Feasibility of performing multiple point of care testing for HIV anti-retroviral treatment initiation and monitoring from multiple or single fingersticks 

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Authors

Gous, Natasha
Scott, Lesley
Potgieter, Joachim
Ntabeni, N.L. (Nokuthula Lumka)
Enslin, Sharon
Newman, Ronel
Stevens, Wendy

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Volume Title

Publisher

Public Library of Science

Abstract

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 fingerstick.

Description

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.

Keywords

Feasibility, Care testing, HIV anti-retroviral, Treatment, Fingersticks

Sustainable Development Goals

Citation

Gous N, Scott L, Potgieter J, Ntabeni L, Enslin S, et al. (2013) Feasibility of Performing Multiple Point of Care Testing for HIV Anti-Retroviral Treatment Initiation and Monitoring from Multiple or Single Fingersticks. PLoS ONE 8(12): e85265. DOI: 10.1371/journal.pone.0085265