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. 2020 Jan 7;15(1):e0226987.
doi: 10.1371/journal.pone.0226987. eCollection 2020.

Proportions of CD4 test results indicating advanced HIV disease remain consistently high at primary health care facilities across four high HIV burden countries

Katherine Lamp  1 , Seth McGovern  1 , Youyi Fong  2 , Charles Diko Atem  3 , Jean Bosco Elat Nfetam  4 , Divine Nzuobontane  3 , Timothy Bollinger  5 , Ilesh Jani  6 , Nadia Sitoe  6 , Charles Kiyaga  7 , George Senyama  8 , Phibeon M Mangwendeza  9 , Sekesai Mtapuri-Zinyowera  10 , Naoko Doi  1 , Trevor Peter  1 , Jilian A Sacks  1 , Lara Vojnov  1
Affiliations

Proportions of CD4 test results indicating advanced HIV disease remain consistently high at primary health care facilities across four high HIV burden countries

Katherine Lamp et al. PLoS One. .

Abstract

Background: Globally, nearly 22 million HIV-infected patients are currently accessing antiretroviral treatment; however, almost one million people living with HIV died of AIDS-related illnesses in 2018. Advanced HIV disease remains a significant issue to curb HIV-related mortality.

Methods: We analyzed 864,389 CD4 testing records collected by 1,016 Alere Pima Analyzers implemented at a variety of facilities, including peripheral facilities, between January 2012 and December 2016 across four countries in sub-Saharan Africa. Routinely collected data and programmatic records were used to analyze the median CD4 counts and proportions of patients with advanced HIV disease by country, facility type, and year.

Results: Median CD4 counts were between 409-444 cells/ul each year since 2012 with a median in 2016 of 444 cells/ul (n = 319,829). The proportion of test results returning CD4 counts above 500 cells/ul has increased slowly each year with 41.8% (95% CI: 41.6-41.9%) of tests having a CD4 count above 500 cells/ul in 2016. Median CD4 counts were similar across facility types. The proportion of test results indicating advanced HIV disease has remained fairly consistent: 19.4% (95% CI: 18.8-20.1%) in 2012 compared to 16.1% (95% CI: 16.0-16.3%) in 2016. The proportion of test results indicating advanced HIV disease annually ranged from 14.5% in Uganda to 29.8% in Cameroon. 6.9% (95% CI: 6.8-7.0%) of test results showed very advanced HIV disease (CD4<100 cells/ul) in 2016.

Conclusions: The proportion of CD4 test results indicating advanced disease was relatively high and consistent across four high HIV burden countries.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Median CD4 cell counts by year and country.
Fig 2
Fig 2. Percentage of tests with CD4 cell count thresholds by year and country.
See this image and copyright information in PMC

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