Task-shifting point-of-care CD4+ testing to lay health workers in HIV care and treatment services in Namibia
Task-shifting point-of-care CD4+ testing to lay health workers in HIV care and treatment services in Namibia
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DOI：
10.4102/ajlm.v6i1.643
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发表时间：
2017-09-18
影响因子：
1.1
通讯作者：
Lowrance, David W.
中科院分区：
文献类型：
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作者：
Kaindjee-Tjituka, Francina;Sawadogo, Souleymane;Lowrance, David W.
导言：在低收入和中等收入国家，在艾滋病毒/艾滋病患者中及早开始抗逆转录病毒治疗，获得CD4+检测仍然是一个常见的障碍。在纳米比亚，尚未评估将护理点(POC)CD4+检测任务转移到非专业卫生工作者的可行性。方法：2011年7月至8月，在纳米比亚选定的10家公共卫生机构，使用PIMA CD4+分析仪改善了获得CD4+检测的机会。POC PIMA CD4+检测由护士或非专业卫生工作者进行。从10%的患者身上采集静脉血样本，并将其送往中央实验室，用标准方法进行CD4+检测。结果：共有1429例患者接受了PIMA CD4+检测，500例(35.0%)由护士进行了检测，929例(65.0%)由非专业医护人员进行了检测。当由护士或业馀卫生工作者进行PIMACD+检测时，93.2%和95.2%的结果是有效的(p=0.1.1)，95.6%和98.1%的结果是患者接受的(p=0.007)，96.2%和94.0%的结果是患者在同一天收到的(p=0.08)。总体而言，97.2%的PIMACD+结果被患者接受，而标准实验室CD+结果的55.4%(p<；0.001)。结论：当任务转移到非专业卫生工作者时，POCCD+检测是可行和有效的。通过任务转移推出POC CD4+检测可以改善获得CD4+检测的机会，并在低收入和中等收入国家保持艾滋病毒诊断和抗逆转录病毒治疗启动之间的护理。
Introduction: Access to CD4+ testing remains a common barrier to early initiation of antiretroviral therapy among persons living with HIV/AIDS in low- and middle-income countries. The feasibility of task-shifting of point-of-care (POC) CD4+ testing to lay health workers in Namibia has not been evaluated.Methods: From July to August 2011, Pima CD4+ analysers were used to improve access to CD4+ testing at 10 selected public health facilities in Namibia. POC Pima CD4+ testing was performed by nurses or lay health workers. Venous blood samples were collected from 10% of patients and sent to centralised laboratories for CD4+ testing with standard methods. Outcomes for POC Pima CD4+ testing and patient receipt of results were compared between nurses and lay health workers and between the POC method and standard laboratory CD4+ testing methods.Results: Overall, 1429 patients received a Pima CD4+ test; 500 (35.0%) tests were performed by nurses and 929 (65.0%) were performed by lay health workers. When Pima CD4+ testing was performed by a nurse or a lay health worker, 93.2% and 95.2% of results were valid (p = 0.1); 95.6% and 98.1% of results were received by the patient (p = 0.007); 96.2% and 94.0% of results were received by the patient on the same day (p = 0.08). Overall, 97.2% of Pima CD4+ results were received by patients, compared to 55.4% of standard laboratory CD4+ results (p < 0.001).Conclusions: POC CD4+ testing was feasible and effective when task-shifted to lay health workers. Rollout of POC CD4+ testing via task-shifting can improve access to CD4+ testing and retention in care between HIV diagnosis and antiretroviral therapy initiation in low- and middle-income countries.