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Lippincott, Williams & Wilkins, Journal of Acquired Immune Deficiency Syndromes, 2(65), p. e74-e78, 2014

DOI: 10.1097/qai.0b013e3182a20e74

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A Novel Community Health Worker Tool Outperforms WHO Clinical Staging for Assessment of Antiretroviral Therapy Eligibility in a Resource-Limited Setting

Journal article published in 2014 by Peter MacPherson, David G. Lalloo, Deus Thindwa ORCID, Emily L. Webb, S. Bertel Squire, Dip Clin Med, S. Bertel Squire, Geoffrey A. Chipungu, Nicola Desmond ORCID, Simon D. Makombe, Miriam Taegtmeyer, Augustine T. Choko, Elizabeth L. Corbett
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Abstract

The accuracy of a novel community health worker (CHW) ART eligibility assessment tool was examined in community members in Blantyre, Malawi. Nurses independently performed WHO staging and CD4 counts. 110 (55.6%) of 198 HIV-positive participants had a CD4 count of <350 cells/mm. The CHW tool significantly outperformed WHO clinical staging in identifying CD4<350 cells/mm in terms of sensitivity (41% vs. 19%), positive predictive value (75% vs. 68%), negative predictive values (53% vs. 47%) and area under the receiver-operator curve (0.62 vs. 0.54, p=0.017). Reliance on WHO staging is likely to result in missed and delayed ART initiation.