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    Jan 15, 2021
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    Diagnostic performance and usability of the VISITECT CD4 semi-quantitative test for advanced HIV disease screening

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    Name:
    Ndlovu et al 2020 Diagnostic ...
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    Authors
    Ndlovu, Z
    Massaquoi, L
    Bangwen, NE
    Batumba, JN
    Bora, RU
    Mbuaya, J
    Nzadi, R
    Ntabugi, N
    Kisaka, P
    Manciya, G
    Moudashirou, R
    Pangani, H
    Mangochi, P
    Makoko, R
    Van Laeken, D
    Kwitonda, C
    Ronoh, Y
    Kuwenyi, K
    Ortuno, R
    Mangwanya, D
    Zvidzai, E
    Mupepe, T
    Zinyowera, S
    Fajardo, E
    Ellman, T
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    Issue Date
    2020-04-03
    Submitted date
    2020-04-16
    
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    Journal
    PLoS One
    Abstract
    BACKGROUND: In sub-Saharan Africa, a third of people starting antiretroviral therapy and majority of patients returning to HIV-care after disengagement, present with advanced HIV disease (ADH), and are at high risk of mortality. Simplified and more affordable point-of-care (POC) diagnostics are required to increase access to prompt CD4 cell count screening for ambulatory and asymptomatic patients. The Visitect CD4 Lateral Flow Assay (LFA) is a disposable POC test, providing a visually interpreted result of above or below 200 CD4cells/mm3. This study evaluated the diagnostic performance of this index test. METHODS: Consenting patients above 18years of age and eligible for CD4 testing were enrolled in Nsanje district hospital (Malawi), Gutu mission hospital (Zimbabwe) and Centre hopitalier de Kabinda (DRC). A total of 708 venous blood samples were tested in the index test and in the BD FACSCount assay (reference test method) in the laboratories (Phase 1) to determine diagnostic accuracy. A total of 433 finger-prick (FP) samples were tested on the index test at POC by clinicians (Phase 2) and a self-completed questionnaire was administered to all testers to explore usability of the index test. RESULTS: Among 708 patients, 67.2% were female and median CD4 was 297cells/mm3. The sensitivity of the Visitect CD4 LFA using venous blood in the laboratory was 95.0% [95% CI: 91.3-97.5] and specificity was 81.9% [95% CI: 78.2-85.2%]. Using FP samples, the sensitivity of the Visitect CD4 LFA was 98.3% [95% CI: 95.0-99.6] and specificity was 77.2% [95% CI: 71.6-82.2%]. Usability of the Visitect CD4 LFA was high across the study sites with 97% successfully completed tests. Due to the required specific multiple incubation and procedural steps during the Visitect CD4 LFA testing, few health workers (7/26) were not confident to manage testing whilst multi-tasking in their clinical work. CONCLUSIONS: Visitect CD4 LFA is a promising test for decentralized CD4 screening in resource-limited settings, without access to CD4 testing and and it can trigger prompt management of patients with AHD. Lay health cadres should be considered to conduct Visitect CD4 LFA testing in PHCs as well as coordinating all other POC quality assurance.
    Publisher
    Public Library of Science
    URI
    http://hdl.handle.net/10144/619616
    DOI
    10.1371/journal.pone.0230453
    PubMed ID
    32243435
    Type
    Article
    Language
    en
    EISSN
    1932-6203
    ae974a485f413a2113503eed53cd6c53
    10.1371/journal.pone.0230453
    Scopus Count
    Collections
    HIV/AIDS

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