1. International Lab Branch Center for Global Health / Division of Global HIV/AIDS Nichole Arnett, Karen Chang, Mary Schmitz, Ruth Lemwayi, Patrich Rwehumbiza, Michael Mwasekaga, Luciana Kohatsu, Omotayo Bolu, Fasta Mosha, Sehin Birhanu, Lydia Lu, John Nkengasong Larry Westerman, PhD MMSc Clinical and OI Monitoring Team International Laboratory Branch Division of Global HIV/AIDS CDC, Atlanta, Georgia Healthcare workers' acceptance and performance of point-of-care CD4 testing in Dar es Salaam

2. Specimen Collection For Pima CD4 Testing Fingerstick- Direct Fingerstick- Microtube Pima- Venous

3. Preference Fingerstick- Direct Fingerstick- Microtube Pima- Venous Ease Of Use Failed CD4 Result Invalid Test Accuracy 2nd 3rd 1st 1.8 3.0 1.7 1=very easy 5=very difficult 9.9% 4.9% 0.9% 10.1% 8.6% 7.7% R 2 = 0.82 Bias -20 R 2 = 0.88 Bias 0 R 2 = 0.89 Bias -10

4. 1.Collect supplies: - Lancet/alcohol/gauze 2.Identify patient 3.Clean finger with alcohol and dry 4.Select target site- - 3 rd or 4 th Finger, preferred - Off center from finger pad - lancet blade should cut vertical to fingerprint ridges 5.Hold finger firmly 6.Place a new sterile lancet on the target site 7.Activate lancet while applying firm downward pressure 7.With your finger, apply pressure on opposite side of lanced finger 8.Wipe away the first drop of blood with a sterile gauze  Fingerstick Technique is important for CD4 testing  Slighthly more variation and errors with fingerstick compared to venous  Collection of fingerstick specimen in an EDTA microtube more like venous blood