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Implementation of Novel Quality Assurance Program for Hepatitis C Viral Load Point of Care Testing. Viruses 2022; 14:v14091929. [PMID: 36146736 PMCID: PMC9504144 DOI: 10.3390/v14091929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 08/27/2022] [Accepted: 08/29/2022] [Indexed: 11/17/2022] Open
Abstract
All patients should have access to accurate and timely test results. The introduction of point of care testing (PoCT) for infectious diseases has facilitated access to those unable to access traditional laboratory-based medical testing, including those living in remote and regional locations, or individuals who are marginalized or incarcerated individuals. In many countries, laboratory testing for infectious diseases, such as hepatitis C virus (HCV), is performed in a highly regulated environment. However, this is not the case for PoCT, where testing is performed by non-laboratory staff and quality controls are often lacking. An assessment of the provision of laboratory-based quality assurance to PoCT for infectious disease was conducted and the barriers to participation identified. A novel approach to providing quality assurance to PoCT sites, in particular those testing for HCV, was designed and piloted. This novel approach incudes identifying and validating sample types that are inactivated and stable at ambient temperature, creating cost-effective supply chains to facilitate logistics of samples, and the development of a smart phone-enabled portal for data entry and analyses. The creation and validation of this approach to quality assurance of PoCT removes the barriers to participation and acts to improve the quality and accuracy of testing, reduce errors and waste, and improve patient outcomes.
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Kabugo J, Namutebi J, Mujuni D, Nsawotebba A, Kasule GW, Musisi K, Kigozi E, Nyombi A, Lutaaya P, Kangave F, Joloba ML. Implementation of GeneXpert MTB/Rif proficiency testing program: A Case of the Uganda national tuberculosis reference laboratory/supranational reference laboratory. PLoS One 2021; 16:e0251691. [PMID: 33989348 PMCID: PMC8121318 DOI: 10.1371/journal.pone.0251691] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 05/03/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Following the WHO's endorsement of GeneXpert MTB/RIF assay for tuberculosis diagnosis in 2010, Uganda's ministry of health introduced the assay in its laboratory network in 2012. However, assessing the quality of the result produced from this technique is one of its major implementation challenges. To bridge this gap, the National tuberculosis reference laboratory (NTRL) introduced the GeneXpert MTB/RIF proficiency testing (PT) Scheme in 2015. METHODS A descriptive cross-sectional study on the GeneXpert PT scheme in Uganda was conducted between 2015 and 2018. Sets of panels each comprising four 1ml cryovial liquid samples were sent out to enrolled participants at preset testing periods. The laboratories' testing accuracies were assessed by comparing their reported results to the expected and participants' consensus results. Percentage scores were assigned and feedback reports were sent back to laboratories. Follow up of sites with unsatisfactory results was done through "on and off-site support". Concurrently, standardization of standard operating procedures (SOPs) and practices to the requirements of the International Organization for Standardization (ISO) 17043:2010 was pursued. RESULTS Participants gradually increased during the program from 56 in the pilot study to 148 in Round 4 (2018). Continual participation of a particular laboratory yielded an odd of 2.5 [95% confidence interval (CI), 1.22 to 4.34] times greater for achieving a score of above 80% with each new round it participated. The "on and off-site" support supervision documented improved performance of failing laboratories. Records of GeneXpert MTB/RIF PT were used to achieve accreditation to ISO 17043:2010 in 2018. CONCLUSION Continued participation in GeneXpert MTB/RIF PT improves testing accuracy of laboratories. Effective implementation of this scheme requires competent human resources, facility and equipment, functional quality management system, and adherence to ISO 17043:2010.
