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Year : 2012  |  Volume : 30  |  Issue : 2  |  Page : 129--130

Monitoring quality of HIV testing at point of care facilities in India

S Kabra1, R Kanungo2,  
1 Assistant Director General, Laboratory Services, National AIDS Control Organization, Department of AIDS Control, Chandralok Building, 36, Janpath, New Delhi - 110 001, India
2 Dean - Research and Professor of Microbiology, Pondicherry, Institute of Medical Sciences, Kalapet Puducherry - 605 014, India

Correspondence Address:
R Kanungo
Dean - Research and Professor of Microbiology, Pondicherry, Institute of Medical Sciences, Kalapet Puducherry - 605 014

How to cite this article:
Kabra S, Kanungo R. Monitoring quality of HIV testing at point of care facilities in India.Indian J Med Microbiol 2012;30:129-130

How to cite this URL:
Kabra S, Kanungo R. Monitoring quality of HIV testing at point of care facilities in India. Indian J Med Microbiol [serial online] 2012 [cited 2021 Jan 24 ];30:129-130
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Reversing and arresting the epidemic of HIV is a challenge for any country. Although it has been arrested in several industrialized countries, Africa, South Asia, and several other developing countries continue to be burdened by the disease. A multipronged approach to control the disease has been adopted by most of these countries including India. Programs involving surveillance, universal access to diagnosis, treatment, and care of HIV infected individuals are the cornerstone of control measures. Laboratories play a pivotal role in these programs. The population at risk is varied and spread across several geographic areas in the country. Providing quality laboratory service to every individual in need of HIV testing is a challenging task. Efficient laboratory services ensure early detection of the infection in those who are undiagnosed. They are also required to monitor and follow up those who test positive, to facilitate treatment and prevention services. Making reliable tests available at every point of testing, laboratory involves careful planning and implementation of quality control and quality assurance measures. End-user's confidence and increasing service usage are an indicator of good quality laboratory service. The greatest challenge in implementing an effective quality assurance program is lack of adequately trained manpower, and a monitoring mechanism.

Improving quality of service in HIV testing laboratories must include a program of monitoring and evaluation. Routine tracking and periodic assessment are two components of laboratory monitoring and evaluation scheme. A set of laboratory indicators are required to monitor quality of service provided to specific target population. Factors that influence quality testing include trained manpower, timely availability of material, and conducive environment. A major challenge to quality service is training and retaining skilled laboratory personnel. Creating an awareness and training laboratory personnel in the process and work flow is as essential as training in accurate performance of the test. Technicians need to be trained at induction on specific requirements of local target clients and priority population.

Knowledge and familiarity with basic principles of HIV testing and national strategy for HIV testing for different category of population are essential for appropriate service delivery. Care must be taken to familiarize laboratory personnel on preanalytic, analytic, and postanalytic phases of the laboratory workflow. Training must ensure evaluating the test performance, and ability to detect common errors that may be encountered as well as interpretation of test results. During training emphasis must be laid on documentation, review and, corrective actions as essential components of laboratory practice. Refresher training, competency assessments, feedbacks, and incentives are other important ways of developing capacity of the laboratory personnel. Recommended National Guidelines for the HIV testing algorithm must be followed strictly for specific target population, e.g., walk-in clients, antenatal cases, most at risk population, couples of whom one partner is positive, infants born to HIV positive mothers. Retesting for HIV infection has definite indications. Technical persons need to know the strategy and the category of population who may be subjected to retesting. Resolving indeterminate and discordant results as per national guidelines, conveying test results in an appropriate manner to the client, and maintaining confidentiality are the other essential components of the postanalytical phase of a laboratory practice, that a technician needs to be aware of. Monitoring external quality assurance (EQA) by retesting samples, and proficiency testing (PT) of the service laboratory by a monitoring laboratory, is an important quality improvement activity which needs to be undertaken. Laboratory auditing as an integral component of the quality improvement process is a relatively new concept in the HIV testing scene in the country. Specifically trained microbiologists need to be involved in auditing of HIV testing laboratories. This model has been adopted very effectively by the National AIDS Control Organization (NACO) in its laboratory strengthening program.

National AIDS Control Organization has incorporated several strategies for a sustainable capacity development program of HIV testing laboratories across the country. In an effort to provide good quality service at every point of HIV testing site in India, in the public sector, a system of pyramidal monitoring mechanism has been put in place. External quality assurance and proficiency testing are monitored by a tiered system of laboratories. An Apex laboratory provides technical support for training and referral services for high end testing as well monitoring and validating innovative HIV diagnostic kits. It also serves as a national repository for archiving. The Apex laboratory is in close coordination with all National Reference Laboratories (NRLs) which in turn monitor and mentor several State Reference Laboratories (SRLs) through regular feedback, orientation, and training programs. The SRLs in their turn supervise several Integrated Counseling and testing Centers (ICTCs) which are spread across the country providing service to individuals in defined geographic areas. Technical officers appointed by the nodal agency (NACO) in each of the SRLs provide onsite technical assistance to the far-flung testing sites (ICTCs) through visits and online communication. Periodic refresher trainings help in updating the laboratory personnel on current practices and policy changes as well as resolving issues pertaining to test performance. Regular feedback from monitoring laboratories provides inputs to the peripheral testing sites for improving their performance. Flow of information to the nodal agency is carried out by an effective reporting system from the Apex laboratory and the NRLs. The nodal agency is able to monitor quality of testing through the EQAS results. Training activities and infrastructure requirements are also monitored in a similar manner. A concerted effort by all stake holders and several partners in coordination has resulted in a sustainable laboratory quality improvement program in the public sector, that aims to provide good accessible laboratory service to all in need of HIV testing in the country.