BACKGROUND: Point of Care testing (POCT) provides on-site, rapid, accessible results. With current South African
anti-retroviral treatment guidelines, up to 4 fingersticks /patient/clinic visit could be required if utilizing POC. We
determined the feasibility and accuracy of a nurse performing multiple POCT on multiple fingersticks followed by
simplification of the process by performance of multiple POC on a single fingerstick.
METHOD AND FINDINGS: Random HIV positive adult patients presenting at a HIV treatment clinic in South Africa, for
ART initiation/ monitoring, were approached to participate in the study between April-June 2012. Phase I: n=150
patients approached for multiple POCT on multiple fingersticks. Phase II: n=150 patients approached for multiple
POCT on a single fingerstick. The following POC tests were performed by a dedicated nurse: PIMA (CD4), HemoCue
(hemoglobin), Reflotron (alanine aminotransferase, creatinine). A venepuncture specimen was taken for predicate
laboratory methodology. Normal laboratory ranges and Royal College of Pathologists Australasia (RCPA) allowable
differences were used as guidelines for comparison. In 67% of participants, ≥3 tests were requested per visit. All
POCT were accurate but ranged in variability. Phase I: Hemoglobin was accurate (3.2%CV) while CD4, alanine
aminotransferase and creatinine showed increased variability (16.3%CV; 9.3%CV; 12.9%CV respectively). PIMA
generated a misclassification of 12.4%. Phase II: Hemoglobin, alanine aminotransferase and creatinine showed good
accuracy (3.2%CV, 8.7%CV, 6.4%CV respectively) with increased variability on CD4 (12.4%CV) but low clinical
misclassification (4.1%). No trends were observed for the sequence in which POC was performed on a single
fingerstick. Overall, PIMA CD4 generated the highest error rate (16-19%).
CONCLUSIONS: Multiple POCT for ART initiation and/or monitoring can be performed practically by a dedicated nurse
on multiple fingersticks. The process is as accurate as predicate methodology and can be simplified using a single
Thanks to all the patients of CCMT who agreed to participate in
the study and support from the POC suppliers for loan of their
instrumentation during the study.
Conceived and designed the experiments: NG LS JP LN WS.
Performed the experiments: NG SE RN. Analyzed the data: NG
LS. Contributed reagents/materials/analysis tools: JP WS.
Wrote the manuscript: NG LS JP LN WS. Revision of
manuscript: LS JP LN SE RN WS. Final approval of
manuscript: LS JP LN SE RN WS.