Operational challenges in delivering CD4 diagnostics in sub-Saharan Africa

Abstract

Access to reliable and low cost CD4 T-cell enumeration to stage illness and monitor anti-retroviral therapy remains elusive in resource-limited settings. We report challenges in delivering CD4 testing using the microcapillary Fluorescence-Activated Cell Sorter (FACS) methodology (Guava EasyCD4 instrument Guava Technologies, Hayward) in Burkina Faso and Zimbabwe. Resources, instruments, reagents, and training were provided to local laboratories within the existing infrastructure and data on CD4 were collected from routine laboratory testing. Challenges encountered included frequent instrument breakdown; poor manufacturer maintenance; difficulties in managing reagent stocks; high technician turnover; reliance on antiquated data management systems; redundant service provision; and lack of repeat testing in male HIV+ patients and in patients with higher CD4 counts after initial staging. While adopting newer, less expensive technologies such as fluorescent platforms and point of care tests can facilitate access to lower cost CD4 testing, our experience suggests that supply chain, corporate commitment to implementation, and community factors also require consideration.

Keywords:

• CD4 T-cell enumeration
• service delivery
• Burkina Faso
• Zimbabwe

Acknowledgements

The first three authors are affiliated with the Worldwide AIDS Coalition (WWAC), a medical non-profit. We wish to acknowledge WWAC funding from the Gilead Foundation and from the San Mateo County Infectious Diseases Training and Research Fund, and Fogarty International Training Grant (LT). This work would not have been possible without the collaboration of the Appui Moral, Materiel et Intellectuel à l'Enfant in Ouahigouya, Burkina Faso and the Zimbabwe AIDS Prevention Program (ZAPP) (Dr Gerard Kadzirange).