Discover how the integration of point-of-care CD4 testing into tuberculosis case finding is revolutionizing the approach to advanced HIV disease care, offering new insights and hope for patients in our latest tropical medicine feature.
– by Klaus
Note that Klaus is a Santa-like GPT-based bot and can make mistakes. Consider checking important information (e.g. using the DOI) before completely relying on it.
Implementation of the advanced HIV disease care package with point-of-care CD4 testing during tuberculosis case finding: A mixed-methods evaluation.
Gils et al., PLoS One 2023
DOI: 10.1371/journal.pone.0296197
Ho-ho-ho! Gather ’round, my merry friends, for I have a tale from the lands of Lesotho and South Africa, where researchers, much like my elves, have been busy assessing a special package—not of toys, but of care for those with advanced HIV disease (AHD), during their quest to find cases of tuberculosis (TB).
In this yuletide story, set between the years 2021 and 2022, adult participants who showed signs of TB were recruited not by reindeer, but near medical facilities. They were offered a sleigh-full of tests: HIV testing with a drop of blood, Xpert MTB/RIF and Ultra, and MGIT culture from their sputum. Those living with HIV, the good folks of this narrative, were given an additional gift: the VISITECT test, which uses venous blood to spot if someone’s CD4 count had dipped below the festive number of 200 cells/μl, and the AlereLAM test, which checks urine for TB.
Now, if VISITECT revealed a CD4 count as low as the North Pole temperatures, participants were then tested for the Immy cryptococcal antigen, a sign of another naughty infection. With results in hand, they were referred for care, much like how I refer good children to the nice list.
The elves—ahem, I mean the study staff—checked if this whole process was as feasible as fitting down a chimney. They looked at how much the staff liked the tests (acceptability), how well they delivered this care package (intervention delivery), if they followed the procedure to the letter (process compliance), and if it all helped the participants stay on the nice list (early effectiveness), which in this case meant surviving 12 weeks and sticking to their treatment.
Out of 1392 participants, 676 knew they had HIV. Some were just finding out (7.8%), most were already taking their antiretroviral therapy (ART) (81.8%), and a few knew but hadn’t started ART (10.4%). A jolly 41.7% of these folks had AHD, with 29.9% having a CD4 count lower than 200 cells/μl and 20.6% having TB.
The study staff found the procedures as acceptable as milk and cookies, even though there were some challenges, like supply issues and the time it took (a median of 73 minutes, longer than it takes me to deliver presents to a whole neighborhood!).
After 12 weeks, a small number of participants with AHD had taken their sleigh ride to the sky (3.3%), but most were alive and well (84.8%). Interestingly, having AHD or TB didn’t seem to affect whether they stayed on the nice list (survival).
In the end, the researchers found that delivering this AHD care package during TB-case finding was as feasible as guiding a sleigh on a foggy night. AHD was as common as snowflakes in winter, but it didn’t affect survival, possibly because the VISITECT test might have been as overeager as a puppy on Christmas morning. They noted that we need to get better at CD4 testing and encouraging people to take their preventive treatments, much like we need to get better at wrapping presents.
And so, my dear friends, as we close this chapter, let’s remember the importance of caring for those in need, during the holidays and all year round. Merry testing and a healthy new year to all! 🎅🎄