Validation of Microcapillary Flow Cytometry for Community-Based CD4+ T Lymphocyte Enumeration in Remote Burkina Faso

Cybèle A Renault1, *, Arouna Traore 3, Rhoderick N Machekano 2, 4, Dennis M Israelski 1, 2, 3, 5
1 Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
2 San Mateo/San Francisco Peninsula AIDS Research Center, San Mateo, California, USA
3 AIDS Empowerment and Treatment International (AIDSETI), Burkina Faso
4 Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, USA
5 Pangaea Global AIDS Foundation, San Francisco, California, USA

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© Renault et al.; Licensee Bentham Open

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited

* Address correspondence to this author at the Division of Infectious Diseases, Stanford University School of Medicine, 300 Pasteur Drive, Grant Building, S-101D, Stanford, California 94305, USA, Tel: (650) 493-5000; Fax: (650) 498-7011;



CD4+ T lymphocyte enumeration plays a critical role in the initiation and monitoring of HIV-infected patients on antiretroviral therapy. There is an urgent need for low-cost CD4+ enumeration technologies, particularly for use in dry, dusty climates characteristic of many small cities in Sub-Saharan Africa


Cross-sectional study


Blood samples from 98 HIV-infected patients followed in a community HIV clinic in Ouahigouya, Burkina Faso were obtained for routine CD4+ T lymphocyte count monitoring. The blood samples were divided into two aliquots, on which parallel CD4+ measurements were performed using microcapillary (Guava EasyCD4) and dedicated (Becton Dickinson FACSCount) CD4+ enumeration systems. Spearman rank correlation coefficient was calculated, and the sensitivity, specificity and positive predictive value (PPV) for EasyCD4 <200 cells/µL were determined compared to the reference standard FACSCount CD4 <200 cells/µL


Mean CD4 counts for the EasyCD4 and FACSCount were 313.75 cells/µL and 303.47 cells/µL, respectively. The Spearman rank correlation coefficient was 0.92 (p<0.001). Median values using EasyCD4 were higher than those with the FACSCount (p=0.004). For a CD4<350 cells/uL, sensitivity of the EasyCD4 was 93.9% (95%CI 85.2-98.3%), specificity was 90.6% (95% CI 75.0-98.0%), and PPV was 95.4% (95%CI 87.1-99.0%)


Use of the EasyCD4 system was feasible and highly accurate in the harsh conditions of this remote city in Sub-Saharan Africa, demonstrating acceptable sensitivity and specificity compared to a standard operating system. Microcapillary flow cytometry offers a cost-effective alternative for community-based, point-of-care CD4+ testing and could play a substantial role in scaling up HIV care in remote, resource-limited settings

Keywords: Low-cost CD4, CD4+ count, EasyCD4 assay, Guava Technologies, Inc, microcapillary flow cytometry, resource-limited setting.