Synthesizing evidence on point-of-care CD4 testing to inform World Health Organization Guidelines

Published June 19th, 2017

CD4 cell count is an important diagnostic test to manage HIV-positive patients in low- and middle-income countries. CD4 testing is used to prioritize patients for treatment in settings where treatment is not accessible to all, monitor patients on treatment where viral load testing is not available, and monitor and manage patients with advanced HIV disease and/or who are unstable on treatment. However, access to CD4 testing is limited, in part due to the challenges with centralized conventional laboratory networks. Point-of-care (POC) CD4 testing has the potential to address some of these challenges, including delays in delivery of timely test results and antiretroviral therapy (ART) initiation.

In conjunction with the World Health Organization (WHO), CHAI’s Laboratory Services Team (LST) and Applied Analytics Team (AAT) conducted a systematic literature review and meta-analysis to identify the extent to which POC testing improves linkages to HIV care and timeliness of treatment initiation. Through careful review of published and unpublished evidence on this topic and analysis, this review found that POC CD4 technologies reduced the time to testing and treatment initiation and increased the percentage of patients receiving test results and initiating treatment compared to conventional laboratory-based CD4 testing. Based on this analysis, the WHO concluded that POC CD4 can be a useful tool to perform CD4 testing and expedite result delivery.

These findings helped to inform the WHO Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection, which state that CD4 cell count testing at the point of care can be used to prioritize patients for urgent linkage to care and ART initiation. Read more about the study in this publication.