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Antiretroviral Therapy for HIV Infection in Infants and Children: Towards Universal Access: Recommendations for a Public Health Approach: 2010 Revision. Geneva: World Health Organization; 2010.
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Antiretroviral Therapy for HIV Infection in Infants and Children: Towards Universal Access: Recommendations for a Public Health Approach: 2010 Revision.
Show detailsLaboratory tests recommended by level of health care facility for providing HIV-related clinical care. These tables are adapted from WHO, available at http://www.who.int/hiv/amds/WHOLabRecommendationBylevelFinal.pdf
Laboratory tests for diagnosis and monitoring 1 | Primary care level 2 | District level 3 | Regional or referral level 4 | National level 5 | |||
---|---|---|---|---|---|---|---|
Send out 6 | Perform on-site | Send out 6 | Perform on-site | Send out 6 | Perform on-site | Perform on-site | |
HIV antibody testing | |||||||
Lab ELISA | ✓ | ✓ | ✓ | ✓ | |||
Rapid point of care 1 | ✓ | ✓ | ✓ | ✓ | |||
Rapid point of care 2 | ✓ | ✓ | ✓ | ✓ | |||
Rapid point of care 3 | ✓ | ||||||
HIV virological diagnostic testing | |||||||
RNA | ✓ | ✓ | ✓ | ✓ | |||
DNA | ✓ | ✓ | ✓ | ✓ | |||
Up24 Ag | ✓ | ✓ | ✓ | ✓ | |||
HIV viral load measurement | ✓ | ✓ | ✓ | ||||
Haemoglobin | |||||||
Haemoglobinometer such as HemoCue | ✓ | ✓ | ✓ | ✓ | |||
WHO colour scale | ✓ | ✓ | ✓ | ✓ | |||
Full blood count and differential | ✓ | ✓ | ✓ | ✓ | |||
CD4 | |||||||
Absolute count | ✓ | ✓ | ✓ | ✓ | ✓ | ||
% | ✓ | ✓ | ✓ | ✓ | ✓ | ||
HIV resistance testing7 | ✓ 8 | ||||||
Pregnancy testing | |||||||
Urine rapid test ? 9 | ? 9 | ✓ | ✓ | ✓ | |||
Liver function tests (transaminases and bilirubin) | ✓ | ✓ | ✓ | ||||
Glucose | |||||||
Blood dipstick | ✓ | ✓ | ✓ | ||||
Urine dipstick | ✓ | ✓ | ✓ | ✓ | |||
Blood | ✓ | ✓ | ✓ | ||||
Serum electrolytes | ? | ✓ | ✓ | ✓ | |||
Renal function tests (creatinine/urea) | ✓ | ✓ | ✓ | ||||
Urine protein dipstick | ✓ | ✓ | ✓ | ✓ | |||
Lipids | ✓ | ✓ | |||||
Amylase | ✓ | ✓ | ✓ | ||||
Lactate | ✓ | ✓ | ✓ | ||||
Oxygen saturation – pulse oximetry | ✓ | ✓ | ✓ | ||||
Blood gases Ph | ✓ | ✓ |
- 1
These are the generic recommendations and it is recognized that exceptions apply (e.g., some health centers will send out some tests). Where appropriate these tests may used for public health surveillance and quality assurance activities.
- 2
Primary health care services are those providing first point of contact with the health care system.
- 3
District level is defined as hospital at the first referral level that is responsible for a district of a defined geographical area containing a defined population and governed by a politico-administrative organization such as a district health management team.
- 4
In some smaller countries there may not be regional laboratories.
- 5
Including the national reference laboratory or public health laboratory, which is usually responsible for quality assurance and surveillance activities.
- 6
“Send out” refers to not having the testing capability on site and samples or patients are sent to another site for the actual test to be performed.
- 7
HIV DR testing is only recommended as part of national efforts for surveillance and monitoring as outlined in WHO HIV DR strategy and is usually done by sending out to an accredited international lab.
- 8
May be done at national level or sent to accredited lab.
- 9
May need to reconsider recommendation at primary care level.
WHO ART guidelines recommend in context of efavirenz initiation.
Pregnancy test not recommended for routine pregnancy care at the primary level. Most women seek antenatal care when pregnancy is “obvious” and the pregnancy test does not add additional information.
Diagnostic tests for treatable co-infections and major HIV-related opportunistic diseases
Laboratory tests for diagnosis and monitoring 1 | Primary care level 2 | District level 3 | Regional or referral level 4 | National level 5 | |||
---|---|---|---|---|---|---|---|
Send out 6 | Perform on-site | Send out 6 | Perform on-site | Send out 6 | Perform on-site | Perform on-site | |
Tuberculosis | |||||||
Microscopy | |||||||
Light | ✓ | ✓ | ✓ 7 | ✓ | ✓ | ||
Fluorescence | ✓ | ✓ | ✓ | ||||
Culture | |||||||
Solid medium | ✓ | ✓ | ? 7 | ✓ | ✓ | ||
Liquid medium | ✓ | ✓ | ✓ | ✓ | |||
Drug susceptibility tes 8 | |||||||
First-line | ✓ | ✓ | ✓ | ||||
Second-line | ✓ | ✓ | ✓ | ||||
Diagnosis of malaria | |||||||
Rapid test for malaria | ✓ | ✓ | ✓ | ✓ | |||
Microscopy for malaria (thick/thin) | ✓ | ✓ | ✓ | ✓ | |||
Cerebrospinal fluid (CSF) | |||||||
Basic CSF microscopy including India ink and Gram stain and Ziehl-Neelsen | ✓ | ✓ | ✓ | ||||
CSF culture | ✓ | ✓ | ✓ | ||||
CSF glucose | ✓ | ✓ | ✓ | ||||
Cryptococcal antigen (serum or CSF) | ✓ | ✓ | ✓ | ||||
STI diagnostic tests | |||||||
Microscopy (Gram & wet) | ✓ | ✓ | ✓ | ||||
Gonorrhea | ✓ | ✓ | ✓ | ||||
Chlamidya | ✓ | ✓ | ✓ | ||||
Syphilis rapid diagnostic test | ✓ | ✓ | ✓ | ✓ | |||
Syphilis serological (RPR, FTA and TPHA) | ✓ | ✓ | ✓ | ||||
Hepatitis B | ✓ | ✓ | ✓ | ✓ | |||
Hepatitis C12 | ✓ | ✓ | ✓ 10 | ||||
PCP | ✓ | ||||||
Blood culture | ✓ | ✓ | ✓ | ||||
Radiography | ✓ | ✓ | ✓ |
References for Summary of WHO recommendations on laboratory investigations for clinical care by level of health care facility are available at http://www
.who.int/hiv /amds/WHOLabRecommendation-BylevelFinal.pdf - 1
These are the generic recommendations and it is recognized that exceptions apply (e.g., some health centers will send out some tests). Where appropriate these tests may used for public health surveillance and quality assurance activities.
- 2
Primary health care services are those providing first point of contact with the health care system.
- 3
District level is defined as hospital at the first referral level that is responsible for a district of a defined geographical area containing a defined population and governed by a politico-administrative organization such as a district health management team.
- 4
In some smaller countries there may not be regional laboratories.
- 5
Including the national reference laboratory or public health laboratory, which is usually responsible for quality assurance and surveillance activities.
- 7
At some health centres depending on specimen load.
- 8
Given complexity of usng DSTs may need adaptation.
- 9
Provision guided by Hepatitis C prevalence.
- 10
High prevalence, Low IDU and for sureiillance.
- SUMMARY OF WHO RECOMMENDATIONS ON LABORATORY INVESTIGATIONS FOR CLINICAL CARE BY...SUMMARY OF WHO RECOMMENDATIONS ON LABORATORY INVESTIGATIONS FOR CLINICAL CARE BY LEVEL OF HEALTH CARE FACILITY - Antiretroviral Therapy for HIV Infection in Infants and Children: Towards Universal Access
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