oa Southern African Journal of Infectious Diseases - The routine paediatric human immunodeficiency virus visit as an intervention opportunity for failed maternal care, and use of point-of-care CD4 testing as an adjunct in determining antiretroviral therapy eligibility : original research



South African women and children remain at the centre of the human immunodeficiency virus (HIV) pandemic, and maternal well-being plays a critical role in child health. In this study, we evaluated the impact of the paediatric visit on the determination of antiretroviral therapy (ART) eligibility in mothers using Alere Pima™ Analyser (Pima™) testing as an adjunct to routine care. Fifty-two mothers who had failed to obtain routine CD4 screening were enrolled during the paediatric visit at Tygerberg Children's Hospital between November 2011 and May 2012. Clinical staging assessments and parallel standard CD4 cell count testing were performed. Finger-prick samples for the Pima™, and simultaneous venous samples for reference flow cytometry, were obtained. The Pima™ identified 37% of mothers as meeting ART eligibility versus 35% using the reference flow cytometry method. An additional 4% of mothers were identified using World Health Organization clinical staging only. The sensitivity of the Pima™ was 89%, specificity 91%, and positive and negative predictive values 84% and 94%, respectively. These results indicate that the paediatric HIV care visit can provide a valuable additional intervention opportunity to identify mothers in need of ART, with point-of-care CD4 technologies being used as a meaningful adjunct in screening for ART eligibility.


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