title: Acceptability and feasibility of point-of-care CD4 testing on HIV continuum of care in low and middle income countries: a systematic review.
abstract: CD4 testing is, and will remain an important part of HIV treatment and care in low and middle income countries (LMICs). We report the findings of a systematic review assessing acceptability and feasibility of POC CD4 testing in field settings.
  
  
  
  Electronic databases were searched for studies published in English between 2005 and 2015 that describe POC CD4 platforms. Studies conducted in LMICs and under field conditions outside a laboratory environment were eligible. Qualitative and descriptive data analysis was used to present the findings.
  
  
  
  Twelve studies were included, 11 of which were conducted in sub-Saharan countries and used one POC CD4 test (The Alere Pima CD4). Patients reported positively regarding the implementation of POC CD4 testing at primary health care and community level with ≥90 % of patients accepting the test across various study settings. Health service providers expressed preference toward POC CD4 testing as it is easy-to-use, efficient and satisfied patients' needs to a greater extent as compared to conventional methods. However, operational challenges including preference toward venous blood rather than finger-prick sampling, frequent device failures and operator errors, quality of training for test operators and supervisors, and increased staff workload were also identified.
  
  
  
  POC CD4 testing seems acceptable and feasible in LIMCs under field conditions. Further studies using different POC CD4 tests available on the market are required to provide critical data to support countries in selection and implementation of appropriate POC CD4 technologies.
authors.affiliation: Burnet Institute, Melbourne, VIC, Australia. minh.pham@burnet.edu.au.|Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia. minh.pham@burnet.edu.au.
authors.forename: Minh D
authors.initials: MD
authors.lastname: Pham
authors.affiliation: Burnet Institute, Melbourne, VIC, Australia.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Agius
authors.affiliation: The Alfred Hospital, The Ian Potter Library, Melbourne, VIC, Australia.
authors.forename: Lorena
authors.initials: L
authors.lastname: Romero
authors.affiliation: Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: McGlynn
authors.affiliation: Burnet Institute, Melbourne, VIC, Australia.|Department of Immunology, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Anderson
authors.affiliation: Burnet Institute, Melbourne, VIC, Australia.|Department of Infectious Diseases, The Alfred hospital Melbourne, Melbourne, Australia.|Monash School of Medicine, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia.
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Crowe
authors.affiliation: Burnet Institute, Melbourne, VIC, Australia.|Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia.|International Centre for Reproductive Health, Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
authors.forename: Stanley
authors.initials: S
authors.lastname: Luchters
mesh_terms: D000328:Adult; D001800:Blood Specimen Collection; D018791:CD4 Lymphocyte Count; D003266:Continuity of Patient Care; D003906:Developing Countries; D004868:Equipment Failure; D005260:Female; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010549:Personal Satisfaction; D000067716:Point-of-Care Testing; D011320:Primary Health Care
keywords: CD4; Pima; Point-of-care testing; acceptability; feasibility; systematic review