International Journal of STD & AIDS > Volume 20, Number 6 > Pp. 395-398

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Original research articles

Initiating antiretroviral treatment in a resource-constrained setting: does clinical staging effectively identify patients in need?

K Torpey MD MPH ^* , M Lartey MD FWACP , R Amenyah MD MPH , N A Addo MD MPH , J Obeng-Baah MD ^**, Y Rahman BSc , C Suzuki PhD , Y D Mukadi MD MPH  and R Colebunders MD PhD 

^* Family Health International, P.O. Box 320303, Lusaka, Zambia; Department of Medicine, KorleBu Teaching Hospital/University of Ghana Medical School; Ghana AIDS Commission; National AIDS Control Program/Ministry of Health, Accra; ^** Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi; Family Health International, Accra, Ghana; Family Health International, 4401 Wilson Boulevard, Arlington, VA 22203, USA; Institute of Tropical Medicine, Nationalestraat 155, Antwerp B-2000, Belgium

Correspondence to: Dr K Torpey Email: Ktorpey{at}zpct.org

In industrialized countries, the initiation of antiretroviral therapy (ART) is based on virological, immunological and clinical markers. The objective of this study was to identify treatment gaps when ART initiation is based on clinical staging alone. The method employed was a retrospective study of 5784 patients enrolled in an HIV treatment programme in two urban and two rural sites in Ghana. Of the patients, 29.5% were in clinical Stages I and II and had a CD4+ T-lymphocyte count less than 200 cells/mm³. Significantly more patients in clinical Stage I from urban sites (37.0%) had a CD4+ T-lymphocyte count less than 200 cells/mm³ as compared with patients from rural sites (23.8%) (P value <0.05). In addition, more men (39.9%) in clinical Stage I had a CD4+ T-lymphocyte count less than 200 cells/mm³ when compared with women (27.4%) (P value <0.05). In conclusion, clinical staging cannot identify a relatively large number of patients who need ART. A wider availability of CD4+ T-lymphocyte count testing will optimize the identification of patients eligible for ART.

Key Words: clinical staging • CD4 • Ghana • ART eligibility • gender

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