Lessons from the Field

QASI: A collaboration for implementation of an independent quality assessment programme in India

Adrienne F.A. Meyers, Michèle Bergeron, Madhuri Thakar, Tao Ding, Alexandre Martel, Paul Sandstorm, Bharati Mahajan, Philip Abraham, Sandhya Kabra, Namita Singh, Trevor Peter, Terry B. Ball
African Journal of Laboratory Medicine | Vol 5, No 2 | a442 | DOI: https://doi.org/10.4102/ajlm.v5i2.442 | © 2016 Adrienne F.A. Meyers, Michèle Bergeron, Madhuri Thakar, Tao Ding, Alexandre Martel, Paul Sandstorm, Bharati Mahajan, Philip Abraham, Sandhya Kabra, Namita Singh, Trevor Peter, Terry B. Ball | This work is licensed under CC Attribution 4.0
Submitted: 22 March 2016 | Published: 12 October 2016

About the author(s)

Adrienne F.A. Meyers, National HIV & Retrovirology Laboratories, Public Health Agency of Canada, JC Wilt Infectious Diseases Research Centre, Winnipeg, Canada; Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada and Department of Medical Microbiology, University of Nairobi, Kenya
Michèle Bergeron, National HIV & Retrovirology Laboratories, Public Health Agency of Canada, JC Wilt Infectious Diseases Research Centre, Winnipeg, Canada
Madhuri Thakar, National AIDS Research Institute, Pune, India
Tao Ding, National HIV & Retrovirology Laboratories, Public Health Agency of Canada, JC Wilt Infectious Diseases Research Centre, Winnipeg, Canada
Alexandre Martel, National HIV & Retrovirology Laboratories, Public Health Agency of Canada, JC Wilt Infectious Diseases Research Centre, Winnipeg, Canada
Paul Sandstorm, National HIV & Retrovirology Laboratories, Public Health Agency of Canada, JC Wilt Infectious Diseases Research Centre, Winnipeg, Canada and Department of Medical Microbiology, University of Nairobi, Kenya
Bharati Mahajan, National AIDS Research Institute, Pune, India
Philip Abraham, National AIDS Research Institute, Pune, India
Sandhya Kabra, National AIDS Control Organization, New Delhi, India
Namita Singh, Clinton Foundation’s HIV/AIDS Initiative, Botswana
Trevor Peter, Clinton Foundation’s HIV/AIDS Initiative, Botswana
Terry B. Ball, National HIV & Retrovirology Laboratories, Public Health Agency of Canada, JC Wilt Infectious Diseases Research Centre, Winnipeg, Canada; Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada and Department of Medical Microbiology, University of Nairobi, Kenya and Department of Immunology, University of Manitoba, Winnipeg, Canada


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Abstract

Objective: The HIV pandemic remains a significant global health concern. Accurate determination of CD4+ T-cells in patient samples relies on reliable CD4 enumeration. The Quality Assessment and Standardization programme for Immunological measures relevant to HIV/AIDS (QASI) programme of the Public Health Agency of Canada provides clinical laboratories from resource-limited countries with a mechanism to evaluate the quality of CD4 testing and develop the implementation of an independent national External Quality Assessment (EQA) programme. This study describes how QASI helped develop the capacity for managing a sustainable national CD4 EQA programme in India.

Design: Supported by the Public Health Agency of Canada and Clinton Foundation HIV/AIDS Initiative, QASI engaged with the National AIDS Control Organization and the Indian National AIDS Research Institute to assist in technology transfer in preparation for the implementation/ management of an independent CD4 EQA programme. Technology transfer training was provided to support corrective actions and to improve the quality of CD4 testing. Inter- laboratory variation of EQA surveys between pre- and post-skill development was compared.

Results: Prior to training, coefficient of variation values were 14.7% (mid-level CD4 count controls) and 39.0% (low-level). Following training, variation was reduced to 10.3% for mid- level controls and 20.0% for low-level controls.

Conclusion: This training assisted the National AIDS Control Organization and the Indian National AIDS Research Institute in identifying the information necessary for management of an EQA programme, and developed the foundation for India to provide corrective actions for sites with challenges in achieving reliable results for CD4 enumeration. This led to a demonstrable improvement in CD4 testing quality and illustrates how country-specific training significantly improved CD4 enumeration performance for better clinical management of HIV care in India.


Keywords

CD4 cell counts; laboratory proficiency testing; HIV; flow cytometry; developing countries; resource-limited setting; technology transfer; sustainability; EQA program

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