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Table 2 Acceptability and feasibility of POC CD4 test

From: Acceptability and feasibility of point-of-care CD4 testing on HIV continuum of care in low and middle income countries: a systematic review

Author (s), Year Technologies Proportion of HIV patients accepted POC CD4 test when offered Reported attributes of POC CD4 test related to day-to-day field operation System Factors associated with/having effect on acceptability/feasibility of POC CD4 test Locally specific context and operational issues which affect the deployment of POC CD4 test
Galiwango, 2014 [26] Pima   Easy to use; enable same day, on-site immunological assessment and result communication   In busy clinic, it requires 2–4 machines with additional technician to complete patient testing
van Rooyen, 2013 [21] Pima Highly acceptable at the time of learning about HIV test result (96 % of identified HIV positive individuals accepted, tested and received POC CD4 count result at a HBCT visit Feasible to be conducted at homes, as part of home-based HIV counseling and testing program, in a rural South African setting   
Mtapuri-Zinyowera, 2013 [24] Pima   Relatively low throughput, frequent error codes and cartridge rejection before expiration date. Increased technical breakdown after 1 year of operation at busy sites; major breakdowns include hardware and alignment and loss of camera focus
25 % of users reported having some challenges after machine installation of which 67 % (of cases) were resolved by the Manufacturer and 33 % by users
Users reported training was useful and relevant to day-to-day operation. Training for supervisor is needed to monitor staff performance. External quality control was a challenge because of remoteness of sites
Challenges with finger-prick sampling is also noted including that it cannot be used for full blood count (required to determine types of ARVs patient can take), high error rate led to multiple finger-prick exposing patient to more pain
Staff workload was the most prominent challenge reported by users (multiple tasks and increased workload without compensation); task shifting should be considered given prospect of additional staff employment is low
Larson, 2012 [22] Pima When offered a rapid POC CD4 test in a routine mobile HCT setting, acceptance among patients is high (90 %); only 32 /311 (10.3 %) patients declined the offer of POC CD4    
Glencross, 2012 [31] Pima    Negative impact of (poor) capillary blood sampling on POC CD4 test performance: Capillary sampling demands absolute diligence and stringency of sampling technique. Ongoing dedicated training as well as implementation of systems for monitoring and evaluation of testing is strongly recommended  
Thakar, 2012 [25] Pima   Users expressed that PIMA was compact and hence could fit in the small space available at the centers. It is battery operated, showed a battery backup of 3–4 h eliminating requirement of continuous electricity Study participants preferred to give venous blood sample because of requirement of blood collection for other investigations using venous blood and a fear of being subjected to multiple pricks if sufficient volume of blood is not obtained in a single prick  
Manabe, 2012 [27] Pima   Easy-to-use, portable, relatively fast device to test CD4+ T cell counts in the field Quality control and observed practical training for test operators would be required to ensure that good volume and flow of blood (capillary) is obtained  
Jani, 2011 [28] Pima   Essential WHO-recommended ART staging and monitoring diagnostic tests can be accurately conducted at primary health care clinic level by non-laboratory staff using POC CD4 test Operators should be trained for finger prick testing and their performance should be regularly monitored as training and monitoring has been shown to be essential to the ongoing reliability of other POC CD4 test Implementation of POC CD4 in primary health care clinics requires careful planning. Task shifting of ART services to community clinics places additional strain on the workloads of nurses and other healthcare workers that may be unsustainable
Mtapuri-Zinyowera, 2010 [23] Pima The offer of POC CD4 testing within post-test counseling was accepted by almost all eligible clients, even within the context of a study and the need to provide informed consent. POC CD4 testing can be performed in non-laboratory setting by non-laboratory technicians (nurses) It is important to ensure that Pima test operators are well trained on finger-prick sample collection. Preliminary observations in this study suggest that incorrect finger-prick sampling affects the reliability of POC CD4 results  
Wade, 2014 [30] Pima    Significant contribution of operators to variability of POC CD4 test results: dedicated training for test operators, particularly on capillary blood sampling is required to ensure quality of POC CD4  
Mwau, 2014 [7] MyT4   Relatively high throughput: over 20 tests/6 h health facility working day   Implementation would be most effective by assigning a dedicated full time operator
Arnet N, 2013 [29] Pima   100 % (11/11) HCW interviewed trust Pima venous CD4 results; 91 % (10/11) for Pima Microtube and 82 % (9/11) for Pima direct. The most preferred sample collection method was Pima venous 73 % (8/11)   
  1. HBCT home-based HIV counseling and testing