Point-Of-Care CD4 Improves Patient Retention and Time-To-Initiation for ART in Mozambique

1. Point-Of-Care CD4 Improves Patient Retention and Time-To-Initiation for ART in Mozambique Ilesh Jani1, Nádia Sitoe 1, Eunice Alfai1, Patrina Chongo1, Jonathan Lehe2, Beatriz Rocha2, Jorge Quevedo2 and Trevor Peter2 1 Instituto Nacional de Saúde, Mozambique 2 Clinton Health Access Initiative

2. Background • The scaling-up of ART is facing problems due to delays in ART initiation and high patient loss-to-follow-up (LTFU) • These challenges are partly due to limitations in access to CD4 testing • Emerging Point Of Care (POC) technologies for CD4 counting could improve patient outcomes by: • Increasing access to CD4 testing • Reducing LTFU after HIV diagnosis • Shortening CD4 test turn-around time • Reducing total time from enrollment to initiation of ART in eligible patients

3. Objective • Alere PIMATM was evaluated in Mozambique and showed good agreement with the FACSCaliburTM (Bias=-50.6 cells/µL; see Jani et al. abstract THAB0104) • The main objective is to measure the impact of POC CD4 counting (and haemoglobin determination) implementation in primary health care settings

4. Methodology • Pilot implementation of POC CD4 (and haemoglobin) at 7 sites • Chart review for data collection performed at baseline and post-implementation (data presented for Matola Health Centre only – POC installed in the lab) • Parameters measured included: • Complexity of patient process flow • Total time for enrollment to ART initiation • Access to initial CD4 result

5. The complexity of patients flow decreased after implementation of POC CD4 • HIV diagnosis • Patient enrollment • CD4 requisition • Blood drawn • CD4 test performed • CD4 result received • CD4 result given to patient • Clinical consultation • ART initiation Before POC CD4 After POC CD4 • HIV diagnosis • Patient enrollment • CD4 requisition, CD4 test performed, CD4 result given to patient • Clinical consultation • ART initiation

6. Total time to ART initiation was reduced from 44 days to 21 days N=849 89 days N=125 44 days N=140 21 days

7. Patient access to initial CD4 result improved from 57% to 93%

8. The improvement of access to CD4 result in not uniform across all clinics • Factors Limiting Universal Access To CD4 Testing: • Limited HR capacity • Patient overflow • Clinic workflow still in process of adapting

9. Conclusions • The Introduction of POC CD4 in Matola ART clinic resulted in: • Reduction in complexity of patients’ flow • Decrease in total time to ART initiation (from 44 days to 21 days) • Improvement in access to initial CD4 result (from 57% to 93%) • The initial impact of the introduction of POC technologies may not be uniform across all sites

10. Next steps • Measure the impact of POC CD4 in other ART clinics involved in the pilot • Measure the impact on patient important outcomes after 6 and 12 months • Measure impact on the health system • Perform cost-efficiency analysis • Investigate needs (e.g. human resources) for large-scale implementation of POC technologies

11. Acknowledgements • Patients • Provincial Health Directorates (Maputo City, Maputo Province, Sofala, Niassa) • Staff at Pilot Sites • INS Staff • CHAI Staff • ARK • UNITAID

12. Northern shore of Lake Niassa (Lake Malawi) - This mobile unit brings CD4/Heam