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Affiliation(s)
- Joel Kabugo
- Uganda National Tuberculosis Reference Laboratory, Kampala, Uganda
| | - Joanita Namutebi
- Uganda National Tuberculosis Reference Laboratory, Kampala, Uganda
| | - Dennis Mujuni
- Uganda National Tuberculosis Reference Laboratory, Kampala, Uganda
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Andrew Nsawotebba
- Uganda National Tuberculosis Reference Laboratory, Kampala, Uganda
- Uganda National Health and Laboratory Diagnostic Services, Kampala, Uganda
| | | | - Kenneth Musisi
- Uganda National Tuberculosis Reference Laboratory, Kampala, Uganda
| | - Edgar Kigozi
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Abdunoor Nyombi
- Uganda National Tuberculosis Reference Laboratory, Kampala, Uganda
| | - Pius Lutaaya
- Uganda National Tuberculosis Reference Laboratory, Kampala, Uganda
| | - Fredrick Kangave
- Uganda National Tuberculosis Reference Laboratory, Kampala, Uganda
| | - Moses L. Joloba
- Uganda National Tuberculosis Reference Laboratory, Kampala, Uganda
- Makerere University College of Health Sciences, Kampala, Uganda
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3
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Terris-Prestholt F, Boeras D, Ong JJ, Torres-Rueda S, Cassim N, Mbengue MAS, Mboup S, Mwau M, Munemo E, Nyegenye W, Odhiambo CO, Dabula P, Sandstrom P, Sarr M, Simbi R, Stevens W, Tucker JD, Vickerman P, Ciaranello A, Peeling RW. The potential for quality assurance systems to save costs and lives: the case of early infant diagnosis of HIV. Trop Med Int Health 2020; 25:1235-1245. [PMID: 32737914 DOI: 10.1111/tmi.13472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Scaling up of point-of-care testing (POCT) for early infant diagnosis of HIV (EID) could reduce the large gap in infant testing. However, suboptimal POCT EID could have limited impact and potentially high avoidable costs. This study models the cost-effectiveness of a quality assurance system to address testing performance and screening interruptions, due to, for example, supply stockouts, in Kenya, Senegal, South Africa, Uganda and Zimbabwe, with varying HIV epidemics and different health systems. METHODS We modelled a quality assurance system-raised EID quality from suboptimal levels: that is, from misdiagnosis rates of 5%, 10% and 20% and EID testing interruptions in months, to uninterrupted optimal performance (98.5% sensitivity, 99.9% specificity). For each country, we estimated the 1-year impact and cost-effectiveness (US$/DALY averted) of improved scenarios in averting missed HIV infections and unneeded HIV treatment costs for false-positive diagnoses. RESULTS The modelled 1-year costs of a national POCT quality assurance system range from US$ 69 359 in South Africa to US$ 334 341 in Zimbabwe. At the country level, quality assurance systems could potentially avert between 36 and 711 missed infections (i.e. false negatives) per year and unneeded treatment costs between US$ 5808 and US$ 739 030. CONCLUSIONS The model estimates adding effective quality assurance systems are cost-saving in four of the five countries within the first year. Starting EQA requires an initial investment but will provide a positive return on investment within five years by averting the costs of misdiagnoses and would be even more efficient if implemented across multiple applications of POCT.
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Affiliation(s)
| | - D Boeras
- London School of Hygiene and Tropical Medicine, London, UK.,Global Health Impact Group, Atlanta, GA, USA
| | - J J Ong
- London School of Hygiene and Tropical Medicine, London, UK.,Central Clinical School, Monash University, Clayton, Vic, Australia
| | - S Torres-Rueda
- London School of Hygiene and Tropical Medicine, London, UK
| | - N Cassim
- National Health Laboratory Service, National Priority Programmes, Johannesburg, South Africa.,Department of Molecular Medicine and Haematology, University of Witwatersrand, Johannesburg, South Africa
| | - M A S Mbengue
- Institut de Recherche en Santé, de Surveillance Epidémiologique et de Formations, Dakar, Sénégal.,Department of Epidemiology and Biostatistics, University of the Witwatersrand, Johannesburg, South Africa
| | - S Mboup
- Institut de Recherche en Santé, de Surveillance Epidémiologique et de Formations, Dakar, Sénégal
| | - M Mwau
- Kenya Medical Research Institute, Nairobi, Kenya
| | - E Munemo
- Ministry of Health and Child Care, National Microbiology Reference Laboratory, Harare Central Hospital, Harare, Zimbabwe
| | - W Nyegenye
- Ministry of Health Uganda, Kampala, Uganda
| | | | - P Dabula
- National Health Laboratory Service, National Priority Programmes, Johannesburg, South Africa
| | - P Sandstrom
- National HIV & Retrovirology Laboratories, Public Health Agency of Canada, Winnipeg, Canada
| | - M Sarr
- Westat, Inc., Rockville, MD, USA
| | - R Simbi
- Ministry of Health and Child Care, National Microbiology Reference Laboratory, Harare Central Hospital, Harare, Zimbabwe
