The effect of CD4 point of care testing on CD4 access among newly initiated art clients in Kisenyi HC IV, Kampala in 2019.

Abstract

Introduction: In order to increase access to CD4 testing, MoH/ UNHLS procured a BD FACS Presto CD4 point of Care (POC) machine that was installed at Kisenyi H/C IV given its high patient volumes. Since January 2019 when the POC machine was installed its effect on access and timeliness of CD4 testing results has not been assessed. Objectives: This study sought to assess the effect of CD4 point of care testing on CD4 access and same day CD4 test results among newly initiated ART clients in Kisenyi Health Centre IV Kampala and the barriers to receiving CD4 test results the same day the test is done. Methods: This was a before and after study design. The study looked at data before the POC intervention when CD4 tests were conducted in the laboratory using the BD FACS Calibur in comparison to the data after installing the POC CD4 testing using the BD FACS Presto. Data on CD4 testing was collected from the laboratory VL/CD4 register for the period January to December 2018 before POC CD4 testing intervention and was compared with data for the period January to December 2019 after introducing the POC CD4 testing. Purposive sampling was used to select HIV positive patients for FGDs while KIIs were conducted with health workers to obtain perspectives concerning same day CD4 access barriers. The over-all proportion of newly initiated clients accessing CD4 testing and same day results before and after CD4 POC was calculated and the change was subjected to a chi2 test for significance. Trend analysis was done to demonstrate the change in proportions of CD4 testing access and same day results over the period January 2018 to December 2019. Qualitative data from interviews were transcribed, coded and analysed thematically. Results: There was a significant (Chi2 pr = 0.000) increase in access to CD4 testing from 259 (35.9%) to 615 (85.1%) and increase in proportion of same day results from 16 (2.2%) to 434 (60%) after the introduction of CD4 POC testing. The enhancers of receiving CD4 results on the same day the sample is tested were; one stop centre, fast CD4 machines, samples taken off once for both HIV verification and CD4 testing. The barriers were; stock out of testing kits, inadequate staff in the ART clinic and lab, lack of stationery, unreliable power supply, fear & anxiety and inadequate knowledge about HIV among the newly initiated clients. Conclusion: CD4 POC led to an improvement in access to CD4 testing and receiving CD4 test results the same day the samples were taken among the HIV+ newly initiated clients. Ministry of health needs to roll out the CD4 POC testing intervention country wide and bridge up identified barriers to achieve 100% universal access to timely CD4 results.