The presence of CD4 counts for the management of HIV patients in East Africa: A multicentred study

Abstract

New WHO guidance stipulates six-monthly CD4 testing and treatment initiation at CD4 less than 350. This study aimed to determine the presence of CD4 results in patient records across five care facilities in Kenya, and to identify factors associated with the presence of CD4 count. This is a cross-sectional study of consecutive outpatients. Participants completed self-reported outcomes of demographics, and both physical and mental health dimensions of quality of life and function; charts were reviewed for a CD4 count in the previous 13 months; 548 patients participated. For those diagnosed during the 13-month study period, 7.1% of the sample had no CD4 result on record. For those diagnosed prior to the study, 8.7% had no result. Multivariate logistic regression revealed that 30 days post-HIV diagnosis, facility and antiretroviral therapy use were associated with the odds of having a CD4 result on file. At six months, poverty and prevalence of multidimensional problems were associated with lack of CD4 result. For those diagnosed prior to the observation period, education level was associated with more infrequent CD4 counts, and facility and number of dependants were associated with odds of a CD4 result within six months. Our data suggest inconsistencies in CD4 results availability within and between facilities. Implementation of new guidance will require a shift in practice.

Keywords:

• HIV
• Africa
• CD4
• policy
• patient records

Acknowledgements

We are grateful to the United States Agency for International Development for funding this study under a sub-agreement GPO-A-00-03-00003-00, made under the authority provided to the University of North Carolina. The present study benefited from the participation of a wide range of partners, medical professionals, HIV specialists and palliative care researchers. The authors are grateful for the guidance provided by the US Government Palliative Care Technical Working Group and to the Kenyan and Ugandan Country Teams. Finally, we are grateful to the staff and patients at the participating facilities, and to Hetty Kaye for manuscript management.