| | - W Stevens
- National Health Laboratory Service, National Priority Programmes, Johannesburg, South Africa
| | - J D Tucker
- London School of Hygiene and Tropical Medicine, London, UK.,University of North Carolina, Chapel Hill, NC, USA
| | - P Vickerman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - A Ciaranello
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - R W Peeling
- London School of Hygiene and Tropical Medicine, London, UK
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4
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Gumma V, DeGruy K, Bennett D, Nguyen Thi Kim T, Albert H, Bond KB, Gutreuter S, Alexander H, Ngyuen Thi Phong L, Rush TH, Nguyen Viet N, Nguyen Van H. Impact of External Quality Assurance on the Quality of Xpert MTB/RIF Testing in Viet Nam. J Clin Microbiol 2019; 57:e01669-18. [PMID: 30567748 PMCID: PMC6425173 DOI: 10.1128/jcm.01669-18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/06/2018] [Indexed: 11/20/2022] Open
Abstract
Following the endorsement of the Xpert MTB/RIF assay (Cepheid, Sunnyvale, CA, USA) by the World Health Organization (WHO) in 2010, Viet Nam's National Tuberculosis Control Program (NTP) began using GeneXpert instruments in NTP laboratories. In 2013, Viet Nam's NTP implemented an Xpert MTB/RIF external quality assurance (EQA) program in collaboration with the U.S. Centers for Disease Control and Prevention (CDC) and the Foundation for Innovative New Diagnostics (FIND). Proficiency-testing (PT) panels comprising five dried tube specimens (DTS) were sent to participating sites approximately twice a year from October 2013 to July 2016. The number of enrolled laboratories increased from 22 to 39 during the study period. Testing accuracy was assessed by comparing reported and expected results; percentage scores were assigned; and feedback reports were provided to sites. On-site evaluation (OSE) was conducted for underperforming laboratories. The results from the first five rounds demonstrate the positive impact of PT and targeted OSE visits on testing quality. On average, for every additional round of feedback, the odds of achieving PT scores of ≥80% increased 2.04-fold (95% confidence interval, 1.39- to 3.00-fold). Future work will include scaling up PT to all sites and maintaining the performance of participating laboratories while developing local panel production capacity.
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Affiliation(s)
- Vidyanidhi Gumma
- Foundation for Innovative New Diagnostics (FIND), National Lung Hospital, Hanoi, Viet Nam
| | - Kyle DeGruy
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Davara Bennett
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Thanh Nguyen Thi Kim
- National Tuberculosis Reference Laboratory, National Tuberculosis Control Programme, National Lung Hospital, Hanoi, Viet Nam
| | - Heidi Albert
- Foundation for Innovative New Diagnostics (FIND), Mowbray, Cape Town, South Africa
| | - Kyle B Bond
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Steve Gutreuter
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Heather Alexander
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Thomas H Rush
- U.S. Centers for Disease Control and Prevention, Hanoi, Viet Nam
| | - Nhung Nguyen Viet
- National Tuberculosis Control Programme, National Lung Hospital, Hanoi, Viet Nam
| | - Hung Nguyen Van
- National Tuberculosis Reference Laboratory, National Tuberculosis Control Programme, National Lung Hospital, Hanoi, Viet Nam
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Abstract
HIV diagnostics have played a central role in the remarkable progress in identifying, staging, initiating, and monitoring infected individuals on life-saving antiretroviral therapy. They are also useful in surveillance and outbreak responses, allowing for assessment of disease burden and identification of vulnerable populations and transmission "hot spots," thus enabling planning, appropriate interventions, and allocation of appropriate funding. HIV diagnostics are critical in achieving epidemic control and require a hybrid of conventional laboratory-based diagnostic tests and new technologies, including point-of-care (POC) testing, to expand coverage, increase access, and positively impact patient management. In this review, we provide (i) a historical perspective on the evolution of HIV diagnostics (serologic and molecular) and their interplay with WHO normative guidelines, (ii) a description of the role of conventional and POC testing within the tiered laboratory diagnostic network, (iii) information on the evaluations and selection of appropriate diagnostics, (iv) a description of the quality management systems needed to ensure reliability of testing, and (v) strategies to increase access while reducing the time to return results to patients. Maintaining the central role of HIV diagnostics in programs requires periodic monitoring and optimization with quality assurance in order to inform adjustments or alignment to achieve epidemic control.
