title: Assessment of laboratory test utilization for HIV/AIDS care in urban ART clinics of Lilongwe, Malawi.
abstract: BACKGROUND
  The 2011 Malawi HIV guidelines promote CD4 monitoring for pre-ART assessment and considering HIVRNA monitoring for ART response assessment, while some clinics used CD4 for both. We assessed clinical ordering practices as compared to guidelines, and determined whether the samples were successfully and promptly processed.
  
  
  METHODS
  We conducted a retrospective review of all patients seen in from August 2010 through July 2011,, in two urban HIV-care clinics that utilized 6-monthly CD4 monitoring regardless of ART status. We calculated the percentage of patients on whom clinicians ordered CD4 or HIVRNA analysis. For all samples sent, we determined rates of successful lab-processing, and mean time to returned results.
  
  
  RESULTS
  Of 20581 patients seen, 8029 (39%) had at least one blood draw for CD4 count. Among pre-ART patients, 2668/2844 (93.8%) had CD4 counts performed for eligibility. Of all CD4 samples sent, 8082/9207 (89%) samples were successfully processed. Of those, mean time to processing was 1.6 days (s.d 1.5) but mean time to results being available to clinician was 9.3 days (s.d. 3.7). Regarding HIVRNA, 172 patients of 17737 on ART had a blood draw and only 118/213 (55%) samples were successfully processed. Mean processing time was 39.5 days (s.d. 21.7); mean time to results being available to clinician was 43.1 days (s.d. 25.1). During the one-year evaluated, there were multiple lapses in processing HIVRNA samples for up to 2 months.
  
  
  CONCLUSIONS
  Clinicians underutilize CD4 and HIVRNA as monitoring tools in HIV care. Laboratory processing failures and turnaround times are unacceptably high for viral load analysis. Alternative strategies need to be considered in order to meet laboratory monitoring needs.
authors.affiliation: Johns Hopkins Bayview Medical Center, Baltimore, MD, USA ; University of North Carolina Project, Lilongwe, Malawi.
authors.forename: Sonali
authors.initials: S
authors.lastname: Palchaudhuri
authors.affiliation: Lighthouse Trust, Lilongwe, Malawi; 4University of North Carolina School of Medicine, Chapel Hill, USA.
authors.forename: Hannock
authors.initials: H
authors.lastname: Tweya
authors.affiliation: University of North Carolina Project, Lilongwe, Malawi.
authors.forename: Mina
authors.initials: M
authors.lastname: Hosseinipour
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000379:methods* / Q000458:organization & administration; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation / Q000458:organization & administration*; D012189:Retrospective Studies; D013997:Time Factors; D014505:Urban Population / Q000706:statistics & numerical data; D019562:Viral Load; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents