Testing for CD4 T-cells is a critical part of care for HIV/AIDS patients, which shows doctors how the disease is progressing.

But a new study finds that analyzing the CD4 tests right at the clinic or doctor’s office — so-called “point-of-care” — can help patients in poor countries.

CD4 blood tests are normally sent out for laboratory processing, which requires the patient to make a return visit to get results. Patients who live a long way from the clinic, for example, may decide not to come back.

But one study of CD4 point-of-care testing shows that patients who get the results right away may have increased odds for successful treatment.

“They can actually be told how immunosuppressed they are and what that means for the next steps in their care,” said Emily P. Hyle, MD, of Massachusetts General Hospital, the study’s lead author.

Using a mathematical analysis based on data from Mozambique, Hyle and her colleagues calculated that patients with access to point-of-care CD4 tests would live longer than those whose CD4 tests were done at a distant laboratory.

“Because it can have a big impact on the number of patients who actually get that CD4 test back in their hands, for the additional cost … of the point-of-care CD4 [test] that we found it to actually be quite cost-effective,” she said in a telephone interview.

That assessment is based on World Health Organization definitions, which look at the cost of a health-care activity against a country’s per-capita Gross Domestic Product.

It’s somewhat complicated to compute the cost per test, which can vary considerably depending on how many tests are done at a particular clinic. But Hyle says it might be an additional $10 or $20 per test, compared with sending a specimen off to a central laboratory.

Hyle stresses that improving access to the CD4 test only helps when it actually leads to better use of anti-retroviral medicines.

“In order for the point-of-care tests to be worth an investment, you also have to have the capacity within the community to start anti-retroviral therapy for these patients,” she said.

It’s estimated that fewer than two-thirds of people in low- and middle-income countries who should be getting anti-AIDS drugs are getting the medicine they need.

The study is published in the journal PLOS Medicine.
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