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Saeed DK, Hasan R, Naim M, Zafar A, Khan E, Jabeen K, Irfan S, Ahmed I, Zeeshan M, Wajidali Z, Farooqi J, Shakoor S, Chagla A, Rao J. Readiness for antimicrobial resistance (AMR) surveillance in Pakistan; a model for laboratory strengthening. Antimicrob Resist Infect Control 2017; 6:101. [PMID: 29021895 PMCID: PMC5622515 DOI: 10.1186/s13756-017-0260-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 09/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Limited capacity of laboratories for antimicrobial susceptibility testing (AST) presents a critical diagnostic bottleneck in resource limited countries. This paper aims to identify such gaps and to explore whether laboratory networks could contribute towards improving AST in low resource settings. METHODS A self-assessment tool to assess antimicrobial susceptibility testing capacity was administered as a pre-workshop activity to participants from 30 microbiology laboratories in 3 cities in Pakistan. Data from public and private laboratories was analyzed and capacity of each scored in percentage terms. Laboratories from Karachi were invited to join a support network. A cohort of five laboratories that consented were provided additional training and updates sessions over a period of 15 months. Impact of training activities in these laboratories was evaluated using a point scoring (0-11) tool. RESULTS Results of self-assessment component identified a number of areas that required strengthening (scores of ≤60%). These included; readiness for AMR surveillance; 38 and 46%, quality assurance; 49 and 55%, and detection of specific organisms; 56 and 60% for public and private laboratories respectively. No significant difference was detected in AST capacity between public and private laboratories [ANOVA; p > 0.05]. Scoring tool used to assess impact of training within the longitudinal cohort showed an increase from a baseline of 1-5.5 (August 2015) to improved post training scores of 7-11 (October 2016) for the 5 laboratories included. Moreover, statistical analysis using paired t-Test Analysis, assuming unequal variance, indicated that the increase in scored noted represents a statistically significant improvement in the components evaluated [p < 0.05]. CONCLUSION Strengthening of laboratory capacity for AMR surveillance is important. Our data shows that close mentoring and support can help enhance capacity for antimicrobial sensitivity testing in resource limited settings. Our study further presents a model wherein laboratory networks can be successfully established and used towards improving diagnostic capacity in such settings.
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Affiliation(s)
- Dania Khalid Saeed
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | - Rumina Hasan
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | - Mahwish Naim
- Baqai Institute of Health Sciences, Baqai Medical University, Karachi, Pakistan
| | - Afia Zafar
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | - Erum Khan
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | - Kausar Jabeen
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | - Seema Irfan
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | - Imran Ahmed
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | - Mohammad Zeeshan
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | - Zabin Wajidali
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | - Joveria Farooqi
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | - Sadia Shakoor
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | - Abdul Chagla
- Health Security Partners, Washington, DC, 20009 USA
| | - Jason Rao
- Health Security Partners, Washington, DC, 20009 USA
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Diallo K, Modi S, Hurlston M, Beard RS, Nkengasong JN. A Proposed Framework for the Implementation of Early Infant Diagnosis Point-of-Care. AIDS Res Hum Retroviruses 2017; 33:203-210. [PMID: 27758117 PMCID: PMC5333568 DOI: 10.1089/aid.2016.0021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Early diagnosis of HIV infection in infants and children remains a challenge in resource-limited settings, with approximately half of all HIV-exposed infants receiving virological testing for HIV by the recommended age of 2 months in 2015. To reduce morbidity and mortality among HIV-infected children and close the treatment gap for HIV-infected children, there is an urgent need to evaluate existing programmatic and laboratory practices for early infant diagnosis and introduce strategies to improve identification of HIV-exposed infants and ensure access to systematic, early HIV testing, with early linkage to treatment for HIV-infected infants. This article describes progress made in follow-up of HIV-exposed infants since 2006, including remaining unmet laboratory and programmatic needs, and recommends strategies for improvement, especially those related to the implementation of point-of-care technology for early infant diagnosis.
