Maximizing the Delivery Performance of Point-of-Care CD4+ T-Cell Counting Tests in Resource-Limited Settings - A Policy Brief

Managing HIV/AIDS presents challenges to public health policymakers, frontline workers, and researchers worldwide. A key strategy in the disease management is early diagnosis and rapid treatment initiation. While the technological field of point‐of‐care HIV/AIDS diagnostics has advanced significantly in the past two decades, several critical issues remain that hinder the deployment of point‐of‐ care testing devices in resource‐deprived settings. In this policy brief, we discuss these issues, including technological specifics of point‐of‐care CD4 + T‐cell counting approaches and requirements of deploying them. We also discuss cultural and religious concerns on the deployment. At the end of the brief, we propose a roadmap for the efficient and cost‐effective deployment and call for action to assemble multidisciplinary teams for the undertaking. We argue that joint effort must be taken to conduct research and development for low‐cost portable point‐of‐care testing and for tailoring the technology deployment and care delivery support system design for specific cohorts. Early diagnosis and rapid initiation of treatment remains a key strategy to managing HIV/AIDS, which is still an important public health problem worldwide. Low‐cost portable POC tests have shown great promise of completely transforming the management (Yager et al. 2008), especially in resource‐limited settings where healthcare infrastructure is weak and the access to quality and timely care is a challenge. These tests offer rapid results at or near the site of patient care, which allows for rapid initiation of appropriate treatment and/or establishment of linkages to care (Peeling and Mabey 2010). More importantly, POC tests can be simple enough to be used not only at conventional settings but also in settings with no laboratory infrastructure. POC tests are often more cost‐effective for the healthcare delivery system (Peeling and Mabey 2010), and can potentially empower patients to self‐testing with privacy and make informed decisions on their own. Clinicians, researchers, and public health staff who work at the frontline of HIV/AIDS care and control have had access to an outstanding array of POC devices at their hospital. However, great challenges remain in deploying Policy Brief ⏐ www.purdue.edu/globalpolicy 2 these devices in an efficient and cost‐effective manner by considering the socioeconomic status of certain resource‐deprived regions, as well as cultural and religious factors in the regions. To resolve these challenges, there is an urgent need for assembling a multidisciplinary team of experts in the domains of bio‐sensing, operations research, public health, global policy, sociology, and religious studies. The joint effort must …