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J Acquir Immune Defic Syndr. 2014 Feb 1;65(2):e74-8. doi: 10.1097/QAI.0b013e3182a20e74.

A novel community health worker tool outperforms WHO clinical staging for assessment of antiretroviral therapy eligibility in a resource-limited setting.

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*Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; †TB and HIV Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi; ‡Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom; §Department of Pathology and Laboratory Medical Sciences, College of Medicine, University of Malawi, Blantyre, Malawi; ‖Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; and ¶HIV Department, Ministry of Health, Lilongwe, Malawi.


The accuracy of a novel community health worker antiretroviral therapy eligibility assessment tool was examined in community members in Blantyre, Malawi. Nurses independently performed World Health Organization (WHO) staging and CD4 counts. One hundred ten (55.6%) of 198 HIV-positive participants had a CD4 count of <350 cells per cubic millimeter. The community health worker tool significantly outperformed WHO clinical staging in identifying CD4 count of <350 cells per cubic millimeter 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 antiretroviral therapy initiation.

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