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Affiliation(s)
- Karidia Diallo
- International Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Surbhi Modi
- Maternal and Child Health Branch, Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mackenzie Hurlston
- International Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - R. Suzanne Beard
- International Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John N. Nkengasong
- International Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
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Ryan J, Abbato S, Greer R, Vayne-Bossert P, Good P. Rates and Predictors of Professional Interpreting Provision for Patients With Limited English Proficiency in the Emergency Department and Inpatient Ward. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2017; 54:46958017739981. [PMID: 29144184 PMCID: PMC5798672 DOI: 10.1177/0046958017739981] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 09/17/2017] [Accepted: 09/21/2017] [Indexed: 12/04/2022]
Abstract
The provision of professional interpreting services in the hospital setting decreases communication errors of clinical significance and improves clinical outcomes. A retrospective audit was conducted at a tertiary referral adult hospital in Brisbane, Australia. Of 20 563 admissions of patients presenting to the hospital emergency department (ED) and admitted to a ward during 2013-2014, 582 (2.8%) were identified as requiring interpreting services. In all, 19.8% of admissions were provided professional interpreting services in the ED, and 26.1% were provided on the ward. Patients were more likely to receive interpreting services in the ED if they were younger, spoke an Asian language, or used sign language. On the wards, using sign language was associated with 3 times odds of being provided an interpreter compared with other languages spoken. Characteristics of patients including their age and type of language spoken influence the clinician's decision to engage a professional interpreter in both the ED and inpatient ward.
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Affiliation(s)
- Jennifer Ryan
- Mater Health Services, South Brisbane, Queensland, Australia
| | | | - Ristan Greer
- G&R Greer Pty Ltd T/A Torus Research, Brisbane, Australia
- Mater Research Institute - The University of Queensland, Brisbane, Australia
| | - Petra Vayne-Bossert
- Mater Health Services, South Brisbane, Queensland, Australia
- University Hospitals of Geneva, Switzerland
| | - Phillip Good
- Mater Health Services, South Brisbane, Queensland, Australia
- Mater Research Institute - The University of Queensland, Brisbane, Australia
- St Vincent’s Private Hospital Brisbane, Queensland, Australia
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9
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Diallo K, Kim AA, Lecher S, Ellenberger D, Beard RS, Dale H, Hurlston M, Rivadeneira M, Fonjungo PN, Broyles LN, Zhang G, Sleeman K, Nguyen S, Jadczak S, Abiola N, Ewetola R, Muwonga J, Fwamba F, Mwangi C, Naluguza M, Kiyaga C, Ssewanyana I, Varough D, Wysler D, Lowrance D, Louis FJ, Desinor O, Buteau J, Kesner F, Rouzier V, Segaren N, Lewis T, Sarr A, Chipungu G, Gupta S, Singer D, Mwenda R, Kapoteza H, Chipeta Z, Knight N, Carmona S, MacLeod W, Sherman G, Pillay Y, Ndongmo CB, Mugisa B, Mwila A, McAuley J, Chipimo PJ, Kaonga W, Nsofwa D, Nsama D, Mwamba FZ, Moyo C, Phiri C, Borget MY, Ya-Kouadio L, Kouame A, Adje-Toure CA, Nkengasong J. Early Diagnosis of HIV Infection in Infants - One Caribbean and Six Sub-Saharan African Countries, 2011-2015. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2016; 65:1285-1290. [PMID: 27880749 DOI: 10.15585/mmwr.mm6546a2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Pediatric human immunodeficiency virus (HIV) infection remains an important public health issue in resource-limited settings. In 2015, 1.4 million children aged <15 years were estimated to be living with HIV (including 170,000 infants born in 2015), with the vast majority living in sub-Saharan Africa (1). In 2014, 150,000 children died from HIV-related causes worldwide (2). Access to timely HIV diagnosis and treatment for HIV-infected infants reduces HIV-associated mortality, which is approximately 50% by age 2 years without treatment (3). Since 2011, the annual number of HIV-infected children has declined by 50%. Despite this gain, in 2014, only 42% of HIV-exposed