Point-of-care diagnostic systems (Article)

Title:

PIMA Point of Care CD4 Cell Count Machines in remote maternal, newborn and child health (MNCH) settings: Lessons learnt from seven Districts in Zimbabwe.

S. Mtapuri-Zinyowera1, E. Chiyaka2, W. Mushayi3, G. Musuka3, V. Chikwasha4, T. Zinyowera5, S. Bhatasara4, T. Chevo4, N. Muparamoto4, A. Mushavi5, F. Naluyinda-Kitabire3

1National Microbiology Reference Laboratory, Laboratory, Harare, Zimbabwe, 2National University of Science and Technology, Bulawayo, Zimbabwe, 3UNICEF, Harare, Zimbabwe, 4University of Zimbabwe, Harare, Zimbabwe, 5Ministry of Health and Child Welfare, Harare, Zimbabwe

Background

Several evaluations have been published that compare CD4 point-of-care machines to conventional flow cytometry methods yet a few have been done focusing on how PIMA POC CD4 machines actually performs in clinical settings.

Methods

A cross-sectional survey was conducted on 35 MNCH sites with the POC machine and 10 without in 7 Districts in Zimbabwe. There were a total of 346 interviews done with national and subnational stakeholders involved in procurement, distribution and use of the POC machine, among them trained users of the PIMA POC CD4 count machines at health facilities and clients. Additionally, data was also abstracted from 207 patient records from 35 sites with the PIMA POC CD4 count machines and 10 other comparative sites without the PIMA POC CD4 count machines. 

Results

The median time taken to initiate clients on ART was substantially less, 15days (IQR-1-149) for sites with a PIMA POC machine as compared to 32.7 days (IQR-1-192) at sites with no PIMA POC machine. Additionally, in order to enhance quality of service delivery there is need for a clearer training strategy.

Conclusion

The PIMA POC technology has contributed to the improvement of service delivery at site level through provision of a timely CD4 cell count to pregnant mothers in order to assess eligibility to ART for their own health and prevention of mother to child transmission of HIV.

References

  1. Balakrishnan P, Shanmugham S, Iqbal HS, Solomon SS, Mohanakrishnan J, Mayer KH and Solomon S. Low-cost assays for monitoring HIV infected individuals in resource-limited settings. Indian J Med Res. 134: 823-834; 2011
  2. Manabe YC, Wang Y, Elbireer A, Auerbach B and Castelnuovo B. Evaluation of portable point-of-care CD4 counter with high sensitivity for detecting patients eligible for antiretroviral therapy. Plos one. 7(4):e34319; 2012.
  3. Jani VI, Sitoe NE, Alfai ER, Changa PL, Queredo JI, Rocha BM, Lehe JD and Peter TF. Effect of point-of-care CD4 cell count tests on retention of patients and rates of antiretroviral therapy initiation in primary health clinics: an observational cohort study. Lancet. (378):1572-79; 2011.

Posted by: Dr Sekesai Mtapuri-Zinyowera, Coordinator, National Microbiology Reference Laboratory, Zimbabwe (21-Jul-2013)
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