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Implementation of Point-of-Care Diagnostics Leads to Variable Uptake of Syphilis, Anemia and CD4+ T-Cell Count Testing in Rural Maternal and Child Health Clinics
PLoS One
  • Caroline De Schacht, Elizabeth Glaser Pediatric AIDS Foundation, Maputo
  • Carlota Lucas, Elizabeth Glaser Pediatric AIDS Foundation, Maputo
  • Nádia Sitoe, Instituto Nacional de Saúde, Maputo
  • Rhoderick Machekano, Elizabeth Glaser Pediatric AIDS Foundation, Washington DC
  • Patrina Chongo, Instituto Nacional de Saúde, Maputo
  • Marleen Temmerman, Aga Khan University
  • Ocean Tobaiwa, Clinton Health Access Initiative, Maputo
  • Laura Guay, Elizabeth Glaser Pediatric AIDS Foundation, Washington DC
  • Seble Kassaye, Elizabeth Glaser Pediatric AIDS Foundation, Washington DC
  • Ilesh V. Jani, Instituto Nacional de Saúde, Maputo
Publication Date
1-1-2015
Document Type
Article
Abstract

Introduction: Anemia, syphilis and HIV are high burden diseases among pregnant women in sub-Saharan Africa. A quasi-experimental study was conducted in four health facilities in Southern Mozambique to evaluate the effect of point-of-care technologies for hemoglobin quantification, syphilis testing and CD4+ T-cell enumeration performed within maternal and child health services on testing and treatment coverage, and assessing acceptability by health workers.

Methods: Demographic and testing data on women attending first antenatal care services were extracted from existing records, before (2011; n = 865) and after (2012; n = 808) introduction of point-of-care testing. Study outcomes per health facility were compared using z-tests (categorical variables) and Wilcoxon rank-sum test (continuous variables), while inverse variance weights were used to adjust for possible cluster effects in the pooled analysis. A structured acceptability-assessment interview was conducted with health workers before (n = 22) and after (n = 19).

Results: After implementation of point-of-care testing, there was no significant change in uptake of overall hemoglobin screening (67.9% to 83.0%; p = 0.229), syphilis screening (80.8% to 87.0%; p = 0.282) and CD4+ T-cell testing (84.9% to 83.5%; p = 0.930). Initiation of antiretroviral therapy for treatment eligible women was similar in the weighted analysis before and after, with variability among the sites. Time from HIV diagnosis to treatment initiation decreased (median of 44 days to 17 days; p<0.0001). A generally good acceptability for point-of-care testing was seen among health workers.

Conclusions: Point-of-care CD4+ T-cell enumeration resulted in a decreased time to initiation of antiretroviral therapy among treatment eligible women, without significant increase in testing coverage. Overall hemoglobin and syphilis screening increased. Despite the perception that point-of-care technologies increase access to health services, the variability in results indicate the potential for detrimental effects in some settings. Local context needs to be considered and services restructured to accommodate innovative technologies in order to improve service delivery to expectant mothers.

Citation Information
Caroline De Schacht, Carlota Lucas, Nádia Sitoe, Rhoderick Machekano, et al.. "Implementation of Point-of-Care Diagnostics Leads to Variable Uptake of Syphilis, Anemia and CD4+ T-Cell Count Testing in Rural Maternal and Child Health Clinics" PLoS One Vol. 10 Iss. 8 (2015) p. 1 - 16
Available at: http://works.bepress.com/marleen_temmerman/8/