infants received a diagnostic test for HIV (2), and in 2015, only 51% of children living with HIV received antiretroviral therapy (1). Access to services for early infant diagnosis of HIV (which includes access to testing for HIV-exposed infants and clinical diagnosis of HIV-infected infants) is critical for reducing HIV-associated mortality in children aged <15 years. Using data collected from seven countries supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), progress in the provision of HIV testing services for early infant diagnosis was assessed. During 2011-2015, the total number of HIV diagnostic tests performed among HIV-exposed infants within 6 weeks after birth (tests for early infant diagnosis of HIV), as recommended by the World Health Organization (WHO) increased in all seven countries (Cote d'Ivoire, the Democratic Republic of the Congo, Haiti, Malawi, South Africa, Uganda, and Zambia); however, in 2015, the rate of testing for early infant diagnosis among HIV-exposed infants was <50% in five countries. HIV positivity among those tested declined in all seven countries, with three countries (Cote d'Ivoire, the Democratic Republic of the Congo, and Uganda) reporting >50% decline. The most common challenges for access to testing for early infant diagnosis included difficulties in specimen transport, long turnaround time between specimen collection and receipt of results, and limitations in supply chain management. Further reductions in HIV mortality in children can be achieved through continued expansion and improvement of services for early infant diagnosis in PEPFAR-supported countries, including initiatives targeted to reach HIV-exposed infants, ensure access to programs for early infant diagnosis of HIV, and facilitate prompt linkage to treatment for children diagnosed with HIV infection.
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10
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Mbengue MAS, Sarr M, Diaw PA, Diall PAN, Toure MD, Faye NFFN, Gueye B, Kane NCT, Mboup S. Establishing a national laboratory quality system for HIV diagnosis and monitoring in resource-limited settings: Experience from Senegal. Afr J Lab Med 2016; 5:440. [PMID: 28879122 PMCID: PMC5433821 DOI: 10.4102/ajlm.v5i2.440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 08/12/2016] [Indexed: 11/05/2022] Open
Affiliation(s)
- Mouhamed A S Mbengue
- Laboratory of Bacteriology and Virology, Cheikh Anta Diop University, CHU Aristide Le Dantec, Dakar, Senegal
| | - Moussa Sarr
- Laboratory of Bacteriology and Virology, Cheikh Anta Diop University, CHU Aristide Le Dantec, Dakar, Senegal.,Westat, Rockville, Maryland, United States
| | - Papa A Diaw
- Laboratory of Bacteriology and Virology, Cheikh Anta Diop University, CHU Aristide Le Dantec, Dakar, Senegal
| | - Papa A N Diall
- National Committee for the Control of AIDS, Dakar, Senegal
| | - Maimouna D Toure
- Laboratory of Bacteriology and Virology, Cheikh Anta Diop University, CHU Aristide Le Dantec, Dakar, Senegal
| | - Ndeye F F N Faye
- Division for the Control of AIDS and STDs, Ministry of Health, Dakar, Senegal
| | - Bousso Gueye
- Laboratory of Bacteriology and Virology, Cheikh Anta Diop University, CHU Aristide Le Dantec, Dakar, Senegal
| | - Ndeye C T Kane
- Laboratory of Bacteriology and Virology, Cheikh Anta Diop University, CHU Aristide Le Dantec, Dakar, Senegal
| | - Souleymane Mboup
- Laboratory of Bacteriology and Virology, Cheikh Anta Diop University, CHU Aristide Le Dantec, Dakar, Senegal
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11
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Meyers AFA, Sandstrom P, Denny TN, Hurlston M, Ball TB, Peeling RW, Boeras DI. Quality assurance for HIV point-of-care testing and treatment monitoring assays. Afr J Lab Med 2016; 5:557. [PMID: 28879133 PMCID: PMC5433832 DOI: 10.4102/ajlm.v5i2.557] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 08/31/2016] [Indexed: 12/01/2022] Open
Abstract
