Mentorship Strengthens HIV-1 Viral Load Laboratory Quality and Testing in Mozambique

Abstract

Abstract Objectives In response to the urgent need for high-quality HIV viral load (VL) testing scale-up to reach the UNAIDS goal of 90% of HIV+ patients on ART treatment and 90% of these patients reaching viral suppression worldwide, the American Society for Clinical Pathology (ASCP) has directed a VL mentorship program across six provinces in Mozambique. Methods Through this program, three in-country consultants with advanced molecular biology and quality management system skills have mentored nine molecular biology laboratories conducting VL testing (four new laboratories, five established laboratories) through both in-person and remote mentorship methods. Using external audit evaluations conducted by CDC and Ministry of Health using the CDC VL Scorecard (scored 1-5), mentors have directed targeted interventions to address laboratory needs including (but not limited to) the following: biosafety, document control, quality control, corrective actions, assay troubleshooting, and codevelopment of key technical and quality-based SOPs and job aids with local laboratory management. In-person mentorship visits also focus on skills building of laboratory staff and management. Results Excluding two new laboratories with only baseline assessments available, the majority of mentored laboratories (six of seven; 85%) showed improvement at follow-up audits compared to baseline assessment scores, with only one laboratory showing a one-level backslide between sequential audits. Potential reasons for this backslide include more limited in-person mentorship during the time period or interevaluator scoring variability. Conclusion These data suggest that mentorship focused on test methodology and quality management is an effective way to promote laboratory quality while scaling up services; however, additional efforts, including integration of methods for improved remote mentorship to in-laboratory mentors and management, are needed in order to sustain high laboratory quality in the absence of an external mentor.