title: Multi point of care instrument evaluation for use in anti-retroviral clinics in South Africa.
abstract: BACKGROUND
  South Africa has the largest prevalence of HIV infected individuals in the world. The introduction of point of care testing to anti-retroviral (ARV) clinic sites is hoped to fast track initiation of patients on ARVs and to allow for earlier recognition of adverse effects such as dyslipidaemia, renal and hepatic dysfunction.
  
  
  METHODS
  We evaluated six instruments for the following analytes: glucose, lactate, creatinine, cholesterol, triglycerides, HDL-cholesterol, alanine transaminase (ALT), and glycated haemoglobin. Comparisons with the central laboratory analyser were performed as well as precision studies. A scoring system was developed by the authors to evaluate the instruments in terms of analytical performance, cost, ease of use, and other operational characteristics. As one of the goals of the placement of these instruments was that their operation was simple enough to be used by non-laboratory staff, ease of use contributed a large proportion to the final scoring.
  
  
  RESULTS
  Analytical performance of the POC analysers were generally similar, however, there were significant differences in operational characteristics and ease of use. Bias for the different analytes when compared to the laboratory analyser ranged from -27% to 14%. Calculated total errors for all analytes except for HDL cholesterol were within total allowable error recommendations. The two instruments (Roche Reflotron and Cholestech LDX) with the highest overall total points achieved the highest scores for ease of use.
  
  
  CONCLUSIONS
  This pilot study has led to the development of a scoring system for the evaluation of POC instruments.
authors.affiliation: Department of Chemical Pathology, University of the Witwatersrand and National Health Laboratory Services, Parktown, Johannesburg, South Africa. verenagounden@yahoo.com
authors.forename: Verena
authors.initials: V
authors.lastname: Gounden
authors.forename: Jaya
authors.initials: J
authors.lastname: George
mesh_terms: D044966:Anti-Retroviral Agents / Q000009:adverse effects*; D001774:Blood Chemical Analysis; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis*; D050171:Dyslipidemias / Q000139:chemically induced / Q000175:diagnosis; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced / Q000175:diagnosis; D010865:Pilot Projects; D019095:Point-of-Care Systems / Q000191:economics; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013019:South Africa; D013647:Task Performance and Analysis
chemical_list: D044966:Anti-Retroviral Agents