In 2015, UNAIDS launched the 90-90-90 targets aimed at increasing the number of people infected with HIV to become aware of their status, access antiretroviral therapies and ultimately be virally suppressed. To achieve these goals, countries may need to scale up point-of-care (POC) testing in addition to strengthening central laboratory services. While decentralising testing increases patient access to diagnostics, it presents many challenges with regard to training and assuring the quality of tests and testing. To ensure synergies, the London School of Hygiene & Tropical Medicine held a series of consultations with countries with an interest in quality assurance and their implementing partners, and agreed on an external quality assessment (EQA) programme to ensure reliable results so that the results lead to the best possible care for HIV patients. As a result of the consultations, EQA International was established, bringing together EQA providers and implementers to develop a strategic plan for countries to establish national POC EQA programmes and to estimate the cost of setting up and maintaining the programme. With the dramatic increase in the number of proficiency testing panels required for thousands of POC testing sites across Africa, it is important to facilitate technology transfer from global EQA providers to a network of regional EQA centres in Africa for regional proficiency testing panel production. EQA International will continue to identify robust and cost-effective EQA technologies for quality POC testing, integrating novel technologies to support sustainable country-owned EQA programmes in Africa.
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Affiliation(s)
- Adrienne F A Meyers
- QASI, National HIV & Retrovirology Laboratories, Public Health Agency of Canada, JC Wilt Infectious Diseases Research Centre, Winnipeg, Manitoba, Canada.,Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Paul Sandstrom
- QASI, National HIV & Retrovirology Laboratories, Public Health Agency of Canada, JC Wilt Infectious Diseases Research Centre, Winnipeg, Manitoba, Canada.,Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Thomas N Denny
- Duke University, Department of Medicine, Durham, North Carolina, United States
| | - Mackenzie Hurlston
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Terry B Ball
- QASI, National HIV & Retrovirology Laboratories, Public Health Agency of Canada, JC Wilt Infectious Diseases Research Centre, Winnipeg, Manitoba, Canada.,Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.,Department of Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rosanna W Peeling
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Debrah I Boeras
- London School of Hygiene & Tropical Medicine, London, United Kingdom
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Inalegwu A, Phillips S, Datir R, Chime C, Ozumba P, Peters S, Ogbanufe O, Mensah C, Abimiku A, Dakum P, Ndembi N. Active tracking of rejected dried blood samples in a large program in Nigeria. World J Virol 2016; 5:73-81. [PMID: 27175352 PMCID: PMC4861873 DOI: 10.5501/wjv.v5.i2.73] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 02/17/2016] [Accepted: 04/06/2016] [Indexed: 02/05/2023] Open
Abstract
AIM: To study the impact of rejection at different levels of health care by retrospectively reviewing records of dried blood spot samples received at the molecular laboratory for human immunodeficiency virus (HIV) early infant diagnosis (EID) between January 2008 and December 2012.
METHODS: The specimen rejection rate, reasons for rejection and the impact of rejection at different levels of health care was examined. The extracted data were cleaned and checked for consistency and then de-duplicated using the unique patient and clinic identifiers. The cleaned data were ciphered and exported to SPSS version 19 (SPSS 2010 IBM Corp, New York, United States) for statistical analyses.
RESULTS: Sample rejection rate of 2.4% (n = 786/32552) and repeat rate of 8.8% (n = 69/786) were established. The mean age of infants presenting for first HIV molecular test among accepted valid samples was 17.83 wk (95%CI: 17.65-18.01) vs 20.30 wk (95%CI: 16.53-24.06) for repeated samples. HIV infection rate was 9.8% vs 15.9% for accepted and repeated samples. Compared to tertiary healthcare clinics, secondary and primary clinics had two-fold and three-fold higher likelihood of sample rejection, respectively (P < 0.05). We observed a significant increase in sample rejection rate with increasing number of EID clinics (r = 0.893, P = 0.041). The major reasons for rejection were improper sample collection (26.3%), improper labeling (16.4%) and insufficient blood (14.8%).
CONCLUSION: Programs should monitor pre-analytical variables and incorporate continuous quality improvement interventions to reduce errors associated with sample rejection and improve patient retention.
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Performance of Roche CAP/CTM HIV-1 qualitative test version 2.0 using dried blood spots for early infant diagnosis. J Virol Methods 2015; 229:12-5. [PMID: 26706730 DOI: 10.1016/j.jviromet.2015.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 12/14/2015] [Accepted: 12/14/2015] [Indexed: 11/21/2022]
Abstract
In the context of early infant diagnosis (EID) decentralization in sub-Saharan Africa, dried blood spot (DBS) is now widely used for HIV proviral DNA detection in resource-limited settings. A new version of CAP/CTM (version 2) has been introduced, recently by Roche Diagnosis as a new real-time PCR assay to replace previous technologies on qualitative detection of HIV-1 DNA using whole blood and DBS samples. The objective of this study was to evaluate CAP/CTM version 2 compared to CAP/CTM version 1 and Amplicor on DBS. A total of 261 DBS were collected from children aged 4 weeks to 17 months born from HIV-seropositive mothers and tested by the three techniques. CAP/CTM version 2 showed 100% of agreement with Amplicor including 74 positive results and 187 negative results. CAP/CTM version 2 versus CAP/CTM version 1 as well as CAP/CTM version 1 versus Amplicor showed two discordant results giving a sensitivity of 98.6%, specificity of 99.5%, positive predictive value of 98.6% and negative predictive value of 99.5%. The concordance was 99.12% (95% of confidence interval) giving a Kappa coefficient of 0.97 (p<0.001). These findings confirmed the expected good performance of CAP/CTM version 2 for HIV-1 EID.
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Chang J, Omuomo K, Anyango E, Kingwara L, Basiye F, Morwabe A, Shanmugam V, Nguyen S, Sabatier J, Zeh C, Ellenberger D. Field evaluation of Abbott Real Time HIV-1 Qualitative test for early infant diagnosis using dried blood spots samples in comparison to Roche COBAS Ampliprep/COBAS TaqMan HIV-1 Qual test in Kenya. J Virol Methods 2014; 204:25-30. [PMID: 24726703 DOI: 10.1016/j.jviromet.2014.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 03/11/2014] [Accepted: 03/14/2014] [Indexed: 10/25/2022]
Abstract
Timely diagnosis and treatment of infants infected with HIV are critical for reducing infant mortality. High-throughput automated diagnostic tests like Roche COBAS AmpliPrep/COBAS TaqMan HIV-1 Qual Test (Roche CAPCTM Qual) and the Abbott Real Time HIV-1 Qualitative (Abbott Qualitative) can be used to rapidly expand early infant diagnosis testing services. In this study, the performance characteristics of the Abbott Qualitative were evaluated using two hundred dried blood spots (DBS) samples (100 HIV-1 positive and 100 HIV-1 negative) collected from infants attending the antenatal facilities in Kisumu, Kenya. The Abbott Qualitative results were compared to the diagnostic testing completed using the Roche CAPCTM Qual in Kenya. The sensitivity and specificity of the Abbott Qualitative were 99.0% (95% CI: 95.0-100.0) and 100.0% (95% CI: 96.0-100.0), respectively, and the overall reproducibility was 98.0% (95% CI: 86.0-100.0). The limits of detection for the Abbott Qualitative and Roche CAPCTM Qual were 56.5 and 6.9copies/mL at 95% CIs (p=0.005), respectively. The study findings demonstrate that the Abbott Qualitative test is a practical option for timely diagnosis of HIV in infants.
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Affiliation(s)
- Joy Chang
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
| | - Kenneth Omuomo
- Kenya Medical Research Institute (CDC/KEMRI), Kisumu, Kenya
| | - Emily Anyango
- Kenya Medical Research Institute (CDC/KEMRI), Kisumu, Kenya
| | | | - Frank Basiye
- Centers for Disease Control and Prevention (CDC), Kenya
| | - Alex Morwabe
- Kenya Medical Research Institute (CDC/KEMRI), Kisumu, Kenya
| | | | - Shon Nguyen
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | - Clement Zeh
- Kenya Medical Research Institute (CDC/KEMRI), Kisumu, Kenya
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