Point-of-Care CD4 Testing in Resource-Limited Settings

Is CD4 Testing Outside of the Laboratory Ready for Prime Time?

Shahin Lockman, MD, MS


October 03, 2012

In This Article

The Value of CD4 Point-of-Care Testing

Lack of adequate laboratory infrastructure remains a significant impediment to the optimal initiation and monitoring of antiretroviral therapy (ART) and mother-to-child transmission prevention interventions in resource-limited settings.[1] Some tests, such as viral load assays, are generally still not accessible outside of a few central reference laboratories. Other tests, such as CD4 testing, may be accessible at district or regional laboratories, but their utility is limited by many factors that can hamper their implementation, including lack of equipment maintenance, reliable electricity, supply chain management, or quality assurance, as well as insufficiently trained personnel or inadequate means of transport for sending samples to and test results back from the laboratory. Patient-specific factors impose additional challenges: for example, the need for multiple patient visits to perform testing and provide results, which entails cost and time commitments from patients, and organizing and managing results to ensure that they are shared with patients in a timely manner.

Point-of-care testing may circumvent several of these challenges. In point-of-care testing, clinical specimens are analyzed at or near the site where the patient is located outside of a clinical laboratory, and results are available rapidly for use in patient care.[2] Point-of-care testing is already used successfully and routinely for such assessments as blood glucose, urine pregnancy tests, and urinalysis. The number of new tests that are performed at the point of care continues to increase, despite general concerns about the reliability and quality of tests performed by a large number of staff with varying levels of experience and oversight.