CD4+ cell count testing more effective than HIV disease clinical staging in identifying pregnant and postpartum women eligible for antiretroviral therapy in resource-limited settings

  • Journal of Acquired Immune Deficiency Syndromes, Volume 55, No. 3, Year 2010

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Study Justification:
– The study aimed to investigate the effectiveness of CD4+ cell count testing compared to clinical staging in identifying pregnant and postpartum women eligible for antiretroviral therapy (ART) in resource-limited settings.
– This research is important because identifying and rapidly initiating ART in HIV-infected pregnant women can preserve maternal health and prevent mother-to-child transmission of HIV.
– There is a lack of investigations on the performance of ART eligibility criteria specifically in pregnant and postpartum women in resource-limited settings.
Study Highlights:
– The study included 6036 pregnant and recently postpartum HIV-infected women.
– The women received CD4+ cell count and World Health Organization (WHO) clinical staging at enrollment into the mother-to-child transmission Plus Initiative.
– The study compared the effectiveness of immunologic criteria (CD4+ cell count) and clinical criteria (WHO stage 3/4) in identifying ART eligible women.
– Results showed that only 23% of the women had WHO stage 3 or 4 disease, whereas 94% met the CD4+ cell count criterion.
– Among women with WHO stage 1 or 2 disease, 42% had CD4+ ≤350 cells per cubic millimeter.
– Changing the CD4+ cell count ART eligibility threshold from ≤200 to ≤350 cells per cubic millimeter increased the proportion of ART eligible women from 21% to 45%.
Recommendations:
– The study recommends the use of CD4+ cell count criterion over clinical staging in identifying pregnant and postpartum HIV-infected women eligible for ART.
– Improving access to CD4+ testing is essential to identify and treat eligible women, thereby optimizing maternal and child health outcomes.
Key Role Players:
– Healthcare providers: Responsible for conducting CD4+ cell count testing and interpreting the results.
– Laboratory technicians: Perform the CD4+ cell count tests and ensure accurate and timely results.
– Policy makers: Responsible for implementing policies that improve access to CD4+ testing and ART for pregnant and postpartum women.
– Funding agencies: Provide financial support for CD4+ testing infrastructure and ART provision.
Cost Items for Planning Recommendations:
– CD4+ testing equipment and supplies: Includes the cost of purchasing or maintaining CD4+ testing machines, reagents, and consumables.
– Training and capacity building: Budget for training healthcare providers and laboratory technicians on CD4+ testing procedures and interpretation.
– Infrastructure and logistics: Includes the cost of establishing or upgrading laboratory facilities, ensuring proper storage and transportation of samples, and maintaining quality control measures.
– Outreach and awareness campaigns: Budget for promoting the importance of CD4+ testing and ART eligibility among pregnant and postpartum women.
– Integration into existing healthcare systems: Cost of integrating CD4+ testing and ART eligibility assessment into routine antenatal and postnatal care services.

The strength of evidence for this abstract is 9 out of 10.
The evidence in the abstract is strong because it presents findings from a study comparing the effectiveness of CD4+ cell count testing and clinical staging in identifying pregnant and postpartum women eligible for antiretroviral therapy (ART) in resource-limited settings. The study included a large sample size of 6036 women and found that CD4+ cell count criterion was superior to clinical staging in identifying ART eligible women. The study also highlighted the importance of improving access to CD4+ testing to optimize maternal and child health outcomes. To further improve the evidence, it would be beneficial to include information on the study design, methodology, and statistical analysis used. Additionally, providing more details on the characteristics of the study population and any potential limitations would enhance the overall strength of the evidence.

Objective: Identifying antiretroviral therapy (ART) eligible HIV-infected (HIV+) pregnant women and rapidly initiating treatment preserves maternal health and prevents mother-to-child transmission. However, there have been few investigations of the performance of ART eligibility criteria in pregnant and postpartum women in resource-limited settings. Methods: Pregnant and recently postpartum HIV+ women received CD4+ cell count and World Health Organization (WHO) clinical staging at enrollment into the mother-to-child transmission Plus Initiative. We compared immunologic and clinical criteria based on 2009 WHO ART treatment guidelines (WHO stage 3/4 or CD4+ cell count ≤350 cells/mm) in identifying ART eligible women. Results: Among 6036 women (62% antepartum, 38% postpartum), 2915 (48%) were ART eligible. Only 23% had WHO stage 3 or 4 disease, whereas 94% met CD4+ cell count criterion. Among 5356 women with WHO stage 1 or 2 disease, 2235 (42%) had CD4+ ≤350 cells per cubic millimeter. Change of CD4+ cell count ART eligibility threshold from ≤200 to ≤350 cells per cubic millimeter increased the proportion of ART eligible women from 21% to 45%. Conclusions: Use of CD4+ cell count criterion is superior to clinical staging in identifying pregnant and postpartum HIV+ women eligible for ART. Improving access to CD4+ testing is essential to identify and treat eligible women, optimizing maternal and child health outcomes. © 2010 by Lippincott Williams & Wilkins.

