1. A novel community health worker tool outperforms WHO clinical staging for assessment of antiretroviral therapy eligibility in a resource-limited setting.
- Author
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Macpherson P, Lalloo DG, Thindwa D, Webb EL, Squire SB, Chipungu GA, Desmond N, Makombe SD, Taegtmeyer M, Choko AT, and Corbett EL
- Subjects
- Adult, Antiretroviral Therapy, Highly Active, CD4 Lymphocyte Count methods, Developing Countries, Female, HIV Infections immunology, HIV Infections pathology, Humans, Malawi, Male, Middle Aged, Predictive Value of Tests, Pregnancy, Sensitivity and Specificity, Anti-Retroviral Agents therapeutic use, Clinical Medicine methods, Community Health Workers, HIV Infections diagnosis, HIV Infections drug therapy
- Abstract
The accuracy of a novel community health worker antiretroviral therapy eligibility assessment tool was examined in community members in Blantyre, Malawi. Nurses independently performed World Health Organization (WHO) staging and CD4 counts. One hundred ten (55.6%) of 198 HIV-positive participants had a CD4 count of <350 cells per cubic millimeter. The community health worker tool significantly outperformed WHO clinical staging in identifying CD4 count of <350 cells per cubic millimeter in terms of sensitivity (41% vs. 19%), positive predictive value (75% vs. 68%), negative predictive values (53% vs. 47%), and area under the receiver-operator curve (0.62 vs. 0.54; P = 0.017). Reliance on WHO staging is likely to result in missed and delayed antiretroviral therapy initiation.
- Published
- 2014
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