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BMJ 2011; 343 doi: http://dx.doi.org/10.1136/bmj.d6311 (Published 05 October 2011) Cite this as: BMJ 2011;343:d6311

Treatment rates improve after HIV clinics switch to point of care CD4 tests

When four primary care clinics in Mozambique introduced point of care testing for CD4 cell counts, the median delay between HIV diagnosis and antiretroviral treatment fell from 48 days to 20 days, and the proportion of patients who dropped out of care before receiving treatment fell from 64% (314/492) to 33% (142/437) (adjusted odds ratio 0.27, 95% CI 0.21 to 0.36).

Clinics made the switch from off-site laboratory testing to a point of care test in spring 2010, to streamline the complex pathway between diagnosis and treatment. Only a minority of patients in resource poor settings currently make it all the way, and the staging process that determines eligibility for antiretroviral drugs is one of the biggest hurdles, say researchers. An observational analysis comparing patient flow before and after the switch suggests that the new, faster CD 4 cell count helped retain patients in the care pathway. Losses to follow-up between diagnosis and completion of staging fell from 57% (278/492) to 21% (92/437) (0.2, 0.15 to 0.27).

The study included close to 1000 adults and children with a new diagnosis of HIV, split evenly before and after the clinics introduced point of care CD4 tests. Median CD4 cell counts were around 300 per µL in both groups. Just over two thirds of the participants were female, mostly young women.

Plant extract helps smokers in Poland to quit

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Cytisine, a plant extract, has been available for decades as an aid to smoking cessation in some eastern European countries. The extract is much cheaper than alternative oral treatments, such as bupropion and varenicline, and a placebo controlled trial shows it can work. Polish adults who took a 25 day course were significantly more likely to quit for good than controls who took a …

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