The Sunday Mail
Shamiso Yikoniko
Health Reporter
Defective CD4 count machines have forced some health institutions to revert back to using the World Health Organisation clinical staging method when initiating people living with HIV on anti-retroviral drugs, it has emerged.
This development risks reversing the gains achieved so far in the fight against HIV in the country.
A CD4 count machine helps to indicate the strength of one’s immune system so as to assist doctors in determining when a person living with HIV may start taking ARVs.
WHO clinical stages three and four determines that one may be initiated on ART.
Stage three presents symptoms such as unexplained weight loss, unexplained chronic diarrhoea, oral candidiasis, unexplained anaemia and pulmonary tuberculosis, among others.
Stage four symptoms include HIV wasting syndrome, pneumonia, oesophageal candidiasis and Kaposi sarcoma, among others.
Health centres that have defective CD4 count machines are initiating ARVs once a person living with HIV shows symptoms articulated in either WHO clinical stage three or four.
Midlands Province acting provincial medical director, Dr Mary Muchekeza supported clinical staging for initiation in the absence of a CD4 count machine.
“We are emphasising on clinical staging for the initiation of ART at our health institutions which don’t have functional CD4 count machines because we are aware of our inadequacies,” she said.
“Our hope is to have CD4 count machines at each ART initiating facility but we are highly donor-dependent on HIV programmes.
However, we continue to lobby for funds.”
However, Dr Mugurungi stressed the importance of CD4 testing.
“CD4 testing is the gateway for identifying individuals in WHO stage one and two who need ART. When a person presents symptoms in the first two stages, it’s highly unlikely that the health practitioners identifies that the person is in need of ART,” he said.
“Those who present symptoms in stages three and four are most likely to have their CD4 count cells around 200 or less which goes against our national strategy,” he said.
Zimbabwe is currently initiating people living with HIV on ART at a CD4 count of 500 or less.
This is in tandem with the 2013 WHO guidelines on HIV treatment.
Findings by the WHO reveal that early treatment for people living with HIV reduces mortality and reduction in tuberculosis incidence.
The director of AIDS and TB unit in the Ministry of Health and Child Care, Dr Owen Mugurungi, blamed the shortage of the machines to mismanagement in hospitals.
“A number of review teams have been dispatched to all provinces to find out the problems that hospitals are facing.
The report we got from some sites in Midlands, for example, is that the shortage of CD4 count machines is an issue of management,” he explained.
“CD4 count machines distributed to the country’s hospitals are under service contract(s) which means that whenever a CD4 machine malfunctions, the hospital management has to contact a local agent of the supplier of that machines to get it fixed.”
With an HIV prevalence rate standing at 15 percent, the country currently has around 665 299 people on ART.
