Auditing national HIV guidelines and policies: The United Kingdom CD4 surveillance scheme

Alison Brown, Meaghan M. Kall, Ruth D. Smith, Zheng Yin, Alan Hunter, Valerie Delpech

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    23 Citations (Scopus)


    The United Kingdom's CD4 surveillance scheme monitors CD4 cell counts among HIV patients and is a national resource for HIV surveillance. It has driven public health policy and allowed auditing of national HIV testing, treatment and care guidelines. We demonstrate its utility through four example outputs: median CD4 count at HIV diagnosis; late HIV diagnosis and short-term mortality; the timing of first CD4 count to indicate entry into HIV care; and the proportion of patients with CD4 counts <350 cells/mm3 receiving anti-retroviral therapy (ARV). In 2009, 95% (61,502/64,420) of adults living with diagnosed HIV infection had CD4 counts available. The median CD4 count at diagnosis increased from 276 to 335 cells/mm3 between 2000 and 2009, indicating modest improvements in HIV testing. In 2009, 52% of patients were diagnosed at a late stage of HIV infection (CD4 <350 cells/mm3); these individuals had a ten-fold risk of dying within a year of their diagnosis compared to those diagnosed promptly. In 2008, the national target of performing a CD4 count within 14 days of diagnosis was met for 61% of patients. National treatment guidelines have largely been met with 83% patients with CD4 <350 cells/mm3 receiving ARV. The monitoring of CD4 counts is critical to HIV surveillance in the United Kingdom enabling the close monitoring of efforts to reduce morbidity and mortality associated with late diagnosis and underpins the auditing of policies and guidelines. These routine surveillance outputs can be generated at national and local levels to drive and monitor public health policy and prevention efforts.

    Original languageEnglish
    Pages (from-to)149-155
    Number of pages7
    JournalOpen AIDS Journal
    Issue numberSPEC.ISSUE 1
    Publication statusPublished - 2012

    Bibliographical note

    Funding Information:
    Acknowledgments This research has received funding from the Spanish Government, projects COVARIANCE (CTM2010-19709), CODA-RSS (MTM2009-13272) and Metrics (MTM2012-33236).


    • CD4 counts
    • Patient outcomes
    • Surveillance
    • United Kingdom


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