allAfrica.com: Malawi: CD4 Count Testing More Effective than WHO Staging (Page 1 of 1)

WHO Clinical Staging, one of the criteria used to tell whether an HIV positive person is eligible for Antiretroviral Treatment (ART) may not be sufficient to identify those needing ART if government does not take an initiative to make Cluster of Differentiation CD4 Count testing easily accessible to infected people living under debilitated conditions in rural areas.

Of the two criteria, CD4 count testing is reported to have increased the identification of people with HIV who are eligible for antiretroviral therapy by 21% over 2% of the World Health Organisation Clinical Staging (commonly known as WHO Staging).

According to a Research Specialist at the UNC Project, Innocent Mofolo, 70% of HIV positive pregnant women who need treatment at the time of presentation are identified through CD4 Count but only 4% would be identified based on staging.

"There are cases of people living with the virus who do not have the symptoms and signs used in WHO Staging but their defence mechanism requires them to go for ART and the only way to tell if they are eligible for the treatment would be through CD4 Count testing," said Mofolo.

HIV and Aids Coordinator for Likuni Hospital, Joe Kamalizeni, said the hospital's Voluntary Counselling and Testing Centre identify most clients for ART through WHO Staging.

"About 80 per cent of our clients have been identified for antiretroviral therapy through staging," affirmed Kamalizeni.

These statistics may present a picture depicting that most people in the country are not ready for ART because they do not have access to CD4 Count testing when they are identified for ART by the WHO staging.

Kamalizeni, however, attributes the variation to poverty saying most people in rural areas cannot afford the cost of more than 1, 000 Kwacha for CD4 Count testing and opt for WHO Clinical Staging, which is free.

Lilongwe Diocese Home-Based Care Coordinator, Margaret Moyo, concurred with Kamalizeni.

"There are very few medical institutions in the country, especially here in the central region, that are offering CD4 Count testing services and the services being at a cost are not easily accessible to poor people in rural areas," said Moyo.

In the central region, CD4 Count is accessed at the University of North Carolina (UNC) Project laboratories through other facilities such as the Lighthouse. Only those who go for CD4 count through the Lighthouse have the cost subsidized by the National Aids Commission (NAC), according to UNC Country Director, Dr Francis Martinson.

Innocent Mofolo of the UNC Project says appropriate initiation of ART in eligible pregnant women will improve maternal health and reduce transmission to the infant, therefore CD4 count testing should be implemented routinely in Antenatal clinics.

"Coordination with the local ART clinics is essential to limit transport costs as well as required visits to the clinic and other barriers to ART initiation during pregnancy need to be explored," says Mofolo.

The statistics given by the UNC and Likuni Hospital HIV/Aids VCT Centre indicate that many HIV positive people in Malawians are dying as they are not given ART on grounds that they are not yet eligible for the life-prolonging drugs.

There is need for government to put the issue of making CD4 Count testing on the agenda if cases of the transmission of the virus as well as access to ART for poor people in the rural areas are to be promoted, while trying to reduce the HIV infection rate of the virus, which currently is at 14%.

Of major concern, also, are issues related to the prevention of mother to child transmission of HIV whose objective is to reduce the risk of mother to child transmission through integrated HIV/Aids education, routine counselling and testing and administration of prophylaxis single dose Nevirapine therapy to mother/infant pairs.

Having qualified for the global fund continued funding, stakeholders in the country need to put extra effort in ensuring that the programmes funded through this grant present convincing evidence of performance, impact, or the potential for impact on the general population. This includes the specific target groups such as people living with HIV; orphans and other vulnerable; youths; people of the reproductive age group; antenatal attendee; ART patients and TB patients.

Chairperson of Malawi Global Fund Coordinating Committee, Randson Mwadiwa, confirmed Malawi's qualification. He said the Round One Funding of USD 178 million that NAC received in 2003 was for scaling up of HIV Testing and Counselling (HTC), prevention of Mother to Child Transmission (PMTCT) of HIV, Management of Opportunistic Infections including procurement of Antiretroviral (ARV) drugs, Community Home-Based Care (CHBC), Health Systems Strengthening (HSS) and Institutional Support.

"It is with this grant that among other achievements, the country has seen an increase in the number of people tested for HIV from about 40,000 in the year 2002 to about 1.8 million people now. The number of people ever started on antiretroviral treatment (ART) increased from 4, 000 in 2004 to over 100, 000 by June 2007," affirmed Mwadiwa.

The situation should be a wake up call to all stakeholders, primarily government. In order to enhance the achievements registered so far, much more needs to be done to continue the fight against the pandemic by initiating the availability and accessibility of CD4 Count testing equipment close to the poor people especially in rural areas.

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