The Sensitivity and Specificity of WHO clinical Staging in Predicting Cd4 Cell Counts in HIV Infected Patients at the Police Hospital in Accra, Ghana

Abstract

Introduction : Initiating an HIV positive client on ART is an important step in the care of PLHIV. Due to a shortage of CD4 machines and reagents, the WHO clinical staging guideline is widely used to determine when to initiate ART in developing countries.Objective : To determine whether WHO clinical staging is predictive of CD4 of 350 in initiation of ART in patients presenting at the Police Hospital ART clinic.Methods : We reviewed the records of clients on ART, from 2010 to 2012 and compared the WHO clinical staging and CD4 counts at their first visit to the clinic. Pregnant women, hepatitis B infected patients and children below fifteen were excluded from the study.Results : Two hundred and five PLHIVs were eligible for inclusion in the study. Sensitivity of the WHO Clinical staging to predict initiation of ART was 44% and specificity 87%. Positive predictive power was 83% and Negative predictive power was 51%.Conclusion : Almost 50% of those needing ART as per CD4 count were classified as WHO stage 1 or 2. This means that about half of those deemed not qualified to start ART by WHO clinical staging actually needed to be initiated on ART. Access to CD4 machines andreagents must be increased to minimize delay in start of treatment for patients.