Abstract
ProblemUntil 2005, the quality of rapid diagnostic human immunodeficiency virus (HIV) testing was not monitored and no regular technical support was provided to hospital laboratories in Myanmar.ApproachThe national reference laboratory introduced a national external quality assessment scheme. The scheme involved (i) training laboratory technicians in HIV testing and in the requirements of the quality assessment system; (ii) implementing a biannual proficiency panel testing programme; (iii) on-site assessments of poorly-performing laboratories to improve testing procedures; and (iv) development of national guidelines.Local settingIn 2011, a total of 422 public hospitals in Myanmar had laboratories providing HIV tests. In addition, private laboratories supported by nongovernmental organizations (NGOs) conducted HIV testing.Relevant changesThe scheme was started in 65 public laboratories in 2005. In 2012, it had expanded nationwide to 347 laboratories, including 33 NGO laboratories. During the expansion of the scheme, laboratory response rates were greater than 90% and the proportion of laboratories reporting at least one aberrant result improved from 9.2% (6/65) in 2005 to 5.4% (17/316) in 2012.Lessons learntNational testing guidelines and a reference laboratory are needed to successfully implement quality assurance of HIV testing services. On-site assessments are crucial for all participating laboratories and the only source for insight on the causes of aberrant results; lessons that the reference laboratory can share nationally. Proficiency testing helps laboratory technicians to maintain HIV testing skills by ensuring that they regularly encountered HIV-positive samples.
Highlights
Diagnosis of human immunodeficiency virus (HIV) infection is needed to ensure timely access to care and prevent disease transmission.[1]
The emergence of rapid tests that detect HIV antibodies in body fluids has enabled the expansion of HIV diagnosis in resource-poor settings
Others have described some of the challenges of establishing national quality assessment schemes for HIV testing services.[7,8,9,10,11]
Summary
Diagnosis of human immunodeficiency virus (HIV) infection is needed to ensure timely access to care and prevent disease transmission.[1]. The scheme was started in 65 laboratories in 2005 and gradually expanded to include 347 participating laboratories in 2012 (Fig. 1), which included almost all 330 townships in Myanmar Of these laboratories, 33 were supported by NGOs. During the expansion of the scheme, laboratories’ response rates continued to be over 90% despite the inclusion of laboratories in remote areas with communication difficulties. On-site assessment of poorly performing laboratories revealed some misunderstandings regarding HIV testing procedures, such as wrong incubation time or inadequate amount of sample being used (Box 1). Most laboratories have begun to use the recommended test kits, due to clearer guidance and improved procurement of HIV test kits resulting from increased funding
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