1. INS Point-Of-Care CD4 Improves Patient Retention and Time-To-Initiation for ART in Mozambique Ilesh Jani 1, Nádia Sitoe 1, Eunice Alfai 1, Patrina Chongo 1, Jonathan Lehe 2, Beatriz Rocha 2, Jorge Quevedo 2 and Trevor Peter 2 1 Instituto Nacional de Saúde, Mozambique 2 Clinton Health Access Initiative

2. INS Background The scaling-up of ART is facing problems due to delays in ART initiation and high patient loss-to- follow-up (LTFU) These challenges are partly due to limitations in access to CD4 testing Emerging Point Of Care (POC) technologies for CD4 counting could improve patient outcomes by: Increasing access to CD4 testing Reducing LTFU after HIV diagnosis Shortening CD4 test turn-around time Reducing total time from enrollment to initiation of ART in eligible patients

3. INS Alere PIMA TM was evaluated in Mozambique and showed good agreement with the FACSCalibur TM (Bias=-50.6 cells/µL; see Jani et al. abstract THAB0104) Objective The main objective is to measure the impact of POC CD4 counting (and haemoglobin determination) implementation in primary health care settings

4. INS Methodology Pilot implementation of POC CD4 (and haemoglobin) at 7 sites Chart review for data collection performed at baseline and post- implementation (data presented for Matola Health Centre only – POC installed in the lab) Parameters measured included: –Complexity of patient process flow –Total time for enrollment to ART initiation –Access to initial CD4 result

5. INS The complexity of patients flow decreased after implementation of POC CD4 1.HIV diagnosis 2.Patient enrollment 3.CD4 requisition 4.Blood drawn 5.CD4 test performed 6.CD4 result received 7.CD4 result given to patient 8.Clinical consultation 9.ART initiation 1.HIV diagnosis 2.Patient enrollment 3.CD4 requisition, CD4 test performed, CD4 result given to patient 4.Clinical consultation 5.ART initiation Before POC CD4 After POC CD4

6. INS 44 days 89 days 21 days N=849 N=125 N=140 Total time to ART initiation was reduced from 44 days to 21 days

7. INS Patient access to initial CD4 result improved from 57% to 93%

8. INS The improvement of access to CD4 result in not uniform across all clinics Factors Limiting Universal Access To CD4 Testing: Limited HR capacity Patient overflow Clinic workflow still in process of adapting

9. INS Conclusions The Introduction of POC CD4 in Matola ART clinic resulted in: − Reduction in complexity of patients’ flow − Decrease in total time to ART initiation (from 44 days to 21 days) − Improvement in access to initial CD4 result (from 57% to 93%) The initial impact of the introduction of POC technologies may not be uniform across all sites

10. INS Next steps –Measure the impact of POC CD4 in other ART clinics involved in the pilot –Measure the impact on patient important outcomes after 6 and 12 months –Measure impact on the health system –Perform cost-efficiency analysis –Investigate needs (e.g. human resources) for large-scale implementation of POC technologies

11. INS Acknowledgements Patients Provincial Health Directorates (Maputo City, Maputo Province, Sofala, Niassa) Staff at Pilot Sites INS Staff CHAI Staff ARK UNITAID

12. INS Northern shore of Lake Niassa (Lake Malawi) - This mobile unit brings CD4/Heam