Diagnostic accuracy of the WHO clinical staging system for defining eligibility for ART in sub-Saharan Africa

Abstract

The World Health Organization recommends that HIV-positive adults with CD4 count ≤500 cells/mm3 initiate antiretroviral therapy (ART). In many countries of sub-Saharan Africa, CD4 count is not widely available or consistently used and instead the WHO clinical staging system is used to determine ART eligibility. However, concerns have been raised regarding its discriminatory ability to identify patients eligible to start ART. The authors therefore reviewed the accuracy of WHO stage 3 or 4 assessment in identifying ART eligibility according to CD4 count thresholds for ART initiation This research is funded under the Department for International Development’s Evidence Building and Synthesis Research Programme which is led by the Liverpool School of Tropical Medicine