Lost Opportunities to Complete CD4+ T Cell Testing among HIV Positive Patients Attending Selected Health Centers in Afar Region Northeast Ethiopia, 2014

Benti, Haile (2014) Lost Opportunities to Complete CD4+ T Cell Testing among HIV Positive Patients Attending Selected Health Centers in Afar Region Northeast Ethiopia, 2014. Masters thesis, Addis Ababa University.

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Abstract

Background: In resource limited settings CD4+ T cell count (CD4 testing) facility is not available in peripheral areas and often either patients need to travel long distances or the samples need to be transported to the centers where the facility for CD4 testing is available. These results in delays in the completion of CD4 testing, and hence further delays occur in obtaining appropriate care and treatment. Objective: To estimate rates of completion of CD4+ T cell count within 12 weeks of testing positive for human immunodeficiency virus (HIV) as well as predictors for completion at ART clinics in Afar region of Northeast Ethiopia. Methods: The study was conducted in three most accessible selected Health centers with CD4 sample referring and ART services found in Afar Region of Northeast Ethiopia. Monthly report of HIV Positive patients was used to identify individuals with HIV positive results. Routine data was used separately to calculate the number and proportion of patients passing through PICHT, VCT, PMTCT, TB clinic. Of the total 1299 positive individuals at each entry point, 931 were linked to clinic patient card and ART data base. CD4 testing was considered complete once a patient had retrieved the test results. To determine the rate of CD4 testing completion, records of patient were reviewed. Predictors for completion were identified through multivariate logistic regression. SPSS version 16 was used for data cleaning and analysis. P values less than 0.05 were taken as statistically significant. Result: Between September 1, 2007 and June, 2013, a total of 1299 patients consisted of 492(37.88%), 387(29.79%), and 420(32.33%) at Gewane, Werer and Semera health centers, respectively were tested positive for HIV. Patients who initiated CD4 testing after they tested positive for HIV and enrolled to ART clinic had a median CD4 cell count of 172/μl (interquartile range, IQR: 88–261). Majority 326 (59.8% of 545) had a CD4 cell count ≤ 200/μl and were already eligible for ART. The other 219 (40.2% of 545) had a CD4 cell count > 200/μl and were thus eligible for pre-ART medical care. Of the 931 patients who were included in the study, 58.5% initiated CD4 testing within the 12 weeks study timeframe. Of these patients, 59.8% were immediately eligible for antiretroviral therapy (ART) because of a CD4 cell count ≤ 200/μl, but only 42.9% of the patients in thiscategory completed CD4 testing within 12 weeks of HIV testing. Among those not immediately eligible for ART (CD4 cells > 200/μl), only 31.5% completed CD4 testing within 12 weeks. Overall, of HIV+ patients who initiated CD4 testing, 61.65% did not complete it within 12 weeks of diagnosis. Among the predicting factors, the higher the baseline CD4 cell count, the lower the odds of completing CD4 testing within 12 weeks (P<0.05). Conclusion: Majority of patients were already eligible for ART at the time of HIV diagnosis even under the restrictive threshold of 200 CD4 cells/µl that prevailed at the time of the study. But most did not complete CD4 testing within 12 weeks of diagnosis. Proper linkage of patient tested positive at any testing center and provision of immediate baseline CD4 cell count has indispensible role in reducing delayed treatment of patient with low CD4 cell count and maintaining patient enrolled at ART clinic.

Item Type:	Thesis (Masters)
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RZ Other systems of medicine
Divisions:	Africana
Depositing User:	Emmanuel Ndorimana
Date Deposited:	02 Jul 2018 11:41
Last Modified:	02 Jul 2018 11:41
URI:	http://thesisbank.jhia.ac.ke/id/eprint/6368

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