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1. Diagnostic performance and usability of the VISITECT CD4 semi-quantitative test for advanced HIV disease screening.

Author

Zibusiso Ndlovu, Lamin Massaquoi, Ndim Eugene Bangwen, John N Batumba, Rachelle U Bora, Joelle Mbuaya, Roger Nzadi, Nadine Ntabugi, Patrick Kisaka, Gisele Manciya, Ramzia Moudashirou, Harry Pangani, Patrick Mangochi, Roberta Makoko, David Van Laeken, Claude Kwitonda, Yuster Ronoh, Kuziwa Kuwenyi, Reinaldo Ortuno, Douglas Mangwanya, Edmore Zvidzai, Tapiwa Mupepe, Sekesai Zinyowera, Emmanuel Fajardo, and Tom Ellman

Subjects
Medicine, Science
Abstract

BACKGROUND:In sub-Saharan Africa, a third of people starting antiretroviral therapy and majority of patients returning to HIV-care after disengagement, present with advanced HIV disease (ADH), and are at high risk of mortality. Simplified and more affordable point-of-care (POC) diagnostics are required to increase access to prompt CD4 cell count screening for ambulatory and asymptomatic patients. The Visitect CD4 Lateral Flow Assay (LFA) is a disposable POC test, providing a visually interpreted result of above or below 200 CD4cells/mm3. This study evaluated the diagnostic performance of this index test. METHODS:Consenting patients above 18years of age and eligible for CD4 testing were enrolled in Nsanje district hospital (Malawi), Gutu mission hospital (Zimbabwe) and Centre hopitalier de Kabinda (DRC). A total of 708 venous blood samples were tested in the index test and in the BD FACSCount assay (reference test method) in the laboratories (Phase 1) to determine diagnostic accuracy. A total of 433 finger-prick (FP) samples were tested on the index test at POC by clinicians (Phase 2) and a self-completed questionnaire was administered to all testers to explore usability of the index test. RESULTS:Among 708 patients, 67.2% were female and median CD4 was 297cells/mm3. The sensitivity of the Visitect CD4 LFA using venous blood in the laboratory was 95.0% [95% CI: 91.3-97.5] and specificity was 81.9% [95% CI: 78.2-85.2%]. Using FP samples, the sensitivity of the Visitect CD4 LFA was 98.3% [95% CI: 95.0-99.6] and specificity was 77.2% [95% CI: 71.6-82.2%]. Usability of the Visitect CD4 LFA was high across the study sites with 97% successfully completed tests. Due to the required specific multiple incubation and procedural steps during the Visitect CD4 LFA testing, few health workers (7/26) were not confident to manage testing whilst multi-tasking in their clinical work. CONCLUSIONS:Visitect CD4 LFA is a promising test for decentralized CD4 screening in resource-limited settings, without access to CD4 testing and and it can trigger prompt management of patients with AHD. Lay health cadres should be considered to conduct Visitect CD4 LFA testing in PHCs as well as coordinating all other POC quality assurance.

Published
2020
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2. Diagnostic performance and usability of the VISITECT CD4 semi-quantitative test for advanced HIV disease screening

Author

Ramzia Moudashirou, Reinaldo Ortuno, Harry Pangani, Sekesai Zinyowera, Roger Nzadi, Rachelle U Bora, Ndim Eugene Bangwen, Gisele Manciya, Joelle Mbuaya, Tapiwa Mupepe, David Van Laeken, Edmore Zvidzai, Nadine Ntabugi, Claude Kwitonda, Tom Ellman, John N Batumba, Roberta Makoko, Patrick Mangochi, Lamin Massaquoi, Emmanuel Fajardo, Zibusiso Ndlovu, Yuster Ronoh, Patrick Kisaka, Kuziwa Kuwenyi, and Douglas Mangwanya

Subjects
RNA viruses, Bacterial Diseases, 0301 basic medicine, Malawi, Physiology, HIV Infections, Urine, Pathology and Laboratory Medicine, 0302 clinical medicine, Immunodeficiency Viruses, Medicine and Health Sciences, Risk of mortality, Mass Screening, Public and Occupational Health, 030212 general & internal medicine, Multidisciplinary, HIV diagnosis and management, Venous blood, Middle Aged, Vaccination and Immunization, Body Fluids, Test (assessment), Actinobacteria, Blood, Infectious Diseases, Point-of-Care Testing, Medical Microbiology, Viral Pathogens, Viruses, Ambulatory, Medicine, Female, Pathogens, Anatomy, medicine.symptom, Research Article, Adult, Zimbabwe, medicine.medical_specialty, Point-of-care testing, Science, Immunology, Antiretroviral Therapy, Microbiology, Asymptomatic, 03 medical and health sciences, Antiviral Therapy, Diagnostic Medicine, Internal medicine, Retroviruses, medicine, Humans, Tuberculosis, Serologic Tests, Microbial Pathogens, Mass screening, Bacteria, business.industry, Lentivirus, Organisms, Biology and Life Sciences, HIV, Usability, Tropical Diseases, 030112 virology, CD4 Lymphocyte Count, Preventive Medicine, business, Mycobacterium Tuberculosis
Abstract

Background In sub-Saharan Africa, a third of people starting antiretroviral therapy and majority of patients returning to HIV-care after disengagement, present with advanced HIV disease (ADH), and are at high risk of mortality. Simplified and more affordable point-of-care (POC) diagnostics are required to increase access to prompt CD4 cell count screening for ambulatory and asymptomatic patients. The Visitect CD4 Lateral Flow Assay (LFA) is a disposable POC test, providing a visually interpreted result of above or below 200 CD4cells/mm3. This study evaluated the diagnostic performance of this index test. Methods Consenting patients above 18years of age and eligible for CD4 testing were enrolled in Nsanje district hospital (Malawi), Gutu mission hospital (Zimbabwe) and Centre hopitalier de Kabinda (DRC). A total of 708 venous blood samples were tested in the index test and in the BD FACSCount assay (reference test method) in the laboratories (Phase 1) to determine diagnostic accuracy. A total of 433 finger-prick (FP) samples were tested on the index test at POC by clinicians (Phase 2) and a self-completed questionnaire was administered to all testers to explore usability of the index test. Results Among 708 patients, 67.2% were female and median CD4 was 297cells/mm3. The sensitivity of the Visitect CD4 LFA using venous blood in the laboratory was 95.0% [95% CI: 91.3-97.5] and specificity was 81.9% [95% CI: 78.2-85.2%]. Using FP samples, the sensitivity of the Visitect CD4 LFA was 98.3% [95% CI: 95.0-99.6] and specificity was 77.2% [95% CI: 71.6-82.2%]. Usability of the Visitect CD4 LFA was high across the study sites with 97% successfully completed tests. Due to the required specific multiple incubation and procedural steps during the Visitect CD4 LFA testing, few health workers (7/26) were not confident to manage testing whilst multi-tasking in their clinical work. Conclusions Visitect CD4 LFA is a promising test for decentralized CD4 screening in resource-limited settings, without access to CD4 testing and and it can trigger prompt management of patients with AHD. Lay health cadres should be considered to conduct Visitect CD4 LFA testing in PHCs as well as coordinating all other POC quality assurance.

Published
2020

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