Evaluation & Decentralization of CD4 counting technologies in Senegal

CD4 counting is used to initiate antiretroviral therapy (ART) in HIV patients when CD4 count falls below 500 cells/µl, and is also used to monitor ART-response in resource-limited settings, where viral load access is limited. Conventional flow cytometers are expensive and require highly qualified staff. Alternative CD4 technologies including dedicated flow cytometers and CD4 Point-of-Care (POC) technologies were introduced to scale up ART access in resource-limited countries (RLC). The hypothesis was that new generation of CD4 POC technologies will improve decentralization of CD4 monitoring in RLC. This study addressed the issue of decentralization of CD4 monitoring in resource-limited settings by assessing the performance of alternative CD4 technologies under optimal laboratory environment and under field sub-optimal conditions. This study also determined the use of capillary blood as an alternative to venous blood in the field, and proposed a decisional algorithm with the major considerations involved in the implemention of a CD4 technology for a particular setting. The results will help decision makers in decentralizing CD4 monitoring in their settings.