title: Implementation of Point-of-Care Diagnostics Leads to Variable Uptake of Syphilis, Anemia and CD4+ T-Cell Count Testing in Rural Maternal and Child Health Clinics.
abstract: BACKGROUND
  Anemia, syphilis and HIV are high burden diseases among pregnant women in sub-Saharan Africa. A quasi-experimental study was conducted in four health facilities in Southern Mozambique to evaluate the effect of point-of-care technologies for hemoglobin quantification, syphilis testing and CD4+ T-cell enumeration performed within maternal and child health services on testing and treatment coverage, and assessing acceptability by health workers.
  
  
  METHODS
  Demographic and testing data on women attending first antenatal care services were extracted from existing records, before (2011; n = 865) and after (2012; n = 808) introduction of point-of-care testing. Study outcomes per health facility were compared using z-tests (categorical variables) and Wilcoxon rank-sum test (continuous variables), while inverse variance weights were used to adjust for possible cluster effects in the pooled analysis. A structured acceptability-assessment interview was conducted with health workers before (n = 22) and after (n = 19).
  
  
  RESULTS
  After implementation of point-of-care testing, there was no significant change in uptake of overall hemoglobin screening (67.9% to 83.0%; p = 0.229), syphilis screening (80.8% to 87.0%; p = 0.282) and CD4+ T-cell testing (84.9% to 83.5%; p = 0.930). Initiation of antiretroviral therapy for treatment eligible women was similar in the weighted analysis before and after, with variability among the sites. Time from HIV diagnosis to treatment initiation decreased (median of 44 days to 17 days; p<0.0001). A generally good acceptability for point-of-care testing was seen among health workers.
  
  
  CONCLUSIONS
  Point-of-care CD4+ T-cell enumeration resulted in a decreased time to initiation of antiretroviral therapy among treatment eligible women, without significant increase in testing coverage. Overall hemoglobin and syphilis screening increased. Despite the perception that point-of-care technologies increase access to health services, the variability in results indicate the potential for detrimental effects in some settings. Local context needs to be considered and services restructured to accommodate innovative technologies in order to improve service delivery to expectant mothers.
authors: Elizabeth Glaser Pediatric AIDS Foundation, Maputo, Mozambique.
authors: Caroline
authors: C
authors: De Schacht
authors: Elizabeth Glaser Pediatric AIDS Foundation, Maputo, Mozambique.
authors: Carlota
authors: C
authors: Lucas
authors: Instituto Nacional de Saúde, Maputo, Mozambique.
authors: Nádia
authors: N
authors: Sitoe
authors: Elizabeth Glaser Pediatric AIDS Foundation, Washington DC, United States of America.
authors: Rhoderick
authors: R
authors: Machekano
authors: Instituto Nacional de Saúde, Maputo, Mozambique.
authors: Patrina
authors: P
authors: Chongo
authors: International Centre for Reproductive Health, Department of Obstetrics and Gynecology, Ghent University, Ghent, Belgium.
authors: Marleen
authors: M
authors: Temmerman
authors: Clinton Health Access Initiative, Maputo, Mozambique.
authors: Ocean
authors: O
authors: Tobaiwa
authors: Elizabeth Glaser Pediatric AIDS Foundation, Washington DC, United States of America; Department of Epidemiology and Biostatistics, The George Washington University, Milken Institute School of Public Health, Washington DC, United States of America.
authors: Laura
authors: L
authors: Guay
authors: Elizabeth Glaser Pediatric AIDS Foundation, Washington DC, United States of America.
authors: Seble
authors: S
authors: Kassaye
authors: Instituto Nacional de Saúde, Maputo, Mozambique.
authors: Ilesh V
authors: IV
authors: Jani
mesh_terms: D000328:Adult; D000740:Anemia / Q000175:diagnosis*; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count / Q000379:methods; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D008430:Maternal-Child Health Centers; D009073:Mozambique; D019095:Point-of-Care Systems / Q000706:statistics & numerical data*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis; D011296:Prenatal Diagnosis; D012189:Retrospective Studies; D019035:Rural Health Services; D011795:Surveys and Questionnaires; D013587:Syphilis / Q000175:diagnosis*; D013588:Syphilis Serodiagnosis / Q000379:methods; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents