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Randomized Controlled Trial
. 2014 Feb 1;65(2):e74-8.
doi: 10.1097/QAI.0b013e3182a20e74.

A novel community health worker tool outperforms WHO clinical staging for assessment of antiretroviral therapy eligibility in a resource-limited setting

Peter Macpherson  1 , David G Lalloo, Deus Thindwa, Emily L Webb, S Bertel Squire, Geoffrey A Chipungu, Nicola Desmond, Simon D Makombe, Miriam Taegtmeyer, Augustine T Choko, Elizabeth L Corbett
Affiliations
Randomized Controlled Trial

A novel community health worker tool outperforms WHO clinical staging for assessment of antiretroviral therapy eligibility in a resource-limited setting

Peter Macpherson et al. J Acquir Immune Defic Syndr. .

Abstract

The accuracy of a novel community health worker antiretroviral therapy eligibility assessment tool was examined in community members in Blantyre, Malawi. Nurses independently performed World Health Organization (WHO) staging and CD4 counts. One hundred ten (55.6%) of 198 HIV-positive participants had a CD4 count of <350 cells per cubic millimeter. The community health worker tool significantly outperformed WHO clinical staging in identifying CD4 count of <350 cells per cubic millimeter in terms of sensitivity (41% vs. 19%), positive predictive value (75% vs. 68%), negative predictive values (53% vs. 47%), and area under the receiver-operator curve (0.62 vs. 0.54; P = 0.017). Reliance on WHO staging is likely to result in missed and delayed antiretroviral therapy initiation.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

P.M., E.L.C., D.G.L., S.B.S., and S.D.M. designed the study. P.M., D.T., A.T.C., E.L.W., and E.L.C collected and analyzed data. G.A.C. performed the laboratory analysis. P.M., D.G.L., and E.L.C. wrote the first draft of the manuscript. All authors contributed to the final manuscript.

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