Accurate CD4 T-cell enumeration and antiretroviral drug toxicity monitoring in primary healthcare clinics using point-of-care testing
Accurate CD4 T-cell enumeration and antiretroviral drug toxicity monitoring in primary healthcare clinics using point-of-care testing
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DOI：
10.1097/qad.0b013e328344f424
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发表时间：
2011-03-27
期刊：
影响因子：
3.8
通讯作者：
Peter, Trevor F.
中科院分区：
文献类型：
--
作者：
Jani, Ilesh V.;Sitoe, Nadia E.;Peter, Trevor F.
目的：为了评估CD 4细胞，临床化学和血红蛋白在初级保健诊所在Mozambique.Design和方法的即时检测（POCT）的准确性：POCT和实验室为基础的分析进行了成人HIV阳性患者连续登记在莫桑比克的初级保健诊所。患者在现场使用POCT CD 4（Pima）、临床化学（Reflotron）和血红蛋白（HemoCue）设备使用手指采血进行检测。配对血液样本的结果用于一致性分析（偏倚和一致性限度）。还对POCT CD 4细胞计数进行了重复性分析。结果如下：操作Pima、Reflotron和HemoCue POCT器械的初级保健护士产生的CD 4（+）T细胞计数（-52.8个细胞/μ l）、丙氨酸氨基转移酶（-0.2 U/l）、天冬氨酸氨基转移酶（-4.0 U/l）和血红蛋白（0.95 g/dl）结果偏倚水平较低。在POCT CD 4装置上检测的手指点刺和静脉血配对标本中的CD 4（+）T细胞计数非常一致（偏倚-9个细胞/μ l，变异系数10.6%）。POCT CD 4细胞计数的重复性与实验室仪器观察到的结果相似（偏倚-6.2个细胞/μ l，变异系数10.7% vs.偏倚-5.7个细胞/μ l，变异系数7.5%）。初级卫生诊所的护士产生了准确的CD 4（+）T细胞计数结果，在分散的抗逆转录病毒治疗（ART）诊所使用简单的POC设备对手指针刺样本进行肝酶和血红蛋白检测。在初级保健一级监测抗逆转录病毒疗法的POC诊断在技术上是可行的，应在分散艾滋病毒护理和治疗的努力中加以利用。(c)2011年威科健康|利平科特威廉姆斯&威尔金斯
Objective: To evaluate the accuracy of point-of-care tests (POCTs) for CD4 cell, clinical chemistry and hemoglobin in primary healthcare clinics in Mozambique.Design and methods: POCT and laboratory-based assays were conducted on adult HIV-positive patients enrolled consecutively at primary healthcare clinics in Mozambique. Patients were tested on-site with POCT CD4 (Pima), clinical chemistry (Reflotron) and hemoglobin (HemoCue) devices using finger prick blood.Results obtained on paired blood samples were used for agreement analysis (bias and limits of agreement). Repeatability analysis was also performed for POCT CD4 cell counting. Results: Primary health nurses operating the Pima, Reflotron and HemoCue POCT devices produced results with low levels of bias for CD4(+) T-cell counts (-52.8 cells/mu l), alanine aminotransferase (-0.2 U/l), aspartate aminotransferase (-4.0 U/l) and hemoglobin (0.95 g/dl). CD4(+) T-cell counts in paired specimens of finger prick and venous blood tested on the POCT CD4 device were in close agreement (bias -9 cells/mu l, coefficient of variation 10.6%). The repeatability of POCT CD4 cell counting was similar to that observed with laboratory instruments (bias -6.2 cells/mu l, coefficient of variation 10.7% vs. bias -5.7 cells/mu l, coefficient of variation 7.5%).Conclusion: Primary health clinic nurses generated accurate results for CD4(+) T-cell counts, liver enzymes and hemoglobin using simple POC devices on finger prick samples at decentralized antiretroviral therapy (ART) clinics. POC diagnostics to monitor ART at primary healthcare level is technically feasible and should be utilized in efforts to decentralize HIV care and treatment. (c) 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins