Integrating Point-of-Care CD4 Testing into Family Planning Clinics: A Methodological Framework for Evaluating ART Initiation Among HIV-Positive Women in Nigeria

In Nigeria, HIV-positive women face barriers to initiating antiretroviral therapy (ART), often due to delays in receiving CD4 count results from centralised laboratories. Family planning clinics are frequented by women of reproductive age but typically do not offer on-site CD4 testing. Integrating point-of-care (POC) CD4 testing into these services is a potential strategy to improve ART uptake. This article presents a methodological framework for evaluating the impact of integrating POC CD4 testing into family planning clinics on ART initiation rates among HIV-positive women in Nigeria. The primary objective is to detail a study design to measure changes in the proportion of eligible women starting ART within a defined period after diagnosis. The proposed methodology is a quasi-experimental, controlled implementation study. It involves purposively selecting intervention clinics, which will offer integrated POC CD4 testing and counselling, and matched control clinics, which will maintain the standard referral pathway for CD4 testing. The framework details procedures for participant recruitment, data collection on ART initiation (verified via clinic records), and analysis using multivariate logistic regression to control for confounders. Ethical considerations and community engagement strategies are outlined. As a methodology article, this paper presents no empirical results. The 'findings' section of a study using this framework would report the difference in ART initiation proportions between the intervention and control groups, along with adjusted odds ratios. This methodological framework provides a rigorous and contextually appropriate blueprint for assessing a service integration model. Its application would generate evidence on whether POC CD4 testing in family planning settings is an effective strategy to accelerate ART initiation for women in Nigeria. Researchers adopting this framework should ensure strong collaboration with national HIV and reproductive health programmes. Future studies should consider incorporating cost-effectiveness analyses and qualitative components to explore women's experiences and barriers beyond access to testing. point-of-care testing, CD4 count, HIV, antiretroviral therapy initiation, family planning services, integration, methodology, Nigeria, women's health. This article contributes a detailed methodological framework for evaluating service integration, designed to produce robust evidence to inform policy on linking HIV care and reproductive health services in similar settings.