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Estimating the need for anti-retroviral treatment and an assessment of a simplified HIV/AIDS case definition in rural Malawi

Estimating the need for anti-retroviral treatment and an assessment of a simplified HIV/AIDS case definition in rural Malawi
Estimating the need for anti-retroviral treatment and an assessment of a simplified HIV/AIDS case definition in rural Malawi
BACKGROUND: Surveillance in the era of antiretroviral therapy (ART) requires estimates of HIV prevalence as well as the proportion eligible for ART. We estimated HIV prevalence and assessed field staging of individuals to estimate the burden of HIV disease needing treatment in rural Malawi.

METHODS: Adults aged 18-59 years in a demographic surveillance system were interviewed, examined, and HIV counselled and tested. Staging that used a simplified version of the WHO criteria ('field checklist') was compared with staging by a medical assistant using a 'clinic checklist' and to CD4 cell results.

RESULTS: A total of 2129 of 2303 eligible adults (92.4%) were traced, and 2047 (96.1%) participated. Of the 1443 participants (70.5%) tested, 11.6% were HIV positive. ART eligibility classification by the field and clinic checklists were concordant in 122 of 133 HIV-positive individuals. Compared with the clinic checklist, the field checklist had a sensitivity of 50% and a specificity of 96%. Including those already known to be on ART, staging by the field and clinic checklists estimated ART eligibility at 16.3 and 17.7% of HIV-positive individuals, respectively. Using CD4 cell count under 250 cells/mul or WHO stage III/IV, the Malawi national programme criteria, 38% of HIV-positive individuals were eligible for ART, compared with 31% based on the 2006 WHO criteria of CD4 cell count under 200 cells/mul or WHO stage IV or CD4 cell count of 200-350 cells/mul and WHO stage III.

CONCLUSION: The field checklist was not a suitable tool for individual staging. Criteria for ART eligibility based on clinical staging alone missed two-thirds of those eligible by clinical staging and CD4 cell count.
S105-S113
McGrath, N.
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Kranzer, K.
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Saul, J.
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Crampin, A.C.
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Malema, S.
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Kachiwanda, L.
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Zaba, B.
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Jahn, A.
75299d2a-929b-48fa-ab3f-5511268cebbf
Fine, P.E.M.
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Glynn, J.R.
0a3a4c43-6159-49fc-ace9-b3e4670c4557
McGrath, N.
b75c0232-24ec-443f-93a9-69e9e12dc961
Kranzer, K.
f96679ca-8d19-4fe3-b9e7-9487ecc42e2a
Saul, J.
fdf83586-95d6-46df-bad8-fd422167010d
Crampin, A.C.
79d516bb-98a6-4b0c-a1c2-2406f13f4649
Malema, S.
424e6a98-b96d-491f-85bf-98c2470fd933
Kachiwanda, L.
3d187fef-9870-4465-97c9-c840a5123791
Zaba, B.
e6c30ee3-64fb-4d0f-8602-599ff1e79043
Jahn, A.
75299d2a-929b-48fa-ab3f-5511268cebbf
Fine, P.E.M.
6ca7d274-0337-4e28-9e87-34e42c99da8e
Glynn, J.R.
0a3a4c43-6159-49fc-ace9-b3e4670c4557

McGrath, N., Kranzer, K., Saul, J., Crampin, A.C., Malema, S., Kachiwanda, L., Zaba, B., Jahn, A., Fine, P.E.M. and Glynn, J.R. (2007) Estimating the need for anti-retroviral treatment and an assessment of a simplified HIV/AIDS case definition in rural Malawi. AIDS, 21, supplement 6, S105-S113. (doi:10.1097/01.aids.0000299417.69432.65). (PMID:18032933)

Record type: Article

Abstract

BACKGROUND: Surveillance in the era of antiretroviral therapy (ART) requires estimates of HIV prevalence as well as the proportion eligible for ART. We estimated HIV prevalence and assessed field staging of individuals to estimate the burden of HIV disease needing treatment in rural Malawi.

METHODS: Adults aged 18-59 years in a demographic surveillance system were interviewed, examined, and HIV counselled and tested. Staging that used a simplified version of the WHO criteria ('field checklist') was compared with staging by a medical assistant using a 'clinic checklist' and to CD4 cell results.

RESULTS: A total of 2129 of 2303 eligible adults (92.4%) were traced, and 2047 (96.1%) participated. Of the 1443 participants (70.5%) tested, 11.6% were HIV positive. ART eligibility classification by the field and clinic checklists were concordant in 122 of 133 HIV-positive individuals. Compared with the clinic checklist, the field checklist had a sensitivity of 50% and a specificity of 96%. Including those already known to be on ART, staging by the field and clinic checklists estimated ART eligibility at 16.3 and 17.7% of HIV-positive individuals, respectively. Using CD4 cell count under 250 cells/mul or WHO stage III/IV, the Malawi national programme criteria, 38% of HIV-positive individuals were eligible for ART, compared with 31% based on the 2006 WHO criteria of CD4 cell count under 200 cells/mul or WHO stage IV or CD4 cell count of 200-350 cells/mul and WHO stage III.

CONCLUSION: The field checklist was not a suitable tool for individual staging. Criteria for ART eligibility based on clinical staging alone missed two-thirds of those eligible by clinical staging and CD4 cell count.

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e-pub ahead of print date: November 2007
Organisations: Faculty of Health Sciences

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Local EPrints ID: 350473
URI: http://eprints.soton.ac.uk/id/eprint/350473
PURE UUID: b318c84e-eb0f-456d-98b2-f0e12e7bf0dd
ORCID for N. McGrath: ORCID iD orcid.org/0000-0002-1039-0159

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Date deposited: 25 Mar 2013 14:25
Last modified: 10 Dec 2019 01:35

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Contributors

Author: N. McGrath ORCID iD
Author: K. Kranzer
Author: J. Saul
Author: A.C. Crampin
Author: S. Malema
Author: L. Kachiwanda
Author: B. Zaba
Author: A. Jahn
Author: P.E.M. Fine
Author: J.R. Glynn

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