Cost-Consequences Evaluation of POC Test for CD4 Cells in Brazilian Health System

Background:  The Brazilian response against AIDS has been seen as a success story and it is frequently cited as a model for other developing countries facing the AIDS epidemic. The Brazilian National AIDS Program (NAP) has been working to guarantee the universal provision of antiretroviral (ARV) drugs and a free quality treatment for AIDS patients. In Brazil, the expansion of ART program into rural areas, such as Amazon region, brings the necessity to improve the laboratory logistics to carry out patients needs all over the country and CD4 rapid test has been shown as an interesting tool to improve the ART range. CD4 rapid test or point of care (POC) can reduce the logistical barriers and delays in timely dissemination of CD4 results for AIDS patients. At the end, it reflects in the quality of treatment, reducing delay in intervention or loss of follow-up care.

Methods:  A costing instrument was designed to collect cost data related to ART treatment. The costs related to both tests (standard CD4 and POC CD4) were collected and compared. In addition, a sort of different scenarios and benefits related to the introduction of POC test for CD4 cells were identified and organized in different group of information (geographic, logistics, etc.).

Results:  The analysis of costing instrument data denotes a similar estimated costs for each CD4 test strategies. The cost analysis demonstrated that the introduction of POC CD4 test can be a feasible strategy, and also can reflect in the quality of ART treatment, especially in Amazon region

Conclusions:  The introduction of POC CD4 test can alleviate testing burdens at centralized laboratories (LACEN) and also it can improve CD4 test access in rural areas, such as Amazon region. In terms of patient needs, it can bring more quality for AIDS treatment, reducing delay in intervention or loss of follow-up care.