Access to CD4 testing for rural HIV patients: findings from a cohort study in Zimbabwe

CD4 cell count measurement remains an important diagnostic tool for HIV care in developing countries

Abstract

Background

CD4 cell count measurement remains an important diagnostic tool for HIV care in developing countries. Insufficient laboratory capacity in rural Sub-Saharan Africa is frequently mentioned but data on the impact at an individual patient level are lacking. Urban-rural discrepancies in CD4 testing have not been quantified to date. Such evidence is crucial for public health planning and to justify new yet more expensive diagnostic procedures that could circumvent access constraints in rural areas.

Objective

To compare CD4 testing among rural and urban HIV patients during the first year of treatment.

Methods

Records from 2,145 HIV positive adult patients from a Médecins sans Frontières (Doctors without Borders) HIV project in Beitbridge, Zimbabwe, during 2011 and 2012 were used for a retrospective cohort analysis. Covariate-adjusted risk ratios were calculated to estimate the effects of area of residence on CD4 testing at treatment initiation, six and 12 months among rural and urban patients.

Findings

While the proportion of HIV patients returning for medical consultations at six and 12 months decreased at a similar rate in both patient groups, CD4 testing during consultations dropped to 21% and 8% for urban, and 2% and 1% for rural patients at six and 12 months, respectively. Risk ratios for missing CD4 testing were 0.8 (95% CI 0.7-0.9), 9.2 (95% CI 5.5-15.3), and 7.6 (95% 3.7-17.1) comparing rural versus urban patients at treatment initiation, six and 12 months, respectively.

This research was supported by the UK Department for International Development’s Operational Research Capacity Building Programme led by the International Union Against TB and Lung Disease (The Union)

Citation

Vogt F, Tayler-Smith K, Bernasconi A, Makondo E, Taziwa F, Moyo B, et al. (2015) Access to CD4 Testing for Rural HIV Patients: Findings from a Cohort Study in Zimbabwe. PLoS ONE 10(6):e0129166. doi:10.1371/journal.pone.0129166

Access to CD4 testing for rural HIV patients: findings from a cohort study in Zimbabwe

Published 17 June 2015