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Lessons from the Field
Task-shifting point-of-care CD4+ testing to lay health workers in HIV care and treatment services in Namibia
Submitted: 24 May 2017 | Published: 18 September 2017
About the author(s)
Francina Kaindjee-Tjituka, Directorate of Special Programs, Ministry of Health and Social Services, Windhoek, NamibiaSouleymane Sawadogo, US Centers for Disease Control and Prevention, Windhoek, Namibia
Graham Mutandi, US Centers for Disease Control and Prevention, Windhoek, Namibia
Andrew D. Maher, US Centers for Disease Control and Prevention, Windhoek, Namibia
Natanael Salomo, US Centers for Disease Control and Prevention, Windhoek, Namibia
Claudia Mbapaha, US Centers for Disease Control and Prevention, Windhoek, Namibia
Marytha Neo, US Centers for Disease Control and Prevention, Windhoek, Namibia
Anita Beukes, US Centers for Disease Control and Prevention, Windhoek, Namibia
Justice Gweshe, Directorate of Special Programs, Ministry of Health and Social Services, Windhoek, Namibia
Alexinah Muadinohamba, Directorate of Special Programs, Ministry of Health and Social Services, Windhoek, Namibia
David W. Lowrance, Directorate of Special Programs, Ministry of Health and Social Services, Windhoek, Namibia
Abstract
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.
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