Open Access Open Badges Research article

Field evaluation in Chad of community usage of CD4 T lymphocyte counting by alternative single-platform flow cytometry

Donato Koyalta1*, Mohammad-Ali Jenabian2, Barou Djouater3, Noël Djemadji-Oudjeil4, Francois-Xavier Mbopi-Keou5, Angélique Ndjoyi-Mbiguino6 and Laurent Bélec7

Author affiliations

1 Ministère de la Santé Publique, BP 407 N’Djamena, Chad

2 Chronic Viral Illness Service and Research Institute, McGill University Health Centre, Montreal, Canada

3 Conseil National de Lutte contre le SIDA, Primature, N’Djamena, Chad

4 Organisation Mondiale de la Santé, Représentation du Tchad, N’Djamena, Chad

5 National Public Health Laboratory, Ministry of Public Health, University of Yaounde I, Yaounde, Cameroon

6 Laboratoire National de Référence des Maladies Sexuellement Transmissibles et du SIDA, Département de Microbiologie, Faculté de Médecine de Libreville, Université des Sciences de la Santé, Libreville, Gabon

7 Laboratoire de virologie, hôpital Européen Georges Pompidou, and Faculté de Médecine Paris Descartes, Université Paris Descartes (Paris V), Sorbonne Paris Cité, Paris, France

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Citation and License

BMC Health Services Research 2013, 13:373  doi:10.1186/1472-6963-13-373

Published: 1 October 2013



Field and community evaluation of the routine usage of CD4 T counting platforms is essential in resource-poor countries for efficient and cost-effective monitoring of HIV-infected adults and children attending health care centers.


We herein addressed the principal issues raised by the implementation of the single-platform, volumetric Auto40 flow cytometer (Apogee Flow Systems Ltd, Hemel Hempstead, UK) in 8 community HIV monitoring laboratories of different levels throughout Chad. This is a country with particularly difficult conditions, both in terms of climate and vast geographical territory, making the decentralization of the therapeutic management of HIV-infected patients challenging.


The routine usage of the Auto40 flow cytometers for a period of 5 years (2008–2013) confirms the reliability and robustness of the analyzer for community-based CD4 T cell enumeration in terms of both absolute numbers and percentages to enable accurate monitoring of HIV-infected adults and children. However, our observations suggest that the Auto40 mini flow cytometer is not suitable for all laboratories as it is oversized and ultimately very expensive.


The Chad experience with the Auto40 flow cytometer suggests that its usage in resource-limited settings should be mainly reserved to reference (level 1) or district (level 2) laboratories, rather than to laboratories of health care centres (level 3).

Flow cytometry; CD4 T cell count; CD45; Decentralization; Sub-Saharan Africa; Chad