title: Feasibility of performing multiple point of care testing for HIV anti-retroviral treatment initiation and monitoring from multiple or single fingersticks.
abstract: BACKGROUND
  Point of Care testing (POCT) provides on-site, rapid, accessible results. With current South African anti-retroviral treatment guidelines, up to 4 fingersticks /patient/clinic visit could be required if utilizing POC. We determined the feasibility and accuracy of a nurse performing multiple POCT on multiple fingersticks followed by simplification of the process by performance of multiple POC on a single fingerstick.
  
  
  RESULTS
  Random HIV positive adult patients presenting at a HIV treatment clinic in South Africa, for ART initiation/ monitoring, were approached to participate in the study between April-June 2012. Phase I: n=150 patients approached for multiple POCT on multiple fingersticks. Phase II: n=150 patients approached for multiple POCT on a single fingerstick. The following POC tests were performed by a dedicated nurse: PIMA (CD4), HemoCue (hemoglobin), Reflotron (alanine aminotransferase, creatinine). A venepuncture specimen was taken for predicate laboratory methodology. Normal laboratory ranges and Royal College of Pathologists Australasia (RCPA) allowable differences were used as guidelines for comparison. In 67% of participants, ≥3 tests were requested per visit. All POCT were accurate but ranged in variability. Phase I: Hemoglobin was accurate (3.2%CV) while CD4, alanine aminotransferase and creatinine showed increased variability (16.3%CV; 9.3%CV; 12.9%CV respectively). PIMA generated a misclassification of 12.4%. Phase II: Hemoglobin, alanine aminotransferase and creatinine showed good accuracy (3.2%CV, 8.7%CV, 6.4%CV respectively) with increased variability on CD4 (12.4%CV) but low clinical misclassification (4.1%). No trends were observed for the sequence in which POC was performed on a single fingerstick. Overall, PIMA CD4 generated the highest error rate (16-19%).
  
  
  CONCLUSIONS
  Multiple POCT for ART initiation and/or monitoring can be performed practically by a dedicated nurse on multiple fingersticks. The process is as accurate as predicate methodology and can be simplified using a single fingerstick.
authors.affiliation: Department of Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
authors.forename: Natasha
authors.initials: N
authors.lastname: Gous
authors.affiliation: Department of Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
authors.forename: Lesley
authors.initials: L
authors.lastname: Scott
authors.affiliation: Department of Haematology, Tshwane Academic Division and University of Pretoria, Pretoria, South Africa ; National Health Laboratory Service, Johannesburg, South Africa.
authors.forename: Joachim
authors.initials: J
authors.lastname: Potgieter
authors.affiliation: Department of Haematology, Tshwane Academic Division and University of Pretoria, Pretoria, South Africa ; National Health Laboratory Service, Johannesburg, South Africa.
authors.forename: Lumka
authors.initials: L
authors.lastname: Ntabeni
authors.affiliation: Department of Haematology, Tshwane Academic Division and University of Pretoria, Pretoria, South Africa ; National Health Laboratory Service, Johannesburg, South Africa.
authors.forename: Sharon
authors.initials: S
authors.lastname: Enslin
authors.affiliation: Department of Haematology, Tshwane Academic Division and University of Pretoria, Pretoria, South Africa ; National Health Laboratory Service, Johannesburg, South Africa.
authors.forename: Ronel
authors.initials: R
authors.lastname: Newman
authors.affiliation: Department of Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa ; National Health Laboratory Service, Johannesburg, South Africa.
authors.forename: Wendy
authors.initials: W
authors.lastname: Stevens
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D001800:Blood Specimen Collection / Q000379:methods*; D015704:CD4 Antigens / Q000097:blood; D003404:Creatinine / Q000097:blood; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D054539:Medication Therapy Management; D019095:Point-of-Care Systems; D013019:South Africa
chemical_list: D015704:CD4 Antigens; D006454:Hemoglobins; D003404:Creatinine; D000410:Alanine Transaminase