Abstract

COETZEE, L M; CASSIM, N  and  GLENCROSS, D K. Analysis of HIV disease burden by calculating the percentages of patients with CD4 counts <100 cells/μL across 52 districts reveals hot spots for intensified commitment to programmatic support. SAMJ, S. Afr. med. j. [online]. 2017, vol.107, n.6, pp.507-513. ISSN 2078-5135.  http://dx.doi.org/10.7196/samj.2017.v107i6.11311.

BACKGROUND. South Africa (SA)'s Comprehensive HIV and AIDS Care, Management and Treatment (CCMT) programme has reduced new HIV infections and HIV-related deaths. In spite of progress made, 11.2% of South Africans (4.02 million) were living with HIV in 2015. OBJECTIVE. The National Health Laboratory Service (NHLS) in SA performs CD4 testing in support of the CCMT programme and collates data through the NHLS Corporate Data Warehouse. The objective of this study was to assess the distribution of CD4 counts <100 cell/μL (defining severely immunosuppressed HIV-positive patients) and >500 cells/μL (as an HIV-positive 'wellness' indicator). METHODS. CD4 data were extracted for the financial years 2010/11 and 2014/15, according to the district where the test was ordered, for predefined CD4 ranges. National and provincial averages of CD4 counts <100 and >500 cell/μL were calculated. Data were analysed using Stata 12 and mapping was done with ArcGIS software, reporting percentages of CD4 counts <100 and >500 cell/μL by district. RESULTS. The national average percentage of patients with CD4 counts <100 cell/μL showed a marked decrease (by 22%) over the 5-year study period, with a concurrent increase in CD4 counts >500 cell/μL (by 57%). District-by-district analysis showed that in 2010/11, 44/52 districts had >10% of CD4 samples with counts <100 cell/μL, decreasing to only 17/52 districts by 2014/15. Overall, districts in the Western Cape and KwaZulu-Natal had the lowest percentages of CD4 counts <100 cell/μL, as well as the highest percentages of counts >500 cell/μL. In contrast, in 2014/15, the highest percentages of CD4 counts <100 cell/μL were noted in the West Rand (Gauteng), Vhembe (Limpopo) and Nelson Mandela Bay (Eastern Cape) districts, where the lowest percentages of counts >500 cell/μL were also noted. CONCLUSIONS. The percentages of CD4 counts <100 cell/μL highlighted here reveal districts with positive change suggestive of programmatic improvements, and also highlight districts requiring local interventions to achieve the UNAIDS/SA National Department of Health 90-90-90 HIV treatment goals. The study further underscores the value of using NHLS laboratory data, an underutilised national resource, to leverage laboratory test data to enable a more comprehensive understanding of programme-specific health indicators.

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