentation" was the earliest date of HIV testing, CD4 measurement, or clinic visit. Trends in first CD4 testing volumes (2004-2018) were analyzed, with interrupted time-series analyses assessing the impact of UTT (September 2016).
resultsData included 5,274,218 (NHLS) and 2,265,557 (TIER.Net) individuals with a first CD4 count. In NHLS, first CD4 counts increased from 47,604 in 2004 to 383,705 in 2010 and then declined. Lower volumes were recorded in TIER.Net. Adjusting for prior trends, first CD4 counts increased slightly after UTT, by 32 individuals/day in NHLS (95% CI: - 6 to 61) and 88 individuals/day in TIER.Net (95% CI: 30 to 148). Among TIER.Net patients, the percentage with a CD4 count decreased by 4.3% (95% CI: - 5.2 to - 3.0%).
conclusionsWe found no major decline in CD4 testing at presentation following UTT, contrasting findings from resource-constrained settings with greater reliance on external donors.
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