Performance of point-of-care CD4 testing technologies in resource-constrained settings: a systematic review and meta-analysis
Abstract Background Point-of-care (POC) CD4 testing increases patient accessibility to assessment of antiretroviral therapy eligibility. This review evaluates field performance in low and middle-income countries (LMICs) of currently available POC CD4 technologies. Methods Eight electronic databases...
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| Format: | Article |
| Language: | English |
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BMC
2016-10-01
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| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12879-016-1931-2 |
| _version_ | 1818842978231255040 |
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| author | Minh D. Pham Paul A. Agius Lorena Romero Peter McGlynn David Anderson Suzanne M. Crowe Stanley Luchters |
| author_facet | Minh D. Pham Paul A. Agius Lorena Romero Peter McGlynn David Anderson Suzanne M. Crowe Stanley Luchters |
| author_sort | Minh D. Pham |
| collection | DOAJ |
| description | Abstract Background Point-of-care (POC) CD4 testing increases patient accessibility to assessment of antiretroviral therapy eligibility. This review evaluates field performance in low and middle-income countries (LMICs) of currently available POC CD4 technologies. Methods Eight electronic databases were searched for field studies published between January 2005 and January 2015 of six POC CD4 platforms: PointCare NOW™, Alere Pima™ CD4, Daktari™ CD4 Counter, CyFlow® CD4 miniPOC, BD FACSPresto™, and MyT4™ CD4. Due to limited data availability, meta-analysis was conducted only for diagnostic performance of Pima at a threshold of 350 cells/μl, applying a bivariate multi-level random-effects modelling approach. A covariate extended model was also explored to test for difference in diagnostic performance between capillary and venous blood. Results Twenty seven studies were included. Published field study results were found for three of the six POC CD4 tests, 24 of which used Pima. For Pima, test failure rates varied from 2 to 23 % across study settings. Pooled sensitivity and specificity were 0.92 (95 % CI = 0.88–0.95) and 0.87 (95 % CI = 0.85–0.88) respectively. Diagnostic performance by blood sample type (venous vs. capillary) revealed non-significant differences in sensitivity (0.94 vs 0.89) and specificity (0.86 vs 0.87), respectively in the extended model (Wald χ2(2) = 4.77, p = 0.09). Conclusions POC CD4 testing can provides reliable results for making treatment decision under field conditions in low-resource settings. The Pima test shows a good diagnostic performance at CD4 cut-off of 350 cells/μl. More data are required to evaluate performance of POC CD4 testing using venous versus capillary blood in LMICs which might otherwise influence clinical practice. |
| first_indexed | 2024-12-19T04:50:33Z |
| format | Article |
| id | doaj.art-9a0db9ba2e7a4cd58b47ed0987522444 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-19T04:50:33Z |
| publishDate | 2016-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-9a0db9ba2e7a4cd58b47ed09875224442022-12-21T20:35:22ZengBMCBMC Infectious Diseases1471-23342016-10-0116111710.1186/s12879-016-1931-2Performance of point-of-care CD4 testing technologies in resource-constrained settings: a systematic review and meta-analysisMinh D. Pham0Paul A. Agius1Lorena Romero2Peter McGlynn3David Anderson4Suzanne M. Crowe5Stanley Luchters6Burnet InstituteBurnet InstituteThe Alfred Hospital, The Ian Potter LibraryDepartment of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash UniversityBurnet InstituteBurnet InstituteBurnet InstituteAbstract Background Point-of-care (POC) CD4 testing increases patient accessibility to assessment of antiretroviral therapy eligibility. This review evaluates field performance in low and middle-income countries (LMICs) of currently available POC CD4 technologies. Methods Eight electronic databases were searched for field studies published between January 2005 and January 2015 of six POC CD4 platforms: PointCare NOW™, Alere Pima™ CD4, Daktari™ CD4 Counter, CyFlow® CD4 miniPOC, BD FACSPresto™, and MyT4™ CD4. Due to limited data availability, meta-analysis was conducted only for diagnostic performance of Pima at a threshold of 350 cells/μl, applying a bivariate multi-level random-effects modelling approach. A covariate extended model was also explored to test for difference in diagnostic performance between capillary and venous blood. Results Twenty seven studies were included. Published field study results were found for three of the six POC CD4 tests, 24 of which used Pima. For Pima, test failure rates varied from 2 to 23 % across study settings. Pooled sensitivity and specificity were 0.92 (95 % CI = 0.88–0.95) and 0.87 (95 % CI = 0.85–0.88) respectively. Diagnostic performance by blood sample type (venous vs. capillary) revealed non-significant differences in sensitivity (0.94 vs 0.89) and specificity (0.86 vs 0.87), respectively in the extended model (Wald χ2(2) = 4.77, p = 0.09). Conclusions POC CD4 testing can provides reliable results for making treatment decision under field conditions in low-resource settings. The Pima test shows a good diagnostic performance at CD4 cut-off of 350 cells/μl. More data are required to evaluate performance of POC CD4 testing using venous versus capillary blood in LMICs which might otherwise influence clinical practice.http://link.springer.com/article/10.1186/s12879-016-1931-2CD4Point of care testingDiagnostic accuracySystematic reviewMeta-analysis |
| spellingShingle | Minh D. Pham Paul A. Agius Lorena Romero Peter McGlynn David Anderson Suzanne M. Crowe Stanley Luchters Performance of point-of-care CD4 testing technologies in resource-constrained settings: a systematic review and meta-analysis BMC Infectious Diseases CD4 Point of care testing Diagnostic accuracy Systematic review Meta-analysis |
| title | Performance of point-of-care CD4 testing technologies in resource-constrained settings: a systematic review and meta-analysis |
| title_full | Performance of point-of-care CD4 testing technologies in resource-constrained settings: a systematic review and meta-analysis |
| title_fullStr | Performance of point-of-care CD4 testing technologies in resource-constrained settings: a systematic review and meta-analysis |
| title_full_unstemmed | Performance of point-of-care CD4 testing technologies in resource-constrained settings: a systematic review and meta-analysis |
| title_short | Performance of point-of-care CD4 testing technologies in resource-constrained settings: a systematic review and meta-analysis |
| title_sort | performance of point of care cd4 testing technologies in resource constrained settings a systematic review and meta analysis |
| topic | CD4 Point of care testing Diagnostic accuracy Systematic review Meta-analysis |
| url | http://link.springer.com/article/10.1186/s12879-016-1931-2 |
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