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PIMA Point of Care CD4+ Cell Count Machines in Remote MNCH Settings: Lessons Learned from Seven Districts in Zimbabwe
Sekesai Mtapuri-Zinyowera1, Edward T Chiyaka2, Wellington Mushayi3
1National Microbiology Reference Laboratory, Harare, Zimbabwe.
Insights
Point-of-care CD4+ count machines significantly reduced antiretroviral treatment initiation time in Zimbabwe. These PIMA machines improved maternal and child health services by enabling faster ART access.
Area of Science:
- Public Health
- Medical Technology
- HIV/AIDS Research
Background:
- Maternal and new-born child health settings require efficient diagnostic tools.
- Scaling up new technologies like point-of-care (POC) CD4+ count machines presents implementation challenges.
- Antiretroviral treatment (ART) initiation is critical for positive patient outcomes.
Purpose of the Study:
- To evaluate the impact of PIMA POC CD4+ count machines in Zimbabwean maternal and new-born child health settings.
- To document best practices, lessons learned, and challenges in scaling up this technology.
- To assess the effect of POC CD4+ testing on ART initiation timelines.
Main Methods:
- Mixed-methods approach combining 31 in-depth stakeholder interviews.
- Data abstraction from 207 patient records at 35 sites using PIMA POC machines.
- Comparative analysis with 10 sites lacking PIMA POC machines.
Main Results:
- A clearer training strategy is essential for effective implementation.
- ART initiation time was substantially reduced at sites with PIMA POC machines (15 days vs. 32.7 days).
- Stakeholder satisfaction was generally high due to the presence of POC machines facilitating ART initiation.
Conclusions:
- PIMA POC CD4+ count machines are effective in accelerating ART initiation in resource-limited settings.
- Successful scale-up requires addressing training needs and optimizing workflows.
- The technology positively impacts maternal and child health by improving access to timely HIV treatment.
Abstract:
An evaluation was commissioned to generate evidence on the impact of PIMA point-of-care CD4+ count machines in maternal and new-born child health settings in Zimbabwe; document best practices, lessons learned, challenges, and recommendations related to scale up of this new technology. A mixed methodology approach that included 31 in-depth interviews with stakeholders involved in procurement, distribution, and use of the POC machines was employed. Additionally, data was also abstracted from 207 patient records from 35 sites with the PIMA POC CD4+ count machines and 10 other comparative sites without the machine. A clearer training strategy was found to be necessary. The average time taken to initiate clients on antiretroviral treatment (ART) was substantially less, 15 days (IQR-1-149) for sites with a PIMA POC machine as compared to 32.7 days (IQR-1-192) at sites with no PIMA POC machine. There was general satisfaction because of the presence of the PIMA POC CD4+ count machine at sites that also initiated ART.