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The study recommends using CD4+ cell count testing instead of clinical staging to identify pregnant and postpartum women eligible for antiretroviral therapy (ART) in resource-limited settings. The study found that using CD4+ cell count criteria (≤350 cells/mm) identified a higher proportion of ART eligible women compared to clinical staging based on WHO guidelines. By increasing the CD4+ cell count threshold from ≤200 to ≤350 cells/mm, the proportion of ART eligible women increased from 21% to 45%. The study concludes that improving access to CD4+ testing is crucial for identifying and treating eligible women, which can optimize maternal and child health outcomes.
AI Innovations Description
The recommendation from the study is to use CD4+ cell count testing instead of clinical staging to identify pregnant and postpartum women eligible for antiretroviral therapy (ART) in resource-limited settings. The study found that using CD4+ cell count criteria (≤350 cells/mm) identified a higher proportion of ART eligible women compared to clinical staging based on WHO guidelines. Only 23% of women had WHO stage 3 or 4 disease, whereas 94% met the CD4+ cell count criterion. By increasing the CD4+ cell count threshold from ≤200 to ≤350 cells/mm, the proportion of ART eligible women increased from 21% to 45%. The study concludes that improving access to CD4+ testing is crucial for identifying and treating eligible women, which can optimize maternal and child health outcomes.
AI Innovations Methodology
To simulate the impact of the main recommendations of this abstract on improving access to maternal health, the following methodology can be used:

1. Identify the target population: Determine the specific population of pregnant and postpartum women in resource-limited settings who are at risk of HIV infection and require access to antiretroviral therapy (ART).

2. Define the intervention: Implement the recommendation from the study to use CD4+ cell count testing instead of clinical staging to identify eligible women for ART. This involves establishing CD4+ cell count testing facilities and ensuring access to accurate and reliable testing methods.

3. Establish baseline data: Collect data on the current utilization of CD4+ cell count testing and clinical staging in identifying ART eligible women in the target population. This includes the number of women tested, the proportion of women meeting the CD4+ cell count criterion, and the proportion meeting the clinical staging criterion.

4. Implement the intervention: Increase access to CD4+ cell count testing by expanding testing facilities, training healthcare providers on testing procedures, and ensuring the availability of testing supplies. Promote the use of CD4+ cell count testing as the primary method for identifying eligible women for ART.

5. Monitor and evaluate: Track the number of women tested using CD4+ cell count testing, the proportion of women meeting the CD4+ cell count criterion, and the proportion meeting the clinical staging criterion after the intervention is implemented. Compare these data to the baseline data to assess the impact of the intervention on improving access to maternal health.

6. Analyze the results: Calculate the difference in the proportion of ART eligible women identified using CD4+ cell count testing compared to clinical staging. Assess the increase in the proportion of eligible women identified by increasing the CD4+ cell count threshold from ≤200 to ≤350 cells/mm.

7. Draw conclusions: Based on the results, determine the effectiveness of using CD4+ cell count testing instead of clinical staging in identifying eligible women for ART. Evaluate the impact of improving access to CD4+ testing on optimizing maternal and child health outcomes.

8. Make recommendations: Provide recommendations for scaling up the use of CD4+ cell count testing in resource-limited settings to identify and treat eligible women for ART. This may include advocating for increased funding, strengthening healthcare infrastructure, and improving training and education for healthcare providers.

By following this methodology, researchers and policymakers can assess the impact of implementing the recommendations from the study on improving access to maternal health in resource-limited settings.

Statistics:
Citations: 40
Authors: 8
Identifiers:
DOI: 10.1097/QAI.0b013e3181e73f4b
ISSN: 15254135
Research Areas:
Health System and Policy, Infectious Diseases, Maternal and Child Health, Quality of Care
Participants Gender